Case Images
Case Notes
History
59 year old male with COPD who developed tachycardia requiring therapy. Two days later he developed Rt. sided weakness, pupillary dysfunction, and slurred speech. Shortly thereafter he became somnolent and unresponsive.Exam
Non-Contrast Screening Head CT
Purpose
1. Identify all areas of chronic post ischemic (or post traumatic/postoperative) damage, including encephalomalacia, subcortical leukomalacia, ischemic demyelination, shrunken gyri/ulegyria, since they will exhibit reduced Q on the CTA & CT perfusion;
2. Exclude abnormalities that would preclude IV or IA therapy;
3. Include evidence of hyperacute stroke findings in one or more recognizable arterial zones; include evidence of hyperdense proximal arterial segments in the high cervical, the extradural/intracranial, or intradural arterial segments. Be especially careful to analyze those proximal arteries that are accessible for embolectomy.
4. Consider venous based stroke if the cytogenic edema does not conform to an arterial zone, but rather fits best with a venous territory, Plus, search for aggressive sinusitis/otomastoiditis/parapharyngeal infection as a venous (infectious) cause of intracranial phlebothrombosis;
5. Is the parenchymal CT density sufficiently obvious that the stroke, although present, is outside the treatment window.
Purpose
1. Identify all areas of chronic post ischemic (or post traumatic/postoperative) damage, including encephalomalacia, subcortical leukomalacia, ischemic demyelination, shrunken gyri/ulegyria, since they will exhibit reduced Q on the CTA & CT perfusion;
2. Exclude abnormalities that would preclude IV or IA therapy;
3. Include evidence of hyperacute stroke findings in one or more recognizable arterial zones; include evidence of hyperdense proximal arterial segments in the high cervical, the extradural/intracranial, or intradural arterial segments. Be especially careful to analyze those proximal arteries that are accessible for embolectomy.
4. Consider venous based stroke if the cytogenic edema does not conform to an arterial zone, but rather fits best with a venous territory, Plus, search for aggressive sinusitis/otomastoiditis/parapharyngeal infection as a venous (infectious) cause of intracranial phlebothrombosis;
5. Is the parenchymal CT density sufficiently obvious that the stroke, although present, is outside the treatment window.
