Case Notes
History
51 year old female presenting with an acute left facial droop, left side weakness, and mental status change. Patient was able to be seen in the ER within 1 to 1.5 hours after the onset of symptoms.Exam
CTA of the neck: this part of the CTA is performed after the second bolus of contrast, and therefore has dense contrast in both the arteries and the veins related to recirculation plus twice the contrast load. The CTA neck is performed in conjunction with the delayed post contrast head CTA for assessment of the CT-density in the parenchymal venocapillary pool.
Purpose
1. Define sites of any and all arterial thromboses or flow-limiting, high-grade stenosis, or tandem stenoses with lesser degrees of luminal narrowing, but are included within the same arterial circuit;
2. Characterize the features of the stenotic/occluded arterial segment (NASCET, assess length of stenosis/occlusion, intimal dehiscence, atherosclerotic vs inflammatory basis, etc.);
3. Determine whether there is effective collateral around any occluded segment;
4. Assess the presence of effective EC-IC collateral in cases of extradural ICA occlusion.
Purpose
1. Define sites of any and all arterial thromboses or flow-limiting, high-grade stenosis, or tandem stenoses with lesser degrees of luminal narrowing, but are included within the same arterial circuit;
2. Characterize the features of the stenotic/occluded arterial segment (NASCET, assess length of stenosis/occlusion, intimal dehiscence, atherosclerotic vs inflammatory basis, etc.);
3. Determine whether there is effective collateral around any occluded segment;
4. Assess the presence of effective EC-IC collateral in cases of extradural ICA occlusion.
Prior Study
CT HeadRt. parapharyngeal space is abnormal with enlarged high cervical ICA with hyperdensity consistent with an acute high cervical ICA dissection.
Apparent recent, but not hyperacute Rt. parietal subcortical ischemic event.
CT Perfusion
Reduced arterial circulation rate in the Rt. cerebral intradural ICA watershed perfusion zone in the usual centrum semiovale. There is evidence of good pial collateral resulting in normal cortical CBV. Distinct site of actual infarction (low CBV) is not detected. The right ICA dissection was evident on the included post contrast head CTA.