Case Notes
History
50 year old female presenting with acute-onset, left-sided, weakness.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 each stenotic/occluded arterial segment (NASCET, assess length of stenosis/occlusion, intimal dehiscence, atherosclerotic vs inflammatory basis, etc.)
3. Determine whether there is any persistent antegrade flow past the stenosis, but if not, is there effective collateral around any occluded segment;
4. Assess the presence of effective EC-IC collateral in cases of extradural ICA occlusion.
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 each stenotic/occluded arterial segment (NASCET, assess length of stenosis/occlusion, intimal dehiscence, atherosclerotic vs inflammatory basis, etc.)
3. Determine whether there is any persistent antegrade flow past the stenosis, but if not, is there effective collateral around any occluded segment;
4. Assess the presence of effective EC-IC collateral in cases of extradural ICA occlusion.
Prior Study
Noncontrast Head CTDense mural calcification in Rt. ICA which projects over the arterial lumen; this could represent a site of high cervical Rt. ICA flow-limiting stenosis.
No clear evidence of hyperacute stroke is evident
CT Perfusion
Focal calcified high cervical plaque at skull base with prolonged TTP, but physiologically compensated CBV.
No focal reduction in CBV to confirm acute stroke.