Case Notes
History
42 year old male with right sided numbness and neck pain; history of seizures and hypertension.*Note: this case has two imaging sets. The initial stroke survey [Case 9A] utilized MR and MRA head/neck not CTA. The second evaluation [Case 9b] was obtained 10 days later, because of a change in symptoms. The second stroke evaluation was obtained with CTA and limited stroke screen MR series with only MR diffusion sequences. The patient was again imaged 3 months later where follow up MR FLAIR and SWI sequences were available.
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.