Case Notes
History
64 year old female presenting with acute onset Rt. hemiparesis, left gaze deviation and aphasia; no depressed level of consciousness; history of hypertension.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.
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.
Prior Study
Non Contrast Head CTChanges consistent with hyperacute stroke in the Lt. lateral lenticulostriate and the Lt. superior division MCA regions. This makes the likely level of occlusion in the Lt. M1/2 superior division MCA segment.
No intracranial hemorrhage nor hyperdense (acute) thrombotic arterial segments are evident.
CT Perfusion
Acute stroke changes with focal prolonged TTP and MTT plus moderate reduction in CBF and CBV centered in the Lt. orbitofrontal artery with some involvement of the Lt. rostral lentriculostriate, and Lt. anterior insular M3 perfusion zones. The tissue at risk is surrounded by areas of physiological hyperemia.