Case Notes
History
42 year old male with right sided numbness and neck pain; history of seizures and hypertension.Exam
CTA of the neck obtained 10 days after the initial MRA neck.
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
Non-Contrast Head CT1. Acute thrombus in the high cervical and vertical intrapetrous segments of the left cervical ICA without evidence of acute cerebral stroke. The history of acute upper neck pain makes dissection a likely possibility.
2. Early post ischemic hypodensity in the left centrum semiovale.
CT Perfusion
Limited value CT perfusion related to mistimed contrast bolus; there is prolonged TTP in the Lt. hemisphere and right ACA.
CTA of the Neck
1. Acute dissection of the high cervical and vertical intrapetrous ICA on the left with high-grade luminal stenosis.
2. There is reasonable post-dissection blood flow from both EC-IC collateral and some persistent antegrade blood flow.