Case Notes
History
38 yo male w/ Hx hypertension, diffuse rash, chrohn's dz, seizures, brain cysts (biopsied benign), who now presents with stairing spells and acute fatique. Years earlier the patient had surgical drainage of a parenchymal hemorrhage in the left frontal vertex area.Exam
T1-w pre and post contrast MR
Prior Study
Noncontrast CT headThere are brain changes of chronic nature, which are likely the sequelae of a neonatal TORCH encephalopathy. No apparent hyperacute abnormality is evident
CT Perfusion
Possible focal left cortical stroke in the distal left lateral frontal artery territory but whether it is acute ischemia or reduced perfusion on a chronic basis is indeterminate.
CT perfusion changes, likely chronic, within both cerebral hemisphere matching the areas of chronic leukomalacia consistent with the sequelae of a perinatal TORCH infection.
CTA of the head
Focal left high convexity anterior frontal cortex with reduced size and beading of the pial arteries plus reduction in extent of venous egress veins. But, whether this is confirmation of angiitis is indeterminate.