Case Images
Case Notes
History
36 yo female with 2 week history of intermittent weakness on both sides, numbness epsodes lasting 4 hours & word finding difficulty.Exam
Prior Study
CT HeadNegative study for acute arterial or venous occlusion. But, there is focal mural wall calcification in the subclinoidal right ICA with the potential for causing a flow-limitng stenosis.
There is a small completed lacunar infarct in the left caudate head.
The combination of a completed stroke and mild global atrophy and prominent basal ganglia calcificiation suggests the presence of underlying vasculopathy.
CT Perfusion
CT perfusion and CTA evidence of moyamoya disease with expected alteration of blood flow, as above.
Small completed infarct in the left caudate head.
Dicom
Findings
| Low Neck Evaluation (Aorta, Brachiocephalic, Proximal Common Carotid (CCA) & Proximal Vertebral Arteries) | Correct Answer | Your Answer |
|---|---|---|
|
There is evidence of aortic arch dissection or other abnormality. |
No | NA |
|
There is evidence of occlusion of brachiocephalic arteries. |
No | NA |
|
There is evidence of stenosis of brachiocephalic arteries. |
No | NA |
|
There is evidence of occlusion at the origin of a carotid artery. |
No | NA |
|
There is evidence of stenosis at the origin of a carotid artery. |
No | NA |
|
Given a CCA is occluded, are the vertebral to occipital branch of the external carotid artery (EAC) collateral arcades functional. |
No | NA |
|
There is evidence of occlusion in the proximal segment of a vertebral artery. |
No | NA |
|
There is evidence of stenosis in the proximal segment of either vertebral artery. |
No | NA |
| Upper cervical neck & intracranial/extradural evaluation | Correct Answer | Your Answer |
|---|---|---|
|
There is evidence of occlusion at the carotid bifurcation including proximal ICA or ECA or both. |
No | NA |
|
There is evidence of flow-limiting stenoses within either the high cervical carotid or the vertebral arteries, exceeding 60% or less by NASCET standards. |
No | NA |
|
There is dissection, pseudoaneurysm, or intimal web or both in the high cervical ICA's or vertebral arteries. |
No | NA |
|
There is intimal ulceration or intimal dehiscence in the area(s) of carotid plaque. |
No | NA |
|
There is intraluminal soft clot in the area of carotid plaque or pseudoaneurysm. |
No | NA |
|
There is large vessel vasculopathy (FMD) of high cervical or intracranial/extradural ICA or vertebral arteries. |
No | NA |
|
There is focal flow-limiting stenosis/occlusion of the ICA in its' intracranial-extradural segment. |
No | NA |
|
There is focal stenosis or occlusion of the ICA or the vertebral at the dural ring or within the intradural vertebral segment. |
No | NA |
|
There is evidence of reduced size of the either the high cervical carotid or vertebral arteries related to downstream stenosis |
No | NA |
|
There is functional EC-IC collateral with enlargement of the internal maxillary or middle meningeal arteries. |
Yes | NA |
|
There is increased size of either the ICA or vertebral arteries consistent with exaggerated intracranial flow demand (i.e. collateralization). |
Yes | NA |
|
There is is evidence of macrovasculopathy of the proximal intradural ICA with stenoses and or abnormal perforators (both lenticulostriate and/or thalamostriate) representing moyamoya collateralization (disease, syndrome or adult moyamoya forms). |
Yes | NA |
|
There is evidence of meningeal arteries connecting with pial arteries representing moyamoya collateralization. |
No | NA |
|
There is thrombosis of internal jugular or other large neck veins. |
No | NA |
|
There is thrombosis of the sigmoid, transverse, or torcular sinuses. |
No | NA |
| Other | Correct Answer | Your Answer |
|---|---|---|
|
No other abnormalities are noted. |
Yes | NA |
Impression
Expert Answer
All of the above are true.
Your Answer
Recommendations & Acuity
Recommendations
Expert Answer
Your Answer
Acuity
Expert Answer
Emergent (Action Necessary now)
