Hyperacute Transcapillary Stroke - CTA/MRA Head
Hyperacute Transcapillary Stroke - CTA/MRA Head
Search Pattern Assist ?History
Exam
Purpose
2 To assess presence of any combination of proximal stenosis plus an incomplete circle of Willis, which together create an isolated arterial circuit with reduced potential for collateral blood flow.
3 Given there is significant afferent extradural obstruction, is there effective EC-IC collateral (presented in the Arterial stroke module).
4 Is there a watershed of shifted watershed stroke zone affecting the anastomotic arterial boundary zones (presented in the Arterial stroke module).
5 To assess status of retrograde pial collateral for any "pial collateral gap" between a proximal thrombus & the available retrograde pial collateral based on the initial (1st pass) contrast injection.
6 To identify any cortical vein or dural sinus thrombosis (presented in the Venous stroke module).
7 To recognize all the venous collateral rerouting (presented in the Venous stroke module).
8 To identify any intradural arterial vasospasm.
9 To identify any distal small vessel angiitis (i.e. arterial beading appearance, delayed arterial filling rate).
Prior Study
Findings
Supratentorial Intradural arterial circulation (for details see Arterial Stroke Module)
There is a primary stem intradural/extradural, or proximal intradural ICA high grade stenosis or occlusion. [Yes/No]
There is no flow-limiting stenosis or mulicentric stenoses of a secondary stem, division, trunk or pial intracranial artery affecting either the supra or infratentorial arteries. [Yes/No]
The circle of Willis is incomplete. [Yes/No]
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/No]
There is evidence of meningeal arteries connecting with pial arteries representing moyamoya collateralization. [Yes/No]
There is evidence of collateral re-routing of the intracranial pial arteries. [Yes/No]
There is evidence of widespread pial artery stenoses without secondary cause (SAH, encephalitis, meningitis). In a middle age or younger patient distal small vessel stenoses raise the possibility RCVS (reversible angiitis in younger patients), versus primary CNS angiopathy (PACNS), diabetic vasculopathy or inherited CADASIL syndrome in young and middle aged adults. [Yes/No]
There is evidence of widespread proximal and/or distal vasospasm in the context of pregancy, or complications of drug therapy, and associated with thunderclap headaches in younger patient to suggest reversibel vasospastic disorder (RCVS) or migraine vasculopathy. [Yes/No]
Infratentorial Intradural arterial circulation (for details see Arterial Stroke Module)
There is high cervical or intradural vertebral artery thrombosis. [Yes/No]
There is stenosis or thrombosis of all or part of the basilar artery. [Yes/No]
Given there is high-grade stenosis or thrombosis of the basilar artery, there is adequate retrograde collateral filling the distal basilar & its branches. [Yes/No]
There is high grade stenosis or thrombosis of all or part of the superior cerebellar artery (SCA)anterior inferior cerebellar artery (AICA), the posterior inferior cerebellar artery (PICA). [Yes/No]
Supra & infratentorial venous Circulation (for details see Venous Stroke Module)
There is reduced venous egress, stasis, or thrombosis of the deep venous system (septal veins, thalamostriate veins & ICV's, vein of Galen and deep medullary veins). [Yes/No]
There is reduced venous egress, stasis, or thrombosis of the major cerebral (frontal veins, veins of Trolard, veins of Labbe', superior sylvian veins, basal vein of Rosenthal or any of the posterior fossa veins). [Yes/No]
There is acute dural sinus stenosis or thrombosis (sagittal, transverse, straight, transverse, torcula, sigmoid, jugular bulb). [Yes/No]
There is increased or decreased blood flow through the mesial or lateral tentorial venous confluence, the vertex venous confluence, the sphenoparietal sinus/cavernous sinuses, inferior petrosal sinus. [Yes/No]
Other
No other abnormalities are noted. [Yes/No]
