Wk 5, Case 1 - Review

Patient History

A 17-year-old male with a history of autism and developmental delay presents with altered mental status, headache, right-sided weakness, and right facial droop.

Findings

Normal 3-vessel aortic arch. Normal course and caliber of both common carotid arteries without evidence of aneurysmal dilation or flow limiting stenosis. Normal course and caliber of both cervical internal carotid arteries and cervical vertebral arteries without evidence of aneurysmal dilation or flow limiting stenosis.

Normal course and caliber of the intracranial internal carotid arteries, M1/M2 segments of the middle cerebral arteries, and A1/A2 segments of the anterior cerebral arteries. Patency of the anterior communicating artery. Both posterior communicating arteries are present.

Normal course, caliber and patency of the vertebrobasilar system including the basilar artery and P1/P2 segments of the posterior cerebral arteries.
No abnormal restricted diffusion to suggest acute infarction. No acute intracranial hemorrhage or extra-axial collection. Clear basal cisterns. Normal size and symmetric configuration of the ventricles.

Prominence of cortical and deep cerebral veins throughout the left cerebral hemisphere best appreciated on susceptibility weighted imaging. Perfusion imaging demonstrates mildly elevated time to peak, mean transit time and Tmax values throughout the left cerebral hemisphere. Mild T2 FLAIR hyperintensity within the left posterior centrum semiovale.

Mild mucosal thickening of the frontal and sphenoid sinuses as well as the ethmoids. No fluid levels identified. Bilateral mastoid air cells are clear. Symmetric and normal appearance of the orbits.

Conclusion

1. Prominence of cortical and deep cerebral veins throughout the left cerebral hemisphere with associated mild T2/FLAIR hyperintensity within the left centrum semiovale and changes in cerebral perfusion. Findings have been described to occur in the setting of hemiplegic migraines. No abnormal restricted diffusion to suggest acute infarct.

2. No significant vascular abnormality of the major head and neck arterial vessels.