Wk 1, Case 1 - Review

Patient History: 69 y.o. male with a past medical history significant for HTN, HLD, MI (S/p stents 2016), and diabetes (on metformin) who presented to the ED as a BAT for left sided facial droop and upper/lower extremity weakness. Patient was in his usual state of health when he went to take a nap. His wife saw him walk into the bedroom at 3:00p (LKN) and heard him yelling for help when he woke up around 4:30p with left sided weakness.

Findings
CT, CTA, CTP report from 12/31/2020:

INDICATION: 69 y.o. male with a past medical history significant for HTN, HLD, MI (S/p stents 2016), and diabetes (on metformin) who presented to the ED as a BAT for left sided facial droop and upper/lower extremity weakness.

Patient was in his usual state of health when he went to take a nap. His wife saw him walk into the bedroom at 3:00p (LKN) and heard him yelling for help when he woke up around 4:30p with left sided weakness.

COMPARISON: CT brain obtained earlier in the day.

TECHNIQUE/PROTOCOL: Axial CT and CTA images of the head and neck. Sagittal and coronal reformats were included. 3D reconstructions were created for vascular evaluation. Dynamic CT perfusion was performed of the brain with contrast. Data was sent to RAPID server for analysis.

NONVASCULAR FINDINGS:

No intracranial hemorrhage. No extra-axial fluid collection.

The ventricles and sulci are normal in size for age. Basal cisterns are clear.

No intracranial mass or mass effect.

Orbital structures are normal.

The paranasal sinuses and mastoid air cells are clear.

Nonspecific peripheral and subpleural fibrosis and ground glass opacities within the visualized lung apices. Correlate with lab results to exclude COVID-19 pneumonia. Partially visualized pericardial effusion.

VASCULAR FINDINGS:

Evaluation limited by suboptimal contrast opacification of the arterial vasculature.

Aortic arch calcifications. Atherosclerotic calcifications at the carotid bifurcations without high-grade narrowing. There is multifocal irregular narrowing of the cervical right internal carotid artery estimated at approximately 50%. Multifocal calcifications noted within the cavernous segments of the bilateral internal carotids, with likely flow-limiting stenosis on the right. There is irregular atherosclerotic narrowing of the right greater than left M1 segments.

There is abrupt cut off within the distal M1 segment of the right MCA, consistent with acute occlusive thrombus. Faint contrast opacification is noted within the distalright MCA territory, likely from collateral flow.

Bilateral ACA and left MCA arteries are patent. Posterior circulation is patent. Basilar artery is grossly unremarkable. The vertebral arteries are not well opacified, particularly on the left, likely due to atherosclerotic narrowing.