Wk 3, Case 4 - Review

Patient History

Stroke symptoms

Findings

CT Head:

Brain: No mass or hemorrhage. No midline shift. No herniation. Gray-white differentiation is intact. Parenchymal volume is appropriate for age.

Ventricles: No hydrocephalus.

Extra-axial space: No abnormal collection.

Basal cisterns: Unremarkable

Bones: No acute osseous abnormality.

Paranasal sinuses/mastoid air cells: Unremarkable.

Other: Bilateral cataract lens replacements.

CTA Head and Neck:

Arch & Subclavian Arteries: Standard three vessel arch. Subclavian arteries normal bilaterally.

Common Carotids: Normal bilaterally.

Cervical ICAs: Occlusion of the right ICA from the carotid bulb to the clinoid segment with distal reconstitution through the circle of Willis. Patent on the left from the skull base to the carotid terminus.

Vertebral arteries: Mild stenosis of the right vertebral artery origin. Normal left.

MCAs: Normal bilaterally.

ACAs: Normal bilaterally.

ACom: Normal

P-Comms: Visualized bilaterally.

Vertebral arteries: Normal to the confluence of the basilar artery.

Basilar artery: Normal.

PCAs: Focal high-grade stenosis of the right P2 segment. Normal left PCA.

CT Perfusion Brain:

No qualitative asymmetries in the mean transit times, cerebral blood flow, or cerebral blood volume to suggest an autoregulatory compromise.

AIF/VOF placement: Technically adequate

Stroke Location: Not applicable

CBF<30% volume (mL): 0

Tmax>6.0s volume (mL): 0

Mismatch volume (mL): 0

Mismatch ratio: Not applicable

Hypoperfusion Intensity Ratio (Tmax > 10 secs volume/ Tmax > 6 secs volume): Not applicable.

Conclusion

1. Long segment occlusion of the right ICA from the carotid bulb to the clinoid segment with distal reconstitution through the circle of Willis. Findings likely represent compensated, long-standing occlusion given lack of associated acute perfusion abnormality. MRI is recommended if clinical concern persists for acute infarct.

2. Additional focal high-grade stenosis of the right P2 segment. Remainder of the intracranial and extracranial vasculature is without flow-limiting stenosis, aneurysm, or additional site of occlusion. Specifically, normal appearance of the basilar artery.