Wk 1, Case 6 - Review

Report

The following is the report provided for the full exam.
EXAM: CT perfusion stroke protocol with and without IV contrast; CT head with and without IV contrast; CT neck with and without IV contrast only; CT head without contrast protocol

INDICATION: Witnessed seizure. Acute onset headache, left-sided weakness.

TECHNIQUE: CT angiography of the head and neck with intravenous contrast. CT perfusion stroke protocol with and without IV contrast and CT head without contrast stroke protocol. Multiplanar reformats were performed. Maximal intensity projection
renderings were created.

COMPARISON: CT head/brain without contrast dated 10/23/2020

FINDINGS:

CT Head without contrast stroke protocol:

No acute intracranial hemorrhage or extra-axial fluid collection. No mass effect or midline shift. Preserved gray-white matter differentiation. Ventricles are symmetric and normal for age. Patent basal cisterns.

Normal orbits. Visualized paranasal sinuses and mastoid air cells are clear. No acute fracture or soft tissue abnormality.

CT perfusion:
Technically inadequate study. No gross abnormalities are seen.

CTA HEAD:
No aneurysm, high-grade stenosis, or dissection.

Intracranial ICAs: Patent
MCAs: Patent
ACAs: Patent
A-Comm: Patent
P-Comms: Patent

Vertebral arteries: V4 segments are patent.
Basilar artery: Patent
PCAs: Patent

PICAs: Patent
AICAs: Patent
SCAs: Patent

No acute fracture or soft tissue abnormality. No significant stenosis or filling defect in the bilateral internal jugular veins, sigmoid sinuses, transverse sinuses, straight sinus, inferior sagittal sinus, or superior sagittal sinus.


CTA NECK:
No aneurysm, high-grade stenosis, or dissection.

Aortic arch: Patent
Common Carotids: Patent
ICAs: Patent
Vertebral arteries: Patent
Veins of the Neck: Patent

No acute fracture. Soft tissues of the suprahyoid and infrahyoid neck are unremarkable. Salivary glands are unremarkable. No lymphadenopathy. Thyroid is unremarkable. Visualized lungs are clear.

CT Venogram:
There is a thrombus in the superior sagittal sinus on the sagittal and coronal images of the CTV. The sagittal sinus clot affects the anterior 2/3 of the sinus.

IMPRESSION:

CT head:

1. No acute intracranial abnormality.

CTV
1.Large acute clot in the superior sagittal sinus.

CT perfusion:
1. Technically inadequate study. No gross abnormalities however are seen.

CTA head:
1. No hemodynamically significant stenosis of the major arteries of the head.
2. No hemodynamically significant stenosis of the major veins of the head.

CTA neck:
1. No hemodynamically significant stenosis of the major arteries of the neck.