Neuro_CTA_Head/Neck: 66 F, CABG and cardiac arrest, aortic valve dysfunction

CT HEAD PERFUSION WITH AND WITHOUT CONTRAST:

 

CLINICAL HISTORY: 66 years of age, Female, history of prior CABG presenting with cardiac arrest, resuscitated after 18 minutes, 

dysfunctioning aortic valve, new left upper extremity hemiparesis, concern for stroke.

 

FINDINGS:

 

BRAIN (NON-CONTRAST):

 

Parenchyma: There are multiple hypoattenuating foci in the bilateral cerebellar hemispheres, bilateral occipital lobes, and posterior left temporal lobe, larger cerebellar foci have been subtly present on prior CT in retrospect, otherwise new from prior exam and compatible with acute infarcts. There is an additional subtle focus in the subcortical white matter of the right perisylvian region near the hand knob, although this is nonspecific was not clearly evident on prior exam and may represent an additional acute infarct given history of a left upper extremity paresis, though different distribution than remainder of infarcts. No acute hemorrhage or mass effect.

 

Ventricles and extra-axial spaces: Appropriate for age.

 

Visualized paranasal sinuses: Multiple air-fluid levels in the sinuses, may be related to intubation.

 

Mastoid air cells: Underdeveloped mastoid air cells.

 

Bones: No focal abnormality.

 

Additional comment: None.

 

BRAIN (POST-CONTRAST):

 

Enhancement: No abnormal enhancement.

 

INTRACRANIAL ANGIOGRAM:

 

Anterior circulation: No flow-limiting stenosis or aneurysm.

 

Posterior circulation: No flow-limiting stenosis or aneurysm.

 

Dural venous sinuses: Patent.

 

Additional comment: None.

 

EXTRACRANIAL ANGIOGRAM:

 

Proximal great vessels: No flow-limiting stenosis or dissection. Common origin of the right brachiocephalic artery and left common carotid artery, normal variant.

 

Cervical vessels: No flow-limiting stenosis or dissection.

 

Additional comment: Two right-sided central venous catheters via the right internal jugular vein.

 

PERFUSION:

 

Diffuse MTT prolongation is likely technical, CBV, CBF, or Tmax abnormality.

 

NECK:

 

Soft tissues: Anasarca.

 

Bones: Visualized sternotomy wires intact. Multilevel degenerative changes of the cervical spine with prominent posterior ossification associated with C4-C5 disc bulge results in moderate appearing central canal stenosis.

 

Lung apices: Endotracheal tube terminates at the T3 level. Moderate bilateral pleural effusions, with extensive ground-glass opacities in the antidependent lungs which may reflect pulmonary edema. Superimposed dense consolidative opacities in a dependent distribution may represent alveolar edema, atelectasis, and/or aspiration. Superimposed pneumonia would be difficult to exclude.

 

Additional comment: None.

  

IMPRESSION:

 

1.  Multiple small acute infarcts in the posterior circulation involving the bilateral cerebellar hemispheres, bilateral occipital lobes, and the left temporal lobe. Likely related to embolic shower given history of valvular disease and cardiac arrest. Subtle hypoattenuation in the right perisylvian subcortical white matter near the hand knob is nonspecific though not clearly evident on prior exam, could represent additional acute infarct given new left upper extremity weakness. For complete evaluation of infarct burden MRI would be needed.

 

2.  Pulmonary edema and moderate bilateral pleural effusions and the visualized lung apices, with dense dependent consolidations representing edema and/or aspiration.

 

3.  No flow-limiting stenosis, occlusion, or aneurysm in the intracranial and extracranial circulations. 

 

4.  Degenerative changes of the cervical spine with prominent posterior ossification at C4-C5 which results in moderate appearing canal stenosis, this may be evaluated with nonemergent MRI as clinically warranted.