CT HEAD PERFUSION WITH AND WITHOUT CONTRAST:
CLINICAL HISTORY: Acute unresponsiveness and stroke code after angiography.
FINDINGS:
BRAIN (NON-CONTRAST):
Parenchyma: No acute hemorrhage, infarction, or mass.
Ventricles and extra-axial spaces: Appropriate for age.
Visualized paranasal sinuses: Clear.
Mastoid air cells: Clear.
Bones: No focal abnormality.
Additional comment: None.
BRAIN (POST-CONTRAST):
Enhancement: No abnormal enhancement. The right cavernous carotid does not show any enhancement, consistent with occlusion. The left greater than right anterior circulation is poorly opacified, consistent with poor collateral flow. There is
contrast staining of the posterior circulation.
INTRACRANIAL ANGIOGRAM:
Anterior circulation: There is a
focal abrupt occlusion of the right internal carotid artery just distal to the right carotid bifurcation without contrast opacification of distal right intracranial vessels. There is also a
focal abrupt occlusion of the supraclinoid segment of the left internal carotid artery with
minimal contrast opacification of the distal left intracranial vessels.
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.
Additional comment: None.
PERFUSION:
NECK: Endotracheal tube.
Soft tissues: Normal.
Additional comment: Right internal jugular central venous catheter.
IMPRESSION:
1. Focal abrupt occlusion of the right internal carotid artery just distal to the right carotid bifurcation and also the supraclinoid segment of left internal carotid artery with severely decreased perfusion in the anterior circulation bilaterally, right greater than left.
2. Post-contrast brain confirms the right ICA occlusion based on non-filling of the cavernous ICA. The bilateral anterior circulations show poor collateralization, left worse than right.