Neuro_CTA_Head: 71 M, left MCA syndrome.

CT HEAD PERFUSION WITH AND WITHOUT CONTRAST:

 

CLINICAL HISTORY: 71-year-old male with right-sided leg and arm weakness.

 

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.

 

INTRACRANIAL ANGIOGRAM:

 

Anterior circulation: There is an acute dissection which extends from the distal cervical portion of the left ICA into the intracranial portion of the left ICA (petrous segment). Flow is seen distal to the left petrous ICA in the left cavernous, supraclinoid ICA and left MCA. There is at least 50 percent narrowing of the dissected lumen of the left ICA.

Posterior circulation: The V4 segment of the right vertebral artery is diminutive, likely congenital. The basilar is mostly supplied by 

the dominant left vertebral artery.

Dural venous sinuses: Patent.

Additional comment: None.

EXTRACRANIAL ANGIOGRAM:

 

Proximal great vessels: Origins of the great vessels are widely patent. No flow-limiting stenosis or dissection.

Cervical vessels: No flow-limiting stenosis or dissection. Mild atherosclerotic disease at the carotid bifurcations.

 

Additional comment: None.

 

PERFUSION:

 

Question of mildly delayed perfusion to the right MCA territory, otherwise symmetric cerebral perfusion. 

 

NECK:

 

Soft tissues: Normal.

 

Bones: Multilevel degenerative changes within the cervical spine, 

without significant bony central canal stenosis.

 

Lung apices: Clear.

 

Additional comment: None.

  

IMPRESSION:

 

1.  Normal noncontrast and postcontrast CT of the head for age.

 

2.  Acute dissection in the left cervical ICA extending into the petrous segment of the left ICA. There is at least 50% narrowing of the dissected lumen of the left ICA.

 

3.  Apparent mildly delayed perfusion in the right MCA territory is of unclear significance and may be artifactual.