Neuro_CT_Head: 96 F, right MCA syndrome.

CT HEAD PERFUSION WITH AND WITHOUT CONTRAST:

 

CLINICAL HISTORY: 96-year-old woman with right MCA syndrome.

 

FINDINGS:

 

BRAIN (NON-CONTRAST):

 

Parenchyma: No acute hemorrhage, loss of gray-white differentiation, or mass. Scattered hypodense lesions are present in the white matter.

 

Ventricles and extra-axial spaces: Appropriate for age.

 

Visualized paranasal sinuses: Clear.

 

Mastoid air cells: Clear.

 

Bones: No focal abnormality.

 

Additional comment: Status post bilateral lens replacement.

 

BRAIN (POST-CONTRAST):

 

Enhancement: No abnormal enhancement.

 

INTRACRANIAL ANGIOGRAM:

 

Anterior circulation: There is question of vessel cut off at the origin of an M3 branch in the superior division of the right MCA. No other definite vessel cut off is identified. Atherosclerotic calcifications present in the bilateral cavernous carotid arteries with multifocal irregularity. Multifocal irregularity of the bilateral M1 segments, with stenosis of the distal right M1. There are fetal origins of the bilateral posterior cerebral arteries.

 

Posterior circulation: No aneurysm or flow limiting stenosis. Diffuse irregularity of the vertebrobasilar system, with small basilar distal to the origin of the anterior inferior cerebellar arteries, may be due to atherosclerotic narrowing and or presence of bilateral fetal origin PCAs.

 

Dural venous sinuses: Patent.

 

Additional comment: None.

 

EXTRACRANIAL ANGIOGRAM:

 

Proximal great vessels: No flow-limiting stenosis or dissection. Vessels are moderately tortuous in their course.

 

Cervical vessels: No flow-limiting stenosis or dissection.

 

Additional comment: None.

 

PERFUSION:

 

There are 2 areas of delayed Tmax in the right MCA territory, anterior superiorly in the superior division territory corresponding to and 3 vessel cut off, and more posteriorly the inferior division territory, possibly border zone, no definite vessel cut off associated with perfusion abnormality, may be because vessel too small to image or due to border zone infarct in part due to right M1 stenosis. Additionally, there is mild decreased CBV/CBF.

 

NECK:

 

Soft tissues: Normal.

 

Bones: Severe multilevel degenerative changes of the cervical spine, including basilar invagination and anterior inferior translation of C1 relative to C2, results in moderate canal narrowing at the C1 level, and severe spondylosis from C2-C3 through C5-C6, no acute fracture identified.

 

Lung apices: Calcified right upper lobe granuloma.

 

Additional comment: None.

  

IMPRESSION:

 

1.  No intracranial hemorrhage, mass effect, or abnormal enhancement in the brain.

 

2.  Possible vessel cut off M3 branch and right superior division of MCA, corresponding to perfusion abnormality. Intracranial atherosclerosis, including stenosis of the distal right M1 segment.

 

3.  Two areas of delayed Tmax, in the right MCA distribution, one corresponding to right M3 vessel cut off, other more posteriorly in the inferior division of MCA may be due to nonvisualized vessel occlusion or border zone hypoperfusion.