Neuro_CTA_Head: 54 F, headache, recent GI illness.

CT ANGIOGRAM HEAD AND NECK WITH CONTRAST:

 

HISTORY: 54-year-old female with clinical concern for inferior sagittal sinus thrombosis. GI illness two weeks ago.

 

FINDINGS:

 

BRAIN:

 

Parenchyma: Evolving infarcts in the right and left parietal lobes, the MCA - PCA borderzone territories. No hemorrhage or abnormal 

enhancement.

 

Ventricles and extra-axial spaces: No herniation or midline shift.

 

Visualized paranasal sinuses: Retention cyst or polyp in the left 

maxillary sinus.

 

Mastoid air cells: Clear.

 

Bones: Normal.

 

INTRACRANIAL ANGIOGRAM:

 

Anterior circulation: Diminutive right A2. Irregular left A2. The cavernous internal carotid arteries are irregular. The peripheral 

arteries beyond A2 are pruned.

 

Posterior circulation: The basilar artery is irregular. Both posterior cerebral arteries are small

 

Dural venous sinuses: Patent. No thrombosis.

 

EXTRACRANIAL ANGIOGRAM:

 

Proximal great vessels: No flow-limiting stenosis or dissection.

 

Cervical vessels: No flow-limiting stenosis or dissection. Dominant right vertebral artery. Mild plaque at both carotid bifurcations.

 

NECK:

 

Soft tissues: Normal.

 

Bones: Normal.

 

Lung apices: Clear.

 

IMPRESSION:

 

1. No dural venous sinus thrombosis.

 

2. Irregularity and narrowing of the cerebral vasculature as described above. Differential considerations favor reversible cerebral vasoconstriction syndrome. Alternative considerations include vasculitis and posterior reversible encephalopathy syndrome.

 

3. Evolving posterior border zone infarcts.

(RCVS)