Neuro_CTA_Head: 30 M, AMS.

CT ANGIOGRAM HEAD WITH AND WITHOUT CONTRAST:

 

CLINICAL HISTORY: 30-year-old with headache and decompensation, 

intraparenchymal hemorrhage seen on outside CT, evaluate for underlying vascular malformation.

 

FINDINGS:

 

BRAIN (NON-CONTRAST):

 

Parenchyma, ventricles, and extra-axial spaces: Further interval increase in size of intraparenchymal hematoma centered on the left parietal lobe, now extending across the corpus callosum into the right posterior cingulate. Difficult to give comparison measurements given differences in angulation, now measures 5.4 x 4.7 x 4.6 cm in transaxial dimension, overall increased in size. Increase in surrounding edema and mass effect, with worsening midline shift and 

subfalcine herniation now measuring 11 mm, previously 7 mm, early entrapment of the right lateral ventricle, and new left uncal downward transtentorial herniation. Subdural hemorrhage along the falx and left tentorial leaflet stable to slightly increased from prior exam.

 

Visualized paranasal sinuses: Clear.

 

Mastoid air cells: Small right mastoid effusion.

 

Bones: Normal.

 

Additional comment: None.

 

BRAIN (POST-CONTRAST):

Enhancement: No abnormal enhancement.

 

INTRACRANIAL ANGIOGRAM:

 

Anterior circulation: No flow-limiting stenosis, aneurysm, or definite vascular malformation identified. A loop of a distal branch of the right pericallosal artery courses along the medial aspect of the hematoma. However, no active contrast extravasation is seen in this region on delayed postcontrast images to suggest that this is the responsible bleeding artery.

 

Posterior circulation: No flow-limiting stenosis, aneurysm, or definite vascular malformation is identified. 

 

Dural venous sinuses: Patent.

 

Additional comment: None.

 

IMPRESSION:

 

1. Interval increase in size of the large left parietal intraparenchymal hematoma now extending to the right cerebral hemisphere across the corpus callosum, with increasing surrounding edema, mass effect, worsening midline shift, new uncal and downward 

transtentorial herniation. Stable to slight increase in subdural extension.

 

2. No definite vascular malformation identified to account for hemorrhage although a micro-AVM or pseudoaneurysm compressed by the 

large hematoma is difficult to exclude at this time. Of note, a loop of a distal branch of the right pericallosal artery courses along the 

medial aspect of the hematoma. However, no active contrast extravasation is seen in this region on delayed postcontrast images to suggest that this is the responsible bleeding artery. Consider further evaluation with MRI and/or DSA.

(ACA aneurysm with intraparenchymal hemorrhage)