Case 4 - Basilar Artery Clot on CTA, CT, CTP

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

Case 4 Report:

EXAM: CT head without contrast, CTA head and neck, CT perfusion

INDICATION: 40-year-old female presents with possible seizure, intubated for airway protection.

TECHNIQUE: Axial CT examination head was performed without intravenous contrast. Coronal and sagittal reformats were generated the axial data set. CT angiography of the head and neck was then performed with generation of coronal and sagittal reformats and MIP images. CT perfusion protocol was then performed.

COMPARISON: None

FINDINGS:

CT HEAD:

Subtle hypodensity in the right midbrain and asymmetric hypodensity in the right cerebellum, may reflect early infarct. In addition proximal basilar artery to the level of the middle cerebellar peduncles is hyperdense.

No acute intracranial hemorrhage. No mass, mass effect or midline shift. Scattered periventricular and subcortical white matter hypodensities, likely chronic microvascular ischemic changes. Bilateral globus pallidus calcifications. Ventricle size and

configuration unremarkable. Basal cisterns are patent. Calvarium intact. Polypoid mucosal thickening maxillary sinuses bilaterally. Mastoids and middle ear cavities are clear. Orbits are symmetric.

CTA HEAD:

There is occlusive or near-occlusive clot within the distal third of the basilar artery, with flow into the posterior cerebral artery supplied by the posterior communicating arteries. There is little if any identifiable flow into the superior cerebellar arteries or into the anterior inferior cerebellar arteries. The distal vertebral arteries are patent. The right vertebral artery is dominant.

The petrous, cavernous, and super clinoid ICAs are patent and normal in caliber. The ACAs, MCAs are patent and normal in caliber. Posterior communicating arteries and PCAs are patent and normal in caliber.

CTA NECK:

Conventional 3 vessel branching pattern of the aortic arch. The carotid arteries are patent and normal in caliber bilaterally. The carotid bifurcations are widely patent. The cervical internal carotid arteries are patent and normal in caliber.

Vertebral artery origins appear normal. Right dominant vertebral artery system. Vertebral arteries are patent bilaterally.

Endotracheal tube with tip above the carina. Visualized spaces of the neck are mostly unremarkable. Parotids, submandibular glands, and thyroid unremarkable. Cervical spine is intact. No lymphadenopathy. Lung apices are clear.

CT PERFUSION:

Evidence of decreased cerebral blood flow within the right midbrain and pons, and right greater than left cerebellum with evidence of penumbral ischemia on blood volume images. Findings are compatible with early posterior circulation infarction.

IMPRESSION:

1. Likely thrombus with complete or near-complete occlusion within the distal basilar artery. Hypodensities in the right midbrain and right greater than left cerebellum. In addition CT perfusion demonstrates decreased blood flow to the right midbrain

and pons and right greater than left cerebellum with evidence of penumbral ischemia and blood volume images. Taken together, findings are compatible with posterior circulation infarction. No acute intracranial hemorrhage.

2. Patent neck vasculature.