0:00

So these are images of a 38 year old

0:03

male who had right-sided weakness. These are

0:06

five millimeter thick axle non-contrast CT

0:09

and first of all, I'm going to look at

0:13

The left MCA because he's got right side of weakness and I don't see

0:16

a hyperdense vessel sign and this is a little

0:19

grainy image but there's no Hemorrhage or

0:22

other Contra indication to thrombolysis and I don't see any obvious loss of

0:25

great white differentiation here. I look at narrower

0:28

Windows really don't see anything in the MCA. So then

0:31

I'm going to be thinking well, what about post your territory? So

0:36

First glance I do see this hyper density here.

0:39

It's next to the Bowser. I'm not sure you know

0:42

exactly what that is. Maybe it's a little plan Bose aneurysm.

0:45

Maybe it's a little subarachnoid hemorage but

0:48

you know, we'll sort that out. There's all

0:51

this beam hardening through the posterior faucets really

0:54

hard to tell whether there's asymmetry maybe there's a little

0:57

asymmetry on the left. We can look at our coronal images.

1:02

Looking at the ponds and again.

1:05

I don't know lots of beam hardening. I'm gonna

1:08

take narrower windows.

1:11

Still really hard to tell let's see what we see on the CTA.

1:14

So the CTA basically the

1:17

Basler artery looks pretty normal with

1:21

vertebrate Junction is a little bit hard to see here. But

1:24

that was normal. The mca's are all normal.

1:28

We can look at the source images and

1:33

Where that hyper density was the vessel

1:36

looks fine adjacent to it that turned out to be a thrombo standardism,

1:39

which was figured out later, but the vessel

1:42

really looks normal as I'm going to

1:45

show you later. The CTA Source images can help.

1:48

identify infarctions, but even here

1:52

I don't know. Maybe there's something there. Maybe there's not so the bottom

1:55

line. Is that CTE? It's

1:58

just very hard to identify brain stem Strokes

2:01

on non-contrust CT.

2:04

So you really need Mr.

2:06

And this is the DWI.

2:09

And there's the classic pontine stroke.

2:13

It's usually in the hemipons and it's usually from a

2:16

perforator and maybe this was a little perforator off the thrombosed

2:19

aneurysm. But again, really difficult you

2:22

can look and look and look on non-contrast CT and CTA Source

2:25

images. They're really hard to see. So the thing to do

2:28

is we need to get a DWI and we'll discuss

2:31

that a little bit later in this series.

Case - Brainstem Stroke on Noncontrast CT

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0:00

So these are images of a 38 year old

0:03

male who had right-sided weakness. These are

0:06

five millimeter thick axle non-contrast CT

0:09

and first of all, I'm going to look at

0:13

The left MCA because he's got right side of weakness and I don't see

0:16

a hyperdense vessel sign and this is a little

0:19

grainy image but there's no Hemorrhage or

0:22

other Contra indication to thrombolysis and I don't see any obvious loss of

0:25

great white differentiation here. I look at narrower

0:28

Windows really don't see anything in the MCA. So then

0:31

I'm going to be thinking well, what about post your territory? So

0:36

First glance I do see this hyper density here.

0:39

It's next to the Bowser. I'm not sure you know

0:42

exactly what that is. Maybe it's a little plan Bose aneurysm.

0:45

Maybe it's a little subarachnoid hemorage but

0:48

you know, we'll sort that out. There's all

0:51

this beam hardening through the posterior faucets really

0:54

hard to tell whether there's asymmetry maybe there's a little

0:57

asymmetry on the left. We can look at our coronal images.

1:02

Looking at the ponds and again.

1:05

I don't know lots of beam hardening. I'm gonna

1:08

take narrower windows.

1:11

Still really hard to tell let's see what we see on the CTA.

1:14

So the CTA basically the

1:17

Basler artery looks pretty normal with

1:21

vertebrate Junction is a little bit hard to see here. But

1:24

that was normal. The mca's are all normal.

1:28

We can look at the source images and

1:33

Where that hyper density was the vessel

1:36

looks fine adjacent to it that turned out to be a thrombo standardism,

1:39

which was figured out later, but the vessel

1:42

really looks normal as I'm going to

1:45

show you later. The CTA Source images can help.

1:48

identify infarctions, but even here

1:52

I don't know. Maybe there's something there. Maybe there's not so the bottom

1:55

line. Is that CTE? It's

1:58

just very hard to identify brain stem Strokes

2:01

on non-contrust CT.

2:04

So you really need Mr.

2:06

And this is the DWI.

2:09

And there's the classic pontine stroke.

2:13

It's usually in the hemipons and it's usually from a

2:16

perforator and maybe this was a little perforator off the thrombosed

2:19

aneurysm. But again, really difficult you

2:22

can look and look and look on non-contrast CT and CTA Source

2:25

images. They're really hard to see. So the thing to do

2:28

is we need to get a DWI and we'll discuss

2:31

that a little bit later in this series.

Report

Faculty

Pamela W Schaefer, MD, FACR

Professor of Radiology, Vice Chair of Education

Massachusetts General Hospital

Lesson

Pre-Course Activities

Lesson

Introduction to Stroke Imaging

Lesson

Noncontrast CT

Lesson

CTA Neck

Lesson

CTA Head

Lesson

CT Perfusion

Lesson

MRI (DWI, FLAIR, SWI) of Acute Stroke

Lesson

MRA of Head and Neck

Lesson

Multifocal Strokes With No Visualized Vascular Abnormality

Lesson

Brain Ischemia, Hypoxia, & Death

Lesson

Stroke Mimics & Other Causes of Restricted Diffusion

Lesson

MR Perfusion

Lesson

Subacute Stroke & Differentials

Case - Brainstem Stroke on Noncontrast CT