CASES 7-11.

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Presentation transcript:

CASES 7-11

CASE 7 72 year old woman wtih progressive aphasia. Unenhanced CT shows an area of hypoattenuation in the left temporal lobe. CT perfusion shows increased TTM and decreased CBF and CBV in the same area.

CASE 7 CT angiography shows a complete filling defect in a distal branch of the left middle cerebral artery and a non calcified thrombus in the aorta

CASE 8 76 year old man with several episodes of transient ischemic attacks (left leg weakness and right hemihypoesthesia).Unenhanced CT shows an area of hypoattenuation in the left temporal lobe (not shown). CT perfusion was not performed. CT angiography shows a calcified thrombus in the left middle cerebral artery (M2 segment)

CASE 9 49 year old man with acute onset of right hemiparesis, aphasia and seizure. Axial unenhanced CT images show only slight left temporal hypoattenuation. CT perfusion was interpreted as normal.

CASE 9 CT angiography shows no filling defects but there is a temporal area of hypervascularization that was overlooked. The findings were characterized as an ischemic area.

CASE 9 3 months later this patient returned to the ER department with seizure. Axial enhanced CT images and CT perfusion maps show a necrotic mass in the left parietal lobe with increased CBF and CBV and extensive vasogenic edema located in the same area of hipervascularization seen on previous CT angiography. Diagnosis: High grade glioma

CASE 10 2 year old girl who fell out of bed and suddenly started with right arm weakness and progressive loss of consciousness. Axial unenhanced CT images were normal, with no hemorrhagic signs. CT angiography shows no filling defects.

CASE 10 CT perfusion shows a small region of decreased CBF and increased MTT .in the right basal ganglia.MRI shows a hyperintense signal in white matter on T2-weighted and FLAIR images (not shown) with restricted diffusion in the left basal ganglia and corona radiata, suggesting ischemic infarction

CASE 11 21 year old woman who suffered a motorcycle trauma with left hemiparesis. Axial unenhanced CT images show hypoattenuation of the right fronto-parietal lobe. CT perfusion shows a region of decreased blood flow, decreased blood volume and increased mean transit time, without mismatched abnormalities, in the right fronto-parietal lobes.

CASE 11 CT angiography shows a parcial filling defect in the right internal carotid artery suggesting carotid dissection with secondary middle cerebral artery infarct.