N EURORADIOLOGY

S TROKE ISCHEMICHEMORRHAGIC

N ontraumatic intracranial hemorrhage HYPERTENSION RUPTURE ANEURYSM VASCULAR MALFORMATIONS COAGULOPATHY TUMORS HEMORRHAGIC INFARCTION ETC

H YPERTENSIVE HEMORRHAGE

60 y man with acute right hemiparesis 30 mins PTA, at ER BP = 200/100 mmHg 2 HOURS LATER

Stroke mimic : Hemorrhagic metastases 56 y man sudden aphasia

Plain and post contrast CT brain of 28 y female with seizure and weakness of left extremities In Dec 1998 Conventional CT NECT CECT Nonarterial-distribution brain edema with hemorrhage at right frontal lobe

MRI and MRV T1WI T2WI 2D TOF MRV 2D PC

Lupus vasculitis with ICH Plain CT CECT DSA: CNS vasculitis is characterized by “beading” (dilated areas alternating with narrowing of the blood vessels).

Ruptured Brain AVM DSA is important to display the vascular malformation for planning treatment 20 y man

C ONVENTIONAL ANGIOGRAPHY

Basic concepts of CTA Scan during peak arterial enhancement

CTA Protocol Antecubital vein – injection rate 4 ml/sec follow by saline injection 4 ml/sec Contrast volume depends on machine scan time (35-40 ml) Carotid CTA – flu trigger at aortic arch cerebral CTA – flu trigger at cervical ICA P rotocol

Basic concepts of CTA

Cerebral CTA same technique as neck CTA more sophisticate bone removal

Cerebral aneurysm

Vascular malformations: AVM

C AROTID DISSECTION

CTA ADVANTAGE 1.Short scan time 2.Suitable for emergency 3.Non invasive 4.Good resolution 5.Visualized both brain and vessel DISADVANTAGE 1.Ionizing radiation 2.Need proper venous access 3.Limited by patient renal function 4.Poor evaluation of skull base vessel

C TV

CTV Protocol Antecubital vein – injection rate 4 ml/sec Contrast volume 100 ml scan cephalic to caudal P rotocol

C TV

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