1. CT HEAD and ISCHEMIC CVA What to look for on the early scan??
“Doctor, I think I've gone and occluded my MCA again”
Xray rounds Nov 14, 2002
Rob Hall PGY3

2. What is the sensitivity of early CT head in ischemic CVA?
Retrospective studies have looked at what % have findings at 6, 12, 24, 48hrs etc
CANNOT BE DETERMINED
Size of infarct
Location of infarct
Time from infarct
Reader variability
30% will never show on CT

3. CT HEAD and ISCHEMIC STROKE
ISCHEMIC CVA
CLINICAL SYNDROME NO BLEED/TUMOR/MA/AVM

4. What are the early signs of ischemic CVA to look for???
SEVEN SIGNS OF EARLY ISCHEMIC CVA

5. EARLY ISCHEMIC CVA

6. SIGN #1
HYPODENSITY
Typically wedge shaped hypodensity of affected territory due to edema

7. EARLY ISCHEMIC CVA

8. SIGN #2 LOSS OF GREY - WHITE DIFFERENTIATION
Loss of the normal distinction b/w the grey matter and the white matter

10. SIGN #3 HYPERDENSE MCA SIGN
Due to acute occulsion and swelling in the MCA

11. ANATOMY Caudate nucleus Insular cortex Putamen Globus pallidus
Internal capsule

13. SIGNS #4 and #5 INSULAR RIBBON SIGN DISSAPEARING BASAL GANGLIA SIGN
Loss of definition of the insular cortex
DISSAPEARING BASAL GANGLIA SIGN
Loss of definition b/w the basal ganglia

15. SIGN #6
SULCAL EFFACEMENT
Loss of definition of the sulci due to edema

16. SIGN #7

17. SIGN #7 VENTRICULAR COMPRESSION
Ventricles compressed due to edema of overlying cortes

18. Early CT is NOT a sensitive test in ischemic CVA
CONCLUSIONS
Early CT is NOT a sensitive test in ischemic CVA

19. SEVEN SIGNS Hypodensity Loss of Grey - White differentiation
Sulcal Effacement
Hyperdense MCA sign
Insular ribbon sign
Disappearing Basal Ganglia sign
Ventricular compression sign