Patient with acute ischemic stroke symptoms . NIH stroke scale score was 11. Patient received IV TPA and NIHSSS were went down to 8. 46-year-old female presents with dysarthria bilateral low lower extremity weakness and left upper extremity weakness. Please evaluate for potential for embolectomy.Technique:A total of a 130 mL of Omnipaque 350 was used. 65 for the CTA and is 65 mL for the perfusion study. A CT of the head was performed followed by a perfusion study of the brain and within the CTA of the head in neck using the University of Chicago protocols for each of these exams. 3-D reconstructions for the CTA of the head and CT of the neck were performed on an independent workstation. Cerebral blood volume maps, stroke blood flow maps, mean transit time maps were performed on an independent workstation. Individual measures of upper fusion made from the areas in question. CT head: The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Perfusion CT: There is hypoperfusion to right anterior cerebral artery territory anteriorly. Based on the patient's outside MRI exam which included diffusion weighted imaging as well as the cerebral blood volume maps on the current exam much of the involve territory has already infarcted. Embolectomy would not to be of a significant benefit in this case. Along the interrogated region mean transit time was 33 versus 5.5 and the normal side with a screw blood volume in the worst component of flow 1.25 forces 4.4 normal side. Along the more anterior aspect of the hypoperfused territory and appears there is somewhat better perfusionCTA brain:CTA brain demonstrates occlusion of the right anterior cerebral artery at the distal A2 segments. There appears to be a small sliver of contrast spanning a 2-cm length along this vessel and the vessel is reconstituted at distal to this at the A3 segment. No other intracranial occlusions are appreciated.There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior, middle and posterior cerebral arteries. No aneurysms are appreciated.CTA neck: A couple to ablate the defects present along the distal internal carotid artery bilaterally. This is raises the question of fibromuscular dysplasia. these weblike defect can be identified at the C2-3 level on the right and at C1-2 level on the left. Best seen on coronal images 95 and 99.There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.
1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Occlusion of the right anterior cerebral artery and the A2 segment as described above. The associated that perfusion defect indicates that the tissue amenable to salvage is a less than 50% of the hypoperfused territory.3.Weblike defects along the distal cervical internal carotid arteries. The possibility of fibromuscular dysplasia is raised. No significant stenosis as described above.4.Findings were discussed with clinical service at the time of the exam.