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CT HEAD and ISCHEMIC CVA What to look for on the early scan??

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. What is the sensitivity of early CT head in ischemic CVA?.

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CT HEAD and ISCHEMIC CVA What to look for on the early scan??

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  1. CT HEAD and ISCHEMIC CVAWhat 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. SEVEN SIGNSOF EARLY ISCHEMIC CVA What are the early signs of ischemic CVA to look for???

  5. EARLY ISCHEMIC CVA

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

  7. EARLY ISCHEMIC CVA

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

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

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

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

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

  13. SIGN #7

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

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

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

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