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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.

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Presentation on theme: "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."— Presentation transcript:

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

9

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

12

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

14

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

16 SIGN #7

17 VENTRICULAR COMPRESSION –Ventricles compressed due to edema of overlying cortes

18 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


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