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

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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

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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

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CT HEAD and ISCHEMIC STROKE

• ISCHEMIC CVA
• CLINICAL SYNDROME NO
  BLEED/TUMOR/MA/AVM

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What are the early signs of ischemic CVA to look
for???

• SEVEN SIGNS OF EARLY ISCHEMIC CVA

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EARLY ISCHEMIC CVA
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SIGN 1

• HYPODENSITY
• Typically wedge shaped hypodensity of affected
  territory due to edema

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EARLY ISCHEMIC CVA
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SIGN 2

• LOSS OF GREY - WHITE DIFFERENTIATION
• Loss of the normal distinction b/w the grey
  matter and the white matter

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SIGN 3

• HYPERDENSE MCA SIGN
• Due to acute occulsion and swelling in the MCA

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ANATOMY

• Caudate nucleus
• Insular cortex
• Putamen
• Globus pallidus
• Internal capsule

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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

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SIGN 6

• SULCAL EFFACEMENT
• Loss of definition of the sulci due to edema

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SIGN 7
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SIGN 7

• VENTRICULAR COMPRESSION
• Ventricles compressed due to edema of overlying
  cortes

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CONCLUSIONS

• Early CT is NOT a sensitive test in ischemic CVA

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SEVEN SIGNS

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