#MedicalCase
New Onset Right-Sided Hemiparesis with Aphasia
Dr. Dominic Lewis Diggin., DOCTOR OF MEDICINE
Medical Case Details:
I was called to see an 18-year-old male that presented as a "CODE FAST" positive for arm drift, facial droop, and slurred speech. A hyperacute CT (computed tomography) brain was obtained, which showed a hypodense left MCA (middle cerebral artery) on the CTA (trifurcation aneurysm) along with a stable right MCA fusiform aneurysm measuring 0.5 cm. NIHSS (National Institutes of Health Stroke Scale) was 11. The diagnosis in this case was ischemic stroke and the patient was taken to IR due to suspected LVO (Large vessel occlusion in acute stroke)! What is your opinion on this case?Attached Files:
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Dr. Dominic Lewis Diggin
General Medicine Physician
In the images on the right side you can see some ischemia from a previous stroke and on the left side there is obvious hypodensety in the MCA and in the runoff vessels supporting the ischemic stroke diagnosis.
Best comment
23.Jul, 12:16pm
General Medicine Physician
In the images on the right side you can see some ischemia from a previous stroke and on the left side there is obvious hypodensety in the MCA and in the runoff vessels supporting the ischemic stroke diagnosis.
Best comment
23.Jul, 12:16pm
Dr. Dominic Lewis Diggin
General Medicine Physician
CT REPORT:
Reason For Exam
(CT Angiography Head Neck CODE STROKE) Stroke/TIA
Report
CLINICAL HISTORY: Stroke/TIA, Neuro Deficit, Acute, Stroke Suspected CORRELATIVE STUDIES: None
TECHNIQUE: CT angiography of the brain and head was performed from the vertex to the upper chest after administration of intravenous contrast. Multiplanar reformatted MIP images were additionally created. 3-D volume rendered images were created on an independent workstation.
All MedStar CT scans are performed using one of these three dose reduction techniques: automated exposure control, adjustment of the mA and/or kV according to patient size, or use of iterative reconstruction techniques.
FINDINGS:
NECK:
AORTIC ARCH/GREAT VESSEL ORIGINS: Normal.
VERTEBRAL: Normal. Antegrade flow. COMMON CAROTID: Normal.
INTERNAL CAROTID: Normal.
EXTERNAL CAROTID: Normal.
HEAD:
ANTERIOR CIRCULATION: No significant stenosis. Hypoplastic A1 segment of the right anterior cerebral artery with both A2 segments coming from the left via patent anterior communicating artery. Small left posterior communicating artery also noted. There is a right MCA bifurcation region aneurysm approximately measuring 4 x 4.5 x 3.5 mm. This is arising from the superior division M2 segment with apparent variant anatomy and inferior division arising much more proximally. The left MCA has hypodensity compared to the right MCA with visible ischemia to the branching arteries.
POSTERIOR CIRCULATION:No significant stenosis or aneurysm Dural Venous Sinuses: No dural sinus thrombosis is identified
BRAIN: No mass effect or hydrocephalus. ORBITS: Normal.
PARANASAL SINUSES: Clear.
AERODIGESTIVE TRACT: No mass or mass effect involving the pharyngeal mucosal space or larynx. SALIVARY GLANDS: The parotid and submandibular glands are normal.
THYROID: Normal.
Report
LYMPH NODES: Prominent bilateral jugulodigastric lymph nodes, may be reactive.
BONES: No suspicious osseous lesions. Right mandibular condyle appears to be anteriorly positioned with respect to the glenoid fossa.
LUNG APICES: Clear. OTHER: None.
IMPRESSION:
1. Left MCA Stroke
2. Variant right MCA anatomy with right MCA bifurcation region aneurysm approximately measuring 4 x 4.5 x 3.5 mm.
3. Possible right temporomandibular joint dislocation.
CRITICAL FINDINGS: Critical results were communicated to Dr. Rimm by Dr. Intikhab at 4/8/2023 7:51 AM and the findings were acknowledged. **CRITICAL RESULT** LEFT MCA STROKE SUSPECTED
Reading Location: MGRHU1RRMDT203
***** Final *****
Dictated by: Intikhab, MD, Osama Dictated at: 04/08/2023 8:01 am
This Imaging Study Was Reviewed and Its Interpretation Verified by: Intikhab, MD, Osama Electronically Signed: 04/08/2023 8:01 am
General Medicine Physician
CT REPORT:
Reason For Exam
(CT Angiography Head Neck CODE STROKE) Stroke/TIA
Report
CLINICAL HISTORY: Stroke/TIA, Neuro Deficit, Acute, Stroke Suspected CORRELATIVE STUDIES: None
TECHNIQUE: CT angiography of the brain and head was performed from the vertex to the upper chest after administration of intravenous contrast. Multiplanar reformatted MIP images were additionally created. 3-D volume rendered images were created on an independent workstation.
All MedStar CT scans are performed using one of these three dose reduction techniques: automated exposure control, adjustment of the mA and/or kV according to patient size, or use of iterative reconstruction techniques.
FINDINGS:
NECK:
AORTIC ARCH/GREAT VESSEL ORIGINS: Normal.
VERTEBRAL: Normal. Antegrade flow. COMMON CAROTID: Normal.
INTERNAL CAROTID: Normal.
EXTERNAL CAROTID: Normal.
HEAD:
ANTERIOR CIRCULATION: No significant stenosis. Hypoplastic A1 segment of the right anterior cerebral artery with both A2 segments coming from the left via patent anterior communicating artery. Small left posterior communicating artery also noted. There is a right MCA bifurcation region aneurysm approximately measuring 4 x 4.5 x 3.5 mm. This is arising from the superior division M2 segment with apparent variant anatomy and inferior division arising much more proximally. The left MCA has hypodensity compared to the right MCA with visible ischemia to the branching arteries.
POSTERIOR CIRCULATION:No significant stenosis or aneurysm Dural Venous Sinuses: No dural sinus thrombosis is identified
BRAIN: No mass effect or hydrocephalus. ORBITS: Normal.
PARANASAL SINUSES: Clear.
AERODIGESTIVE TRACT: No mass or mass effect involving the pharyngeal mucosal space or larynx. SALIVARY GLANDS: The parotid and submandibular glands are normal.
THYROID: Normal.
Report
LYMPH NODES: Prominent bilateral jugulodigastric lymph nodes, may be reactive.
BONES: No suspicious osseous lesions. Right mandibular condyle appears to be anteriorly positioned with respect to the glenoid fossa.
LUNG APICES: Clear. OTHER: None.
IMPRESSION:
1. Left MCA Stroke
2. Variant right MCA anatomy with right MCA bifurcation region aneurysm approximately measuring 4 x 4.5 x 3.5 mm.
3. Possible right temporomandibular joint dislocation.
CRITICAL FINDINGS: Critical results were communicated to Dr. Rimm by Dr. Intikhab at 4/8/2023 7:51 AM and the findings were acknowledged. **CRITICAL RESULT** LEFT MCA STROKE SUSPECTED
Reading Location: MGRHU1RRMDT203
***** Final *****
Dictated by: Intikhab, MD, Osama Dictated at: 04/08/2023 8:01 am
This Imaging Study Was Reviewed and Its Interpretation Verified by: Intikhab, MD, Osama Electronically Signed: 04/08/2023 8:01 am
23.Jul, 07:19pm
Dr. Chibitam Hope Obia
General Practitioner
Good presentation. what invertion was done for the patient after the CT evaluation?
General Practitioner
Good presentation. what invertion was done for the patient after the CT evaluation?
▲ 1
25.Aug, 10:16pm
Dr. Dominic Lewis Diggin
General Medicine Physician
In this case thrombectomy due to the MCA anyuresm tPA was contradicted.
General Medicine Physician
In this case thrombectomy due to the MCA anyuresm tPA was contradicted.
25.Aug, 10:18pm
Dr. Chibitam Hope Obia
General Practitioner
Yes tPA will be contradicted as the first intervention untill it is proven by a non contrast imaging is done . i reading something about an iv cintrast was given to the patient with the aneurysm. Are i correct ?
General Practitioner
Yes tPA will be contradicted as the first intervention untill it is proven by a non contrast imaging is done . i reading something about an iv cintrast was given to the patient with the aneurysm. Are i correct ?
25.Aug, 10:23pm
Dr. Chibitam Hope Obia
General Practitioner
So what was the patient NIHSS score post thrombectomy?
General Practitioner
So what was the patient NIHSS score post thrombectomy?
25.Aug, 10:27pm
Dr. Dominic Lewis Diggin
General Medicine Physician
Went from 11 to around 3 still had some weakness and tingleing
General Medicine Physician
Went from 11 to around 3 still had some weakness and tingleing
25.Aug, 10:29pm
Dr. Chibitam Hope Obia
General Practitioner
Ok beautiful. i hope he was transferred to the physical therapist for rehabilitation Great job . Early intervention saves life
General Practitioner
Ok beautiful. i hope he was transferred to the physical therapist for rehabilitation Great job . Early intervention saves life
25.Aug, 10:33pm
Dr. Chibitam Hope Obia
General Practitioner
You can probably send me rest of the CT imaging to my email or whatsapp number +2348027019478. i was struggling with the the 2 you sent. Thanks
General Practitioner
You can probably send me rest of the CT imaging to my email or whatsapp number +2348027019478. i was struggling with the the 2 you sent. Thanks
25.Aug, 10:37pm
