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48 Cards in this Set

  • Front
  • Back
What are the main categories of arteries to check
carotid arteries-->ICA bilat
vetebral- basilar circulation
anterior cerebral circulation
posterior cerebral circulation
What do you dictate if normal
no evidence of stenosis, occlusion, or aneurysm.
In addition to aneursym, stenosis, occlusion what else do you look for on brain angiography
AVMs
How do you check the perfusion study
first look at the volume and this should correspond to an infarct. Then look at the MTT. These should be the same size. If MTT is bigger it means there is a pneumobra and an area of ischemia

M (increased) - V (decreased)= pneumbra
What two parts of the perfusion scan are looking at the same thing
MTT and CBF (MTT is used at CSMC)
What is the volume compared with
MTT
What is a pneumbra
if there is increased size of the flow or MTT compared to the volume and this indicates an area of ischemia in addition to the infarction.
What must you be able to see on windowing
plaques within vessels
what is a good widowing
200- 800
What is the a common variant that happens to the A-1 segment

Where is the A-1 segment
A-1 hypoplasia which results in asymmetric appearance of the beginning of the anterior cerebral artery. This is a normal variant

This after the bifurcation of the MCA and ACA and before the ACA gives off the communicating artery to the contralateral ACA
What is a fetal origin of the PCA
this is when the posterior communicating artery supplies the majority or all the blood flow to the posterior part of the brain on that side. In these cases the posterior communicating artery is absent or contributes a minor amount of blood flow. This is a normal variant
When the CCA divides in the ICA and ECA what are there postitions
ICA is posterior lateral

ECA is anterior medial
What is the postion of the ICA after it branches from the CCA
posterior lateral

note it will move around relative to the ECA and eventualy the ECA will be lateral bc it is supplying the blood to the face and head
What are the portions of the ICA
5
cervical, petrous, precavernous, and cavernous, supraclinoid
What is does the cavernous portion of the ICA look like
it is the first horizontal -diagnol portion seen
What are the branches of the supraclinoid
OPA

opthalmic
poterior communicating
anterior choroidal artery
What branches the supraclinoid ICA can you see on a CT angio
posterior communicating (usualy)

anterior choriodal (sometimes)
What does the ICA branch into
ACA and MCA
What does the posteroir communicationg branch off of
the supraclinoid ICA
What part of the code brain should you look at first
after verifying the CT brain look at perfusion to hone in search
What is commonly commented on in the cervical carotids
atherosclerosis.
What is the relation of the jugular vein to the common carotid
lateral
When does the transverse foramen start
C6
What is the cause of a prevetebral neck bulge at the region of the thyroid cartilage or C4 area
the esophagus, this will increase the thickness of the prevetebral space at that level and it may only last a few vetebral levels if the esophagus moves lateral and is no longer anterior to the vetebral body. This can be confused for a mass.
Does the internal jugular branch of the jugular vein
no the internal jugular and external jugular are two seperate veins.
What does the EJ branch off of
the subclavian vein
What does the IJ branch off of
the brachiocephalic which marks the transition of the subclavian vein
When does the cca bifurcate
below the hyoid at the level of the thyroid cartilage
When does the internal jugular vein bifurcate (actual does bifurcate it just gives a branch off)
at the hyoid bone
What does the internal jugular vein bifurcate into
the retromandibular vein and the internal jugular vein
After the jugular vein gives off the retromandibular vein what is the position in relation to the ICA
lateral and posterior (C2 to the skull base)
What is bovine origin of left CCA
Origin of the Left Common Carotid Artery from the right brachiocephalic artery
Increased MTT and decreased flow

normal volume
ischemic pattern
Pneumbra
M-V= peenumbra (not F-V)
perfusion
Perfusion CT mismatch. Imaging of a 76-year-old woman who had been found unresponsive with a right facial droop. (A) Screening head CT is suggestive of left middle cerebral artery ischemic process as manifested by mild sulcal effacement (large solid arrows) and a subtle insular ribbon sign (small, solid arrows). (B) Perfusion CT performed immediately after the screening head CT reveals decreased cerebral blood volume (CBV) in the left frontal lobe region (white arrows), which is suggestive of irreversible ischemic change. The CBV in the left temporal lobe is normal and symmetric with the right temporal lobe. (C) Mean transit time (MTT) perfusion CT shows increased transit time in the left temporal region (straight white arrows) relative to the right temporal region (curved white arrows), which is consistent with a perfusion deficit. This "mismatch" between the MTT (C) and the CBV (B) perfusion scans (ie, the normal CBV with an increased MTT) suggests the presence of possibly salvageable brain tissue in the left temporal region at that time.
Can the vetebral artery be small thoughout its course and be normal
yes
Do vetebral arteries sometimes end in the PICA
yes
If there is a small vetebral artery what must be ruled out
a long dissection
where does the PICA artery come off
the vetebral arteries
Where does the AICA branch off
the basilar artery
What is the formula for the nascet criteria
What should be mentioned on every report that has a perfusion image part
dose criteria was reviewed.
What should the bulb look like on CTA
the bulbous portion should extend down to the bifurcation if doesnt there is stenosis
Can the bulb be measured by the NASCET criteria
no
What is the cavernous portion of the ICA
when the ICA is traveling anteriorly towards the ethmoid and before it curves up towards the clinoid
Where is the clinoid portion
this is after the ICA is traveling anteriorly and then loops up just at where the clinoids are
Where is the supraclinoid section of the ICA
this is when it is traveling posterior and has turned back on its self.
If there is decreased volume in on a perfusion is there always a stroke
yes, there is never just decreased volume, however, if there is hyperperfusion to an area of the brain it may look like there is a large area of decreased volume which is not a stroke.