Examenul CT in Examenul CT in AVC AVC

Prof. dr. DANISIA HABAProf. dr. DANISIA HABA

UMF GR.T. Popa IasiUMF GR.T. Popa Iasi

Dep. de Radiologie, Sp. Cl. De Dep. de Radiologie, Sp. Cl. De UrgentaUrgenta

Prof. dr. N. Oblu IasiProf. dr. N. Oblu Iasi

ACCIDENTE VASCULARE CEREBRALE (AVC)

AVC= deficit neurologic care are drept cauza o leziune vasculara arteriala (frecventa~90%) si implica o leziune temporala/permanenta a parenchimului cerebral.

AVC arteriale - ischemice~ 80%, - hemoragice~20% , pot

fi intra-parenchimatoase +/- HSA AVC venoase –tromboze venoase

cerebrale

AVC

Ischemie arteriala : 80% Occluzia vaselor mari 15-40% Emboli cardiaci 15-30% Infarct lacunar al v. mici 15-30% Leziuni sanghine, vascularita 5-10%

Hemoragie parenchimatoasa 15% HAS 5% Ischemie venoasa 1%

Infarct cerebral acut in ACM stg. la o pacienta de 56ani. Infarct cerebral acut in ACM stg. la o pacienta de 56ani. A. CT cranio-cerebral initial , fara contrast, evidentiind A. CT cranio-cerebral initial , fara contrast, evidentiind hiperdensitate in ACM stanga. (“dense MCA”) is noted hiperdensitate in ACM stanga. (“dense MCA”) is noted (early CT sign of MCA infarct). On follow-up CT scan 1 (early CT sign of MCA infarct). On follow-up CT scan 1 day later, hypodensity in the vascular territory of the day later, hypodensity in the vascular territory of the right MCA is clearly depicted. Hemorrhagic right MCA is clearly depicted. Hemorrhagic transformation of the MCA infarctiontransformation of the MCA infarctionis detected 48 h after the onset of symptoms is detected 48 h after the onset of symptoms

Hemorrhagic transformation of the MCA infarction is Hemorrhagic transformation of the MCA infarction is detected 48 h after the onset of symptoms . On detected 48 h after the onset of symptoms . On unenhanced CT scan of the brain, subtle hypodensity is unenhanced CT scan of the brain, subtle hypodensity is observed in the right insular cortex. b, c CT observed in the right insular cortex. b, c CT angiography (CTA) demonstrates occlusion of the right angiography (CTA) demonstrates occlusion of the right middle cerebral arterymiddle cerebral artery

On unenhanced CT scan of the brain, subtle hypodensity On unenhanced CT scan of the brain, subtle hypodensity is observed in the right insular cortex. b, c CT is observed in the right insular cortex. b, c CT angiography (CTA) - occlusion of the right middle angiography (CTA) - occlusion of the right middle cerebral arterycerebral artery

Acute right MCA infarct in a 60-year-old male Acute right MCA infarct in a 60-year-old male patient. On initial unenhanced CT scan of the patient. On initial unenhanced CT scan of the brain, hyperdensity along the right middle brain, hyperdensity along the right middle cerebral artery (“dense MCA”) -early CT sign cerebral artery (“dense MCA”) -early CT sign of MCA infarct. On follow-up CT scan 1 day of MCA infarct. On follow-up CT scan 1 day later, hypodensity in the vascular territory of later, hypodensity in the vascular territory of the right MCA the right MCA

R.M. 68 ani hemiplegie R.M. 68 ani hemiplegie stgstg

CT in a patient with left-sided weakness, 2 h CT in a patient with left-sided weakness, 2 h after the onset of symptoms. Subtle after the onset of symptoms. Subtle hypoattenuation and sulcal effacement in the hypoattenuation and sulcal effacement in the right insular region are noted on unenhanced right insular region are noted on unenhanced CT of the brain. (Courtesy of Bidyut USA) K. CT of the brain. (Courtesy of Bidyut USA) K. Pramanik, New York University, NY, Pramanik, New York University, NY,

Low perfusion is detected in the region of the Low perfusion is detected in the region of the right MCA on PCT maps (time-to-peak, right MCA on PCT maps (time-to-peak, cerebral blood volume). (Courtesy of Bidyut cerebral blood volume). (Courtesy of Bidyut USA) K. Pramanik, New York UniversityUSA) K. Pramanik, New York University

a-c. Comparison of nonenhanced computed a-c. Comparison of nonenhanced computed tomography (NECT) and diffusion-weighted MRI (DWI) tomography (NECT) and diffusion-weighted MRI (DWI) in the detection of acute ischemia (both imaging in the detection of acute ischemia (both imaging modalities performed 3 h after onset). a NECT scan of modalities performed 3 h after onset). a NECT scan of the brain shows subtle hypodensity in the left frontal the brain shows subtle hypodensity in the left frontal region. B Increased signal intensity is shown on DWI in region. B Increased signal intensity is shown on DWI in the affected the affected region. c Low apparent diffusion region. c Low apparent diffusion coefficient (ADC) value on the ADC map coefficient (ADC) value on the ADC map suggests restricted diffusion in acute ischemiasuggests restricted diffusion in acute ischemia

A. E., 74 ANI, HEMI STG, DEV. A. E., 74 ANI, HEMI STG, DEV. CONJ. CAP SI GO SPRE STGCONJ. CAP SI GO SPRE STG

A. E., 74 ANI, HEMI STG, A. E., 74 ANI, HEMI STG, DEV. CONJ. CAP SI GO DEV. CONJ. CAP SI GO

SPRE STGSPRE STG

G. V. 52 ANI, HEMIPLEGIE G. V. 52 ANI, HEMIPLEGIE DR.DR.

N.O. 45ani- C-PICA DRN.O. 45ani- C-PICA DR

SF 21 -43ani-hemipareza SF 21 -43ani-hemipareza drdr

T.I. 59 ani hemipareza T.I. 59 ani hemipareza stg.stg.