Emergency Radiology Course - Brain, Not Bleed: 4 Review Questions
Emergency Radiology Course - Brain, Not Bleed: 4 Review Questions
Emergency Radiology Course - Brain, Not Bleed: 4 Review Questions
In this lecture, Andrew covers emergency CT brain interpretation with a particular focus on cytotoxic edema
and vasogenic edema, and the pathologies that cause them.
4 Review Questions
Question 1:
Which of the following is the earliest visible CT finding of likely ischemic stroke?
gyriform enhancement of cortex
hyperdense artery sign
hypoattenuation of white matter
loss of grey white matter differentiation
regional swelling
Question 2:
Which is NOT a region used as part of the Alberta stroke program early CT score (ASPECTS) for middle
cerebral artery stroke?
caudate
insular cortex
internal capsule
putamen/lentiform nucleus
thalamus
Question 3:
Axial CT image in an 80-year-old female
with fluctuating GCS. In which vascular
territory is an infarct seen?
Explanations:
Question 1:
The hyperdense artery sign refers to focal increased density of an intracranial artery on CT (typically MCA) and
is direct visualization of thromboembolic material within the lumen. It is thus the earliest visible sign
of infarction seen immediately at the time of embolism.
The hyperdensity of the arterial content is due to the thrombus having previously formed and contracted,
usually within the heart or carotid bulb, prior to embolizing and occluding the artery.
Question 2:
The thalamus is not supplied by the MCA and therefore does not form part of the ASPECTS assessment in early
MCA stroke. The remaining 4 answer options are included as regions along with 6 MCA cortical territory
regions
Question 3:
There is hypoattenuation within the left superior portion of the cerebellum (directly inferomedial to the
tentorium on this image) with the low density stopping at the midline. This is a superior cerebellar artery (SCA)
territory infarct.
Question 4:
Cerebral edema owing to swelling of the cell bodies after cellular death is known as cytoxic edema and is not
vasogenic.
Vasogenic edema represents extra-cellular fluid that has leaked out of capillaries due to breakdown of the blood
brain barrier and is often seen with tumors, metastases, abscesses and may develop around contusions. The fluid
leaks into the white-matter and produces heightened grey-white differentiation.
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