CT Brain (Stroke) + CTA + CT Brain perfusion
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No acute intracranial haemorrhage. There is linear branching hyperdensity in the region of the distal right M1 with extension into proximal M2 branches within the sylvian fissure. There is a subtle region of hypodensity affecting the corona radiata immediately superior to the right anterior limb of the internal capsule. The adjacent caudate head, insular ribbon and lentiform nuclei however remain preserved. Elsewhere, no other convincing region of developing acute/subacute cerebral infarct.
CTA COW (aortic arch to vertex)
Heavily calcified plaque at the carotid bulb and proximal right ICA results in approximately 70% narrowing of the proximal ICA. Partially calcified atherosclerotic plaque at the left carotid bulb results in less than 50% stenosis at the proximal ICA. Minimal irregularity without significant stenosis affecting bilateral petrosal and cavernous ICAs may represent segments of atherosclerotic disease.
There is a filling defect involving the mid to distal right M1 with extension into both M2 divisions. No other filling defect or significant stenosis within the intracranial arterial circulation. No intracranial aneurysm appreciated.
The right V1 segment is of extremely narrow calibre, with the artery only visible to the level of the C5 transverse process. The right vertebral artery reconstitutes around the level of C2 with the V3 and V4 segments also demonstrating small calibre with some irregularity. The right PICA demonstrates an unremarkable origin and appearance off the right V4. The foramina transversaria are of relatively preserved diameter. Appearances are indeterminate between hypoplasia and chronic dissection of the right vertebral artery.
There is a region of increased MTT affecting almost the entire right MCA territory. There are subtle patchy regions of reduced CBF within the right MCA territory however the appearances suggest a perfusion mismatch with ischaemic penumbra.
Occluded distal right M1 with extension into the proximal M2 branches and large ischaemic penumbra.
Calcified atherosclerotic plaque at the right carotid bifurcation and proximal ICA results in approximately 70% stenosis of the artery.