Monthly Archives: May 2016

MCA Angiographic Anatomy

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  • Segments of the MCA: M1, M2, M3, M4
  • Deep perforators from M1
  • Medullary arteries (short and long branches) from cortical branches (M)
  • Anastomoses with ACA  (———-)

 

Reference:

Bradač, G. B. Cerebral Angiography. Berlin: Springer, 2011. Print.

Anterior Cerebral Artery Angiographic Anatomy

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  • ACA segments: A1, A2, A3, A4
  • Deep perforators from A1
  • Artery of Heubner (double arrow)
  • Medullary arteries (M, short and long branches) from cortical branches
  • Leptomeningeal anastomosis with MCA (——–)

Reference:

Bradač, G. B. Cerebral Angiography. Berlin: Springer, 2011. Print.

 

Algorithm: Work-up of Cryptogenic Stroke

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Reference:

Saver, Jeffrey L. “Cryptogenic Stroke”. New England Journal of Medicine 374.21 (2016): 2065-2074.

Cryptogenic Stroke H&P Clues

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Reference:

Saver, Jeffrey L. “Cryptogenic Stroke”. New England Journal of Medicine 374.21 (2016): 2065-2074. Web.

 

 

ASCOD Phenotyping for Stroke

ASCO Criteria:

  • A: atherosclerosis
  • S: small-vessel disease
  • C: cardiac pathology
  • O: other causes

Assigns a degree of likelihood of causal relationship to every potential disease commonly encountered in ischemic stroke describing all underlying diseases in every patient

  • 1 for potentially causal
  • 2 for causality is uncertain
  • 3 for unlikely causal but the disease is present
  • 0 for absence of disease
  • 9 for insufficient workup to rule out the disease

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ASCOD Criteria

  • D: dissection
  • ‘levels of diagnostic evidence’integrated into grades 9 and 0 were left out
  • cutoff for significant carotid or intracranial stenosis changed from 70% to more commonly used 50% luminal stenosis
  • cardiogenic stroke pattern using neuroimaging added

Reference:

Amarenco, P. et al. “The ASCOD Phenotyping Of Ischemic Stroke (Updated ASCO Phenotyping)”.Cerebrovasc Dis 36.1 (2013): 1-5.

 

Angiogram of the Internal Carotid Artery

Common carotid angiogram, lateral view (a) and AP view (b)

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  • arrows indicate the ECA

 

Axial cut through dotted line in figure (b) above

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  • CS = carotid space (inside is ICA and JV, jugular vein and CN 9, 10, 11, 12)
  • PS = parotid space (inside ECA is posterior and retromandibular vein anterior)
  • PPS = parapharyngeal space
  • RPS = retropharyngeal space
  • PVS = perivertebral space
  • MS = masticator space

 

Petrous and cavernous portion of the ICA, lateral carotid angiogram.

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  • Petrous portion (red)
  • Cavernous portion (green)
  • Dural ring proximal to the origin of the ophthalmic artery
  • C5, C4, C3 = parts of cavernous ICA
  • C2, C1 = supraclinoid and subarachnoid ICA

 

Lateral carotid angiogram:

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  • arrow with dot = PComA
  • arrow = anterior choroidal artery
  • arrowhead = ophthalmic artery

 

The ophthalmic artery

Lateral ICA angiogram

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  • OA = ophthalmic artery
  • large arrow = bend around the optic nerve
  • small arrow = ocular complex (retina and cilial arteries)
  • arrowhead = choroid plexus
  • L = lachrymal artery
  • arrow with dot = anterior falx artery

 

Reference:

Bradač, G. B. Cerebral Angiography. Berlin: Springer, 2011. Print.

External Carotid Artery Branches on Angiogram

Common carotid angiogram, lateral view, showing the anterior course of the external carotid artery related to the internal carotid artery.

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  • superior thyroid artery (Th)
  • lingual artery (LA)
  • facial artery (FA)
  • occipital artery (large arrow)
  • ascending pharyngeal artery (small arrow)
  • internal maxillary artery (IMA)
  • middle meningeal artery (MMA)
  • middle deep temporal artery (DT)
  • superficial temporal artery (STA)

Reference:

Bradač, G. B. Cerebral Angiography. Berlin: Springer, 2011. Print.