Hyperacute Transcapillary Stroke - CT Venocapillary Pool
Hyperacute Transcapillary Stroke - CT Venocapillary Pool
Search Pattern Assist ?History
Exam
Purpose
2 To determine whether there is a pial collateral gap, which is likely to undergo completed stroke (presented in the Arterial stroke module).
3 To assess the contrast density in the venocapillary pool in order to recognize tissue at significant ischemic risk (as presented in both the Arterial stroke module and the Venous stroke module).
4 In the context of restricted intradural afferent arterial blood flow obstruction (in the absence of a primary stem occlusion), has regional hypoperfusion produced oligemia in the expected anastomotic border zones producing a watershed stroke pattern.
5 To identify any, and all, sites of intra or extra cranial efferent venous block (as presented in the Venous stroke module).
Prior Study
Findings
Pial Collateral Analysis (for details see Arterial Stroke Module)
Does the pial collateral reach the distal end of the arterial thrombus (good if yes). If it does not there is a pial collateral gap. [Yes/No]
There is an incomplete circle of Willis contributing to delayed collateral filling (increases probability of stroke w/ intercurrent hypotension). [Yes/No]
The post contrast head CT demonstrates reasonable retrograde pial collateral, but, the CT density within venocapillary pool within the stroke-zone appears exaggerated, compared to the contralateral side, reflecting vasodilatation indicating post ischemic dysautoregulation. [Yes/No]
The post contrast head CT demonstrates reasonable retrograde pial collateral, and the CT density within the venocapillary pool now appears normal on the delayed CT, as well indicating the pial collateral effectively supplies the underlying brain. [Yes/No]
The post contrast head CT demonstrates fair retrograde pial collateral but the CT density within venocapillary pool, although present, appears significantly reduced from expected normal. [Yes/No]
There is hyperemia in basal ganglia and thalamic perforating artery territories with increased venocapillary pool CT density consistent with moyamoya disease physiology. [Yes/No]
There is oligemia in brain with a "usual watershed distribution" with both incomplete retrograde pial collateral and reduced or absent venocapillary pool CT density evident on both the initial & delayed post contrast CT head. [Yes/No]
There is oligemia in brain with an end-of the-line watershed distribution with both retrograde pial collateral but reduced or absent venocapillary pool CT density evident in the region of the shifted watershed zone. [Yes/No]
Repeat analysis of the venous egress on the delayed post contrast head CTA reveals persistent evidence of reduced opacification or absence of cortical veins, deep central veins, or of the dural sinuses. [Yes/No]
Other
No other findings abnormalities are noted. [Yes/No]
