KEY FACTS Terminology Reversible stenosis of intracranial arteries Common with aneurysmal subarachnoid hemorrhage (SAH) Caused by exposure to blood breakdown products Contraction of vascular smooth muscle Histological changes in vessel wall Imaging General features (CTA/MRA/DSA) Typically occurs 4-14 days after…
KEY FACTS Terminology Reversible cerebral vasoconstriction syndrome, a.k.a. Call-Fleming syndrome Group of disorders characterized by Reversible, multifocal cerebral artery vasoconstrictions Severe headaches ± focal neurological deficits Imaging Acute/recurrent headaches with vasculitic pattern (DSA) DSA = crucial for diagnosis (100% sensitive)…
KEY FACTS Terminology Heterogeneous group of CNS disorders Characterized by nonatheromatous inflammation and necrosis of blood vessel walls Both arteries, veins may be affected Imaging CTA/MRA useful screening; spatial resolution usually insufficient for subtle disease MR Basal ganglia, cortex, subcortical…
KEY FACTS Terminology Primary arteritis of CNS (PACNS) No evidence of secondary (systemic) vasculitis May involve intracranial arteries of any size 2 features essential for histopathologic diagnosis Inflammation and necrosis of blood vessel wall Imaging CT Look for secondary signs…
KEY FACTS Terminology Progressive narrowing of distal internal carotid artery/proximal circle of Willis (COW) vessels with secondary collateralization Collateral vessels → cloud-like “puff of smoke” (moyamoya) at angiography Moyamoya disease (MMD) = primary (idiopathic) moyamoya Marked East-West gradient (more common…
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KEY FACTS Terminology Intracranial atherosclerotic vascular disease (ASVD) Intracranial atherosclerotic stenosis (ICAS) Imaging Gold standard is now high-resolution MR (HRMR) with direct vessel wall imaging HRMR vessel wall imaging > > depicting lumen (DSA, CTA, MRA) Imaging findings (HRMR) Crescent-shaped…
KEY FACTS Terminology Sclerosis of small-sized arteries (arterioles) Common with chronic hypertension (HTN) &/or diabetes May lead to vascular dementia (VaD) Imaging Multifocal white matter (WM) hypodensity on CT Patchy/confluent ↑ T2/FLAIR hyperintensities Broad or confluent base with ventricles Periventricular…
KEY FACTS Terminology Hypertensive intracranial hemorrhage (hICH) Acute nontraumatic intracerebral hemorrhage (ICH) secondary to systemic hypertension 2nd most common cause of stroke Imaging Initial screen = NECT in patients with HTN CT: Acute round or oval hyperdense mass Striatocapsular: Putamen/external…
KEY FACTS Terminology Primary intraparenchymal hemorrhage (pICH) Acute nontraumatic intracranial hemorrhage (ICH) Imaging Acute round or oval intracerebral hematoma Subcentimeter “microbleeds” to massive ICH Hematoma location for common causes of pICH HTN: Basal ganglia > thalamus > pons > cerebellum…