NONVASCULAR FINDINGS:
No intracranial hemorrhage. No extra-axial fluid collection.
The ventricles and sulci are normal in size for age. Basal cisterns are clear. No intracranial mass or mass effect.
Orbital structures are normal. The paranasal sinuses and mastoid air cells are clear.
Nonspecific peripheral and subpleural fibrosis and ground glass opacities within the visualized lung apices. Correlate with lab results to exclude COVID-19 pneumonia. Partially visualized pericardial effusion.
VASCULAR FINDINGS:
Evaluation limited by suboptimal contrast opacification of the arterial vasculature.
Aortic arch calcifications. Atherosclerotic calcifications at the carotid bifurcations without high-grade narrowing. There is multifocal irregular narrowing of the cervical right internal carotid artery estimated at approximately 50%. Multifocal calcifications noted within the cavernous segments of the bilateral internal carotids, with likely flow-limiting stenosis on the right. There is irregular atherosclerotic narrowing of the right greater than left M1 segments.
There is abrupt cut off within the distal M1 segment of the right MCA, consistent with acute occlusive thrombus. Faint contrast opacification is noted within the distal right MCA territory, likely from collateral flow.
Bilateral ACA and left MCA arteries are patent. Posterior circulation is patent. Basilar artery is grossly unremarkable. The vertebral arteries are not well opacified, particularly on the left, likely due to atherosclerotic narrowing.
CT BRAIN PERFUSION FINDINGS:
RAPID analysis demonstrates asymmetric hypoperfusion primarily throughout the right MCA territory, most pronounced within the subcortical right frontal lobe. Mild hypoperfusion is also noted bilaterally within the posterior circulation. Small focus of hypoperfusion is also noted within the anterior left frontal lobe.
No area of reduced cerebral blood flow or volume is identified to suggest core infarct.
CBF<30% volume (mL): 0
Tmax>6.0s volume (mL): 51
Mismatch volume (mL): 51
Mismatch ratio: infinite
Impressions
Abrupt cut off within the distal M1 segment of the right MCA, consistent with acute occlusive thrombus. Multifocal atherosclerotic narrowing of the right internal carotid artery and right greater than left M1 segments as detailed above. Multifocal atherosclerotic narrowing of the left greater than right vertebral arteries.
RAPID analysis demonstrates asymmetric hypoperfusion primarily throughout the right MCA territory, most pronounced within the subcortical right frontal lobe. Mildhypoperfusion also noted bilaterally within the posterior circulation. Small focus of hypoperfusion within the anterior left frontal lobe. No area of reduced cerebral blood flow or volume is identified to suggest core infarct.
CBF<30% volume (mL): 0
Tmax>6.0s volume (mL): 51
Mismatch volume (mL): 51
Mismatch ratio: infinite
Nonspecific peripheral and subpleural fibrosis and ground glass opacities within the visualized lung apices. Correlate with lab results to exclude COVID-19 pneumonia.