PMC9619329_01
Unenhanced CT brain findings: [Red arrow] right basal ganglia hyper-density suggestive of acute parenchymal bleed measuring approximately 23 x 16 x 12 mm. Left basal ganglia Ill-defined hypodensity likely represents sequela of old insult. Bilateral periventricular/white matter hypodensities suggestive of microangiopathic changes. No significant midline shift or hydrocephalus. Preserved basal cisterns.
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An urgent computed (CT) scan of the head showed right basal ganglia hyperdensity suggestive of acute parenchymal bleed measuring approximately 23 x 16 x 12 mm (Fig. 1).
CT intracranial angiography (CTA) findings: atheromatous calcified plaques were noted at bilateral internal carotid arteries. Bilateral internal carotids, MCAs and ACAs, show adequate caliber and contrast opacification. Non-opacification for a small segment at the origin of the right vertebral artery shows diffuse narrow caliber compared to the left. The terminal part of the left vertebral artery shows a small segment of significant stenosis. The basilar artery and bilateral PCAs appear grossly unremarkable. No evidence of intracranial aneurysm or vascular malformation.
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In addition to a CT scan of the head, the patient was evaluated for intracranial hemorrhage by computed tomography angiography (Fig. 2).
ECG-gated CT aortogram findings: [Red arrow] aortic dissection with flap seen distal to the origin of the left subclavian artery and extending to the level of the celiac trunk. (Stanford type B). Adequate contrast opacification of the major branches of the aorta. Incidentally seen stenosis at the origin of the left main renal artery. Incidentally seen wedging of the L1 vertebral body and partial bony fusion with the vertebral body of T12 (sequela of old injury).
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The study showed aortic dissection with the flap seen just distal to the origin of the left subclavian artery and extending to the level of the celiac trunk (Stanford type B aortic dissection) (Fig. 3).