E-mail this page
 Printer-friendly page

This is a CT from an 85-year-old nursing home resident with known history of A-fib, CAD, DM hypothyroidism, HTN, and asthma who was noted by nursing staff to be awake and non-verbal with a right-sided facial droop and weakness in right upper and lower extremities. At baseline she was alert, fully-verbal, oriented x 3, and able to get out of bed, toilet and feed herself with assistance.

On examination in the ED she was awake and non-verbal with a right-sided facial droop, minimal spontaneous movement on right side, and irregularly irregular heart sounds. INR was 1.02

Q: Which subtle finding on the CT above suggests an acute CVA?

View answer

A:

Compare the gray-white interface on the right and left side. The decreased interface on the (patient’s) left is in the distribution of the left MCA. (see schematic below)

dark gray – anterior cerebral artery distribution
medium gray – middle cerebral artery distribution
light gray – posterior cerebral artery

(from Emergency Radiology, David Schwartz, 2000)

Q: How long does this finding take to develop on CT?

View answer

A: 6 – 12 hours after the event

Q: How long does it take a CT to show more dramatic findings?

View answer

A: While stroke may be apparent within hours in some cases, CT changes are more consistently visualized during the following 24 to 48 hours. Please see the CT below which was done on this patient several days later.