Presentation
Confusion and left-sided weakness since yesterday. History of minor stroke a year ago.
Patient Data
acute right frontal intracerebral bleed with mild surrounding vasogenic edema and a mild mass effect on the adjacent frontal horn of the right lateral ventricle. Another tiny linear hyperdensity (likely hemorrhage) measuring approximately 4 mm is noted in the right posterior frontal lobe. No skull bone fracture. There is no CT evidence of a recently established territorial infarction. Age-related involutional changes in the brain parenchyma, small vessel-induced periarticular deep white matter ischemic changes, and a small old lacunar infarct in the left basal ganglia
common origin of the brachiocephalic trunk and left common carotid artery from the aortic arch (bovine arch -- anatomical variant) and direct origin of the dominant left vertebral artery from the aortic arch (also an anatomical variant)
a few tiny calcifications in the proximal left internal carotid artery; otherwise, normal course, caliber, and contrast opacification of bilateral common carotid arteries, carotid bulbs, internal carotid arteries, and vertebral arteries in the neck
non-visualized/aplastic A1 segment of the right anterior cerebral artery with a patent and well-opacified A2 segment of the right anterior cerebral artery, which is likely opacified from the contralateral circulation via the anterior communicating artery
morphology of the remaining intracranial vessels is unremarkable.
Case Discussion
A CT angiography of the cerebral arteries was performed to rule out any underlying vascular abnormality. The CTA was negative for any vascular malformation; however, it showed a few anatomical variants:
absent A1 segment of the right ACA, an anatomical variant seen in 10% of the individuals
dominant left vertebral artery, an anatomical variant seen in 45% of the individuals
left vertebral artery arising directly from the aortic arch, an anatomical variant seen in 6% of the individuals
common origin of the brachiocephalic trunk and the left common carotid artery from the aortic arch (bovine arch); the most common variant of the aortic arch
Unable to process the form. Check for errors and try again.