Red Flags: Acute Vascular Imaging Abnormalities Encountered in the Emergency Setting (2025)-T6-CNR04-2025

Video Transcription

Video Summary

The transcript covers a radiology-focused review of important, often overlooked emergent vascular findings on CTA/MRA beyond classic acute ischemic stroke. It first highlights “mimics” of stroke pathology that can be misread in the ED, including arterial fenestrations (which may resemble thrombus/occlusion), congenital ICA hypoplasia/aplasia (distinguished by a small/absent bony carotid canal), carotid webs (not dissection but associated with recurrent embolic stroke), TIPIC syndrome (perivascular carotid inflammation mimicking soft plaque), and fibromuscular dysplasia.<br /><br />It then surveys non-ischemic emergencies: aneurysmal subarachnoid hemorrhage workup (using hemorrhage pattern to localize culprit, describing aneurysm morphology and relation to the dural ring), difficult lesions like blister aneurysms, mycotic aneurysms (often peripheral, multiple; linked to endocarditis) and rare myxoma-related pseudoaneurysms, dissecting aneurysms (often posterior circulation), and giant aneurysms masquerading as masses. Reversible cerebral vasoconstriction syndrome (RCVS) is reviewed as a cause of convexity SAH and variable imaging (infarcts, hemorrhage, PRES-like changes), contrasted with vasculitis using vessel-wall MRI.<br /><br />A second talk emphasizes cerebral venous thrombosis: CT/CTA/MRV/MRI signs, territory patterns (vein of Labbe, deep venous, SSS), pitfalls on noncontrast CT, cavernous sinus thrombosis, otogenic sigmoid sinus complications, and trauma-related sinus injury.<br /><br />Spinal emergencies include cord infarct patterns (gray-matter “owl eyes,” DWI restriction, vertebral body infarct clue), venous infarct from epidural infection, fibrocartilaginous embolism, compartment localization of spinal hemorrhage, and key vascular malformations (cavernoma, spinal aneurysm causing SAH, and common spinal dural AV fistula).<br /><br />Finally, an ICH-focused segment explains “red flags” suggesting underlying AVM/dural AVF/cavernoma rather than hypertensive bleed, the importance of early draining veins, venous reflux, and prognostic CTA signs like the spot sign.

Keywords

CTA/MRA emergent vascular findings

stroke mimics (arterial fenestration, ICA hypoplasia, carotid web)

TIPIC syndrome and fibromuscular dysplasia

aneurysmal subarachnoid hemorrhage localization and aneurysm morphology

blister, mycotic, dissecting, and giant intracranial aneurysms

reversible cerebral vasoconstriction syndrome vs vasculitis (vessel-wall MRI)

cerebral venous thrombosis imaging (CT/CTA/MRV/MRI)

spinal cord infarction and spinal vascular emergencies (dural AV fistula, cavernoma)

intracerebral hemorrhage red flags and CTA spot sign