Presentation
Left hemiplegia.
Patient Data
Dense right MCA M2 segment thromboembolic material is accompanied by abrupt cut-off on the CTA, with comparatively mildly reduced MCA branch filling evident distally. The remainder of the intra-cranial circulation lies within normal limits, as do the aortic arch origins, cervical carotid and vertebral arteries, with no significant atheroma, stenosis or dissection demonstrated. Subtle hypodense blurring in the right insular region is compatible with early subacute infarction, with preserved grey-white differentiation elsewhere.
Unfortunately, there is now hemorrhagic transformation of the acute right MCA territory infarct, with large hyperdense central right cerebral hematoma measuring approx 7.2 x 4.8 x 3.0 cm (52 mL). This is associated with right cerebral sulcal/lateral ventricular effacement, up to 5 mm leftward midline shift, moderate IVH and mild/early hydrocephalus. Right MCA M2 segment and branches remain very hyperdense.
Case Discussion
This patient had been treated wtih tPA thrombolysis. They unfortunately succumbed to the ICH.
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