Presentation
Left motor deficits for about two hours.
Patient Data
Acute ischemia of the right lenticulostriate territory results in obscuration of the lentiform nucleus ("blurred basal ganglia"), which appears hypoattenuated because of cytotoxic edema. Dense MCA sign as a result of thrombus or embolus.
The detection of the extension of acute ischemic brain parenchyma with non-enhanced CT scanning was facilitated by soft-copy visual review at a PACS workstation by using variable, non-standard window width and center level settings (a so-called "stroke window", the second series) 2.
The patient underwent intravenous thrombolysis, without success.
Extensive involvement of the territory of the right MCA characterized on T2*, FLAIR and DWI/ADC. Time-of-flight MR angiograms reveal flow cut-off at the right proximal middle cerebral artery.
Case Discussion
Typical appearances of a proximal right MCA occlusion and extensive brain infarct within its vascular territory.
This case is a good example on how CT windowing can improve the assessment of brain infarcts.
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