A calcified focus in the right Sylvian cistern is suspicious for a calcified thromboembolism. Loss of grey-white matter differentiation of the right posterior temporal, insular and parietal cortex. Elsewhere, grey-white matter differentiation is preserved. Automated ASPECTS = 5.
No intra or extra-axial haemorrhage, collection or lesion. General involutional change, with periventricular white matter hypoattenuation, in keeping with prominent chronic small vessel ischaemia. Multi small old bilateral basal ganglia lacuna infarcts.
CT perfusion reveals an area of hypoperfusion in the right MCA territory (Tmax greater than 6 seconds. Using the threshold of CBF <30%, there is an area of ischaemic core within this region with a substantial penumbra (mismatch) volume.
CTA (only limited edge enhanced/bone window images providedemonstrates occlusion of the right inferior division of MCA at the site of calcification and a second more distal occlusion of the right superior division of MCA. Above these occlusions there is reduced vascular enhancement throughout the MCA territory.
Conclusion:
Acute right MCA territory ischaemic stroke with occlusion of inferior division due to calcified thromboembolism. Sizeable penumbra.