Name possible symptoms in this right-handed patient.
Clinical manifestations of infarctions in the middle cerebral artery (MCA) territory of the non-dominant hemisphere depend on the involved segments or branches. Involvement of the entire territory most commonly leads to contralateral hemiparesis, hemisensory loss, sensory neglect phenomena and anosognosia.
True or false: dependent of symptom debut, thrombolytic therapy is indicated.
Hypodensity involving >2/3 of the middle cerebral artery territory is generally considered an absolute contraindication to thrombolytic therapy. Endovascular treatment resulting from large vessel occlusion is appropriate within 6 hours of symptom onset, however in select cases those who fall outside the 6 hour time window may also benefit from thrombectomy (as of 2019).
True or false: images depict right sided malignant media infarction.
This is not correct. While there is complete right MCA-infarction, there is no current mass-effect. However, there is a definite potential for this most devastating form of ischemic stroke necessitating neurocritical care including low threshold for further (serial) imaging.
Head CT obtained in ER 4 mth before
Non-contrast CT of the head reveals dense right MCA (M1-3 segments), hypoattenuating brain tissue with sulcal effacement in the territory of the right MCA, obscuration of right lentiform nucleus and loss of right insular ribbon. No significant mass-effect, no hemorrhage.
Conclusion
Right-sided complete MCA infarction without actual significant mass-effect.