Presentation
Awoke with right sided weakness and dysphasia. Background of non-small cell lung cancer, being treated with chemotherapy and radiotherapy.
Patient Data
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There are confluent hemorrhagic foci within the left temporal lobe in a peripheral subcortical distribution associated with surrounding edema. The distribution is atypical for an infarct involving the left middle cerebral artery territory. Note is made of a filling defect within the torcula Herophili (empty delta sign) and hyperdense left transverse dural venous sinus.
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MRI confirms the venous hemorrhagic infarct within the left temporal lobe and thrombosis within the left transverse and sigmoid dural venous sinuses.
Case Discussion
This is a case that should prompt you to consider venous infarction upon reviewing the first non-contrast CT imaging. The left temporal lobe hemorrhagic infarction has a gyriform pattern within a non-arterial location/territory.