Presentation
Fall to the ground with lowering of sensorium 10 minutes ago.
Patient Data
Signs of hyperacute ischemic stroke, characterized by restricted water diffusion, without correspondence in the FLAIR sequence, affecting the nucleocapsular region, insula, and most of the frontal, parietal, temporal, and occipital lobes on the right (territory of the anterior, middle, and posterior cerebral arteries).
Absent flow-void in the internal carotid artery and proximal segments of the cerebral middle arteries, anterior cerebral and posterior cerebral on the right, probably occluded. The right posterior cerebral artery view apparently originates from the anterior circulation, constituting an anatomical variant (persistence of fetal origin pattern).
Old ischemic sequelae in the bilateral nucleocapsular regions, as well as in the right thalamus, transition right parietotemporal, left parietal lobe and lacunar infarcts in the corona radiata / semioval center on the left.
Absent flow-void in the internal carotid artery and proximal segments of the arteries cerebral middle, anterior cerebral and posterior cerebral on the right, probably occluded. The right posterior cerebral artery apparently originates in the anterior circulation, constituting an anatomical variant (persistence of fetal origin pattern)
Case Discussion
Patients may present to the hospital at various times after an ischemic stroke, and it's important to recognize to establish the correct treatment that varies according to the onset of symptoms and the size of cerebral involvement.
MRI can be used to diagnose hyperacute strokes, as in the case, showing restricted water diffusion, without correspondence in the FLAIR sequence.
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