Acute ischemic stroke - posterior circulation territory

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Fainting attacks, left sided weakness.

Patient Data

Age: 30 years
Gender: Male

Two brain lesions noted at:

  •  medial right thalamus (supplied by thalamoperforating arteries – posterior cerebral artery territory). It shows a central core of spared diffusion restriction with blooming on SWI, tracking till the right ambient cistern, suggestive of a thrombosed feeding artery originating from right posterior cerebral artery
  • upper right cerebellar hemisphere – cortical based (superior cerebellar artery territory)  

Both lesions show high T2/FLAIR signal, low T1 signal, and evident diffusion restriction, consistent with acute infarctions in the posterior circulation territory.

Two hypodense lesions are noted at:

  • medial right thalamus (supplied by thalamoperforating arteries – posterior cerebral artery territory). Minute internal densities are noted 
  • upper right cerebellar hemisphere – cortical based (superior cerebellar artery territory)

Features of subacute infarctions in the posterior circulation territory.

Case Discussion

Both infarction territories are along the right-sided posterior circulation. Thalamic infarction belongs to posterior cerebral artery territory (posterior circulation). The superior part of the cerebellar hemisphere is a territory of the superior cerebellar artery (posterior circulation). 

Further workup for the case is recommended, including carotid Doppler, echocardiography, and coagulation profile.

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