Presentation
Aphasia since about 3 hours, NIHSS score 20
Patient Data
Both non-contrast and post-contrast scans show slight hypodensity of the left posterior temporal lobe with partial loss of grey-white matter differentiation, consistent with hyperacute infarction. On contrast scans there is occlusion of the M2 segment of the left MCA at the level of the posterior insula. There is no significant mass effect and only minimal gyral effacing. No hemorrhage and no signs of a brain tumor.
Case Discussion
In the clinical setting of a suspected acute brain infarct first-line imaging consists of a non-contrast CT in order to exclude hemorrhage, to preliminary assess size and location of the brain infarct, and to rule out stroke mimics (such as tumors).
In this case contrast scans also revealed a complete occlusion of the left MCA at the M2 segment.
Additional imaging in an acute setting could include perfusion CT scans to assess the extent of salvageable infarct area.
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