Acute MCA vascular territory stroke

Case contributed by Dr Bruno Di Muzio

Presentation

Left motor deficits for about two hours.

Patient Data

Age: 80 years
Gender: Male
CT

CT Brain

Acute ischaemia of the right lenticulostriate territory results in obscuration of the lentiform nucleus ("blurred basal ganglia"), which appears hypoattenuated because of cytotoxic oedema. Dense MCA sign as a result of thrombus or embolus.

The detection of the extension of acute ischaemic brain parenchyma with non-enhanced CT scanning was facilitated by soft-copy visual review at a PACS workstation by using variable, non-standard window width and centre level settings (a so-called "stroke window", the second series) 2.

The patient underwent intravenous thrombolysis, without success. 

MRI

MRI Brain + MRA

Extensive involvement of the territory of the right MCA characterised on T2*, FLAIR and DWI/ADC. Time-of-flight MR angiograms reveal flow cut-off at the right proximal middle cerebral artery.

Case Discussion

Typical appearances of a proximal right MCA occlusion and extensive brain infarct within its vascular territory. 

This case is a good example on how CT windowing can improve the assessment of brain infarcts. 

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Case information

rID: 15077
Published: 22nd Sep 2011
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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