Acute right MCA infarct, meningioma and retinal detachment

Case contributed by Dr Craig Hacking

Presentation

Acute left hemiplegia. AF, INR 3.9. ? haemorrhage.

Patient Data

Age: 84
Gender: Female

CT brain

Right frontal lobe encephalomalacia with confluent white matter hypoattenuation involving the right frontal and right parietal lobe unchanged from the prior study 6 moths earlier consistent with an old right MCA infarct.

Hyperdense right MCA consistent with acute thrombus.

Hyperattenuating extra axial mass arising from the right sphenoid ridge measuring 2.5cm. Atrophic changes with prominence of the cortical sulci and ventricular system. Brainstem and cerebellum are within normal limits. No acute intraparenchymal haemorrhage.

Unchanged hypoattenuation within the right lobe most consistent with retinal detachment with haemorrhage.

CTA

Calcification of the aortic arch. Origin of the innominate artery is not identified. The common carotids, internal carotids, vertebral and basilar arteries are patent. Calcified atheroma of the right and left carotid bulb with no haemodynamically significant stenosis. Tortuosity of the right internal carotid artery.

Bilateral carotid siphon calcification. Normal circle of Willis anatomy. Occlusive thrombus within the proximal right MCA (M1). Normal contrast opacification of the anterior cerebral, posterior cerebral and left middle cerebral arteries.

CT perfusion

Perfusion imaging is confounded by the presence of the previous right MCA infarct. Reduced CBF within the right frontal lobe consistent with a region of established chronic infarct present on the non-contrast CT. MTT and Tmax are increased within the entire right MCA territory consistent with proximal occlusive thrombus, although the volume of the acute perfusion deficit is difficult to establish given the prior right MCA infarct.

Conclusion

  • Occlusive thrombus of the proximal right MCA.
  • Old established right MCA infarct unchanged from previous CT 6 months earlier.
  • Right-sided meningioma centred in the right sphenoid ridge.
  • Right retinal detachment.

Case Discussion

The right M1 thrombus was removed with endovascular clot retrieval 4 hours post onset of hemiplegia.

Incidental retinal haemorrhage was secondary to the anticoagulation.

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Case information

rID: 42428
Case created: 20th Jan 2016
Last edited: 12th Jan 2017
Inclusion in quiz mode: Included

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