Acute right middle cerebral territory stroke

Case contributed by Dr Bruno Di Muzio

Presentation

Patient with left motor deficits for about two hours.

Patient Data

Age: 80
Gender: Male

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

The detection of the extension of acute ischemic brain parenchyma with nonenhanced CT scanning was facilitated by soft-copy visual review at a PACS workstation by using variable, nonstandard window width and center level settings (here called as "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. Time-of-flight MR angiograms reveal flow gaps in the right proximal middle cerebral artery.
Cervical angiography also shows gaps caused by plaque.

Case Discussion

Typical appearances of a large MCA infarct. 

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Case information

rID: 15077
Case created: 22nd Sep 2011
Last edited: 1st Dec 2016
Inclusion in quiz mode: Included

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