Bilateral PCA territory infarction - different ages

Case contributed by Dr Ian Bickle

Presentation

Diabetic. Pre-existing visual difficulties. Acute derioriation.

Patient Data

Age: 60
Gender: Female

Diffuse low attenuation in the right occipital lobe in the PCA territory. No hemorrhagic conversion.

Gliotic changes in the left occipital lobe in the (L) PCA territory.

Bilateral basal ganglia and dentate nucleus calcification.

High T2 signal with gliotic change in the left occipital lobe without diffusion restriction.

High T2 signal with avid diffusion restriction in the right occipital lobe.

Extensive periventricular deep white matter high T2 foci.

Case Discussion

An unfortunate patient with a common pathology illustrated a key principle.

Bilateral occipital lobe infarcts (PCA territory) is unusual.

The different between an acute and an established infarct is well illustrated from the symmetry of this bilateral pathology of variable age.

The established infarct is of lower attenuation with the subsequent gliosis virtually the same density as CSF as opposed to the acute stroke with oedematous brain being less dense.

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Case Information

rID: 46200
Case created: 27th Jun 2016
Last edited: 6th Aug 2016
Inclusion in quiz mode: Included

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