Cortical laminar necrosis

Case contributed by Dr Bruno Di Muzio

Presentation

Previous history of multiple TIAs presenting with a right MCA syndrome. DSA showing a high-grade stenosis (70% NASCET) within the cervical internal carotid artery approximately 10mm above the carotid bifurcation.

Patient Data

Age: 85 years
Gender: Male

CT Brain (admission)

ct

No convincing CT features of acute territorial infarcts. Right parietal and occipital lobe likely small old infarcts noted. 

MRI Brain (one day later)

mri

There are small foci of restriction diffusion scattered in the right MCA vascular territory, predominantly within the right parietal lobe, where some cortical laminar necrosis are also present and characterized by intrinsic high T1 signal and corresponding susceptibility artefact. Small old infarcts are also demonstrated within this vascular territory. Chronic small vessel ischemic changes scattered through the supratentorial white matter. The ventricles and basal cisterns are unremarkable. Retrocerebellar arachnoid cyst noted. 

Case Discussion

MRI demonstrating recent punctate infarcts scattered within the right MCA vascular territory, including cortical laminar necrosis

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