Cortical laminar necrosis with persistent fetal PCOM
Disturbed conscious level in patient with previous strokes
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The MRI study reveals the following findings:
- T1 hyperintense/T2 intermediate signal seen around the margin of the right superior frontal sulcus denoting cortical laminar necrosis.
- Right frontal encephalomalacia surrounded by gliosis with exvacue dilatation of right lateral ventricle and ipsilateral wallerian degeneration.
- Acute infarction of the left superior frontal gyrus displaying diffusion restriction. No mass effect could be detected.
- Hypoplastic left PCA with large PCOM from the ICA.
- Atherosclerotic changes of the carotid and vertebrobasilar arteries with focal stenotic lesions at proximal right PCA and multiple stenotic segments at right MCA.
Atherosclerotic changes of the carotid arteries leads to recurrent strokes of old age on the right side with development of wallerian degeneration and cortical laminar necrosis and recent on the left side with involvement of the superior frontal gyrus. Fetal PCOM is a common variant of the posterior circulation.