Presentation
Rapid functional and cognitive decline.
Patient Data
Bilateral hypodense areas in the centrum semiovale with lacunar infarcts, bilateral insular infarcts, and bilateral punctate cerebellar infarcts. Small bilateral frontal and right parietal cortical infarcts and left frontal subcortical infarct.
An MRI scan performed 7 days after the CT:
Innumerable bilateral small infarcts in virtually all vascular territories, including cortical and subcortical infarcts in all cerebral lobes, as well as the cerebellum, cerebral peduncles, left thalamus, and prominent watershed infarcts. The infarcts are acute - hyperintense on T2-weighted sequences with restricted diffusion; several of them display cortical enhancement and are several days old 1.
Tiny, old pontine lacunar infarcts left of the midline.
Case Discussion
Since the infarcts are in both the anterior and posterior vascular territories, one can fairly assume that they originate from a central source, e.g. the heart or the aorta.
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