Embolic shower

Case contributed by Dr Yair Glick

Presentation

Rapid functional and cognitive decline.

Patient Data

Age: 85 years
Gender: Male
CT

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.

MRI

Done 7 days later

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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Case information

rID: 67061
Published: 18th Mar 2019
Last edited: 19th Mar 2019
Inclusion in quiz mode: Included
Institution: Laniado Hospital

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