Evolution of cerebral infarction: oedema to laminar necrosis and haemorrhagic transformation then to atrophy

Case contributed by Dr Chris O'Donnell


Presents with acute left hemiplegia. Progessive scans whilst in rehabilitation.

Patient Data

Age: 70
Gender: Male

Oedema in the distribution of the right middle cerebral artery.  This seems more a vasogenic pattern rather than the typical cytotoxic oedema involving both grey and white matter as usually seen in cerebral infarction.  This is in part explained by early cortical laminar necrosis (cortical ribbon hyperdensity due to proteinaceous material) as well as probable early petechial haemorrhage.

More substantial cortical laminar necrosis with ribbon-like hyperdensity along the entire affected cortex.  Note also more confluent hyperdensity posteriorly representing haemorrhagic transformation of the infarct (typically occuring 4 days to 4 weeks post infarct and associated with clinical deterioration including worsening of neurological deficit, headache and reduced consious state due to raised pressure).

Affected brain has become atrophic involving both grey and white matter with loss of the laminar necrosis pattern and negative mass effect.  Haemorrhagic area shows some residual hyperdensity

Case Discussion

The evolution of infarction from oedema to cortical laminar necrosis and haemorrhagic tarnsformation to atrophy are all well demonstrated in this case.

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Case information

rID: 32935
Published: 23rd Dec 2014
Last edited: 4th Oct 2015
Inclusion in quiz mode: Included

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