Evolving right middle cerebral artery territory infarct

Case contributed by A.Prof Frank Gaillard

Presentation

Falls 2 days. Weak left side.

Patient Data

Age: 85 years
Gender: Male

CT Brain

Modality: CT

Cytotoxic  oedema of  the right  insular  cortex and  right inferior frontal gyrus, most in keeping with  acute right MCA territory infarct, particularly with right anterior middle frontal gyrus encephalomalacia consistent with an old MCA infarct.   Diffuse deep white  matter chronic small vessel ischaemic changes.  No intracranial haemorrhage.   Ventricles and sulci are prominent, in keeping with age related volume loss.  

Left frontotemporal  scalp superficial  swelling.   No calvarial  or base of skull fracture.   Osteopenia.   Minor mucoperiosteal  thickening in the left maxillary sinus.

Encephalomalacia of the right frontal lobe in the territory of the right middle cerebral artery is noted. This involves the pre and post central gyrus. There is marked periventricular, deep and subcortical white matter hypodensity, likely due with the chronic small vessel disease. It is difficult to exclude acute subcortical infarction within this setting. 

Case Discussion

These two scans demonstrate the typical evolution of a subacute infarct into established encephalomalacia, in a patient with extensive small vessel ischaemic change. 

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Case Information

rID: 22238
Case created: 22nd Mar 2013
Last edited: 19th Nov 2015
Inclusion in quiz mode: Included

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