Haemorhagic left middle cerebral artery territory infarction

Case contributed by Dr Heba Abdelmonem


Sudden onset of right hemiparesis followed by loss of consciousness.

Patient Data

Age: Adult
Gender: Male

Conventional MRI images show abnormal signal of the left temporal, left parietal lobe as well as left basal ganglia associated with a mass effect on the left Sylvian fissure, left lateral ventricle with few mm shifting of the midline structures. The typical MR signal of acute infarction is seen within almost all the infarcted area with low SI on T1 and high SI on FLAIR and T2 images also restricted diffusion on DWI. The conventional T1 images demonstrate abnormal high signal intensity within the basal ganglia region suspicious of hemorrhage, SWI shows the low signal of blood within the central part of the infarcted area. MRI findings suggest left middle cerebral artery infarction with ECASS parenchymal hematoma type 1.

Case Discussion

Hemorrhagic transformation of an infarction can be subdivided into:

  1. Hemorrhagic infarction type 1 (HI-1): small dots along the margin of the infarction.
  2. Hemorrhagic infarction type2 (HI-2): larger dots of hemorrhage.
  3. Parenchymal hematoma type 1 (PH-1): hematoma involves less than or equal to 30% of the infarcted area.
  4. Parenchymal hematoma type 2 (PH-2): hematoma of more than 30% of the infarcted area or any hemorrhage outside the infarcted area.


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Case information

rID: 52046
Published: 26th Mar 2017
Last edited: 27th Mar 2017
Inclusion in quiz mode: Included

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