Haemorrhagic MCA infarction

Case contributed by Dr Mahmoud Yacout Alabd

Presentation

Acute left hemiplegia.

Patient Data

Age: 66-year-old
Gender: Female
CT

CT Brain

Large hypodense recent infarction involving the vascular territory of the right MCA.

MRI

MRI Brain (one day later)

A Large right parietal area reflecting bright FLAIR signal with a significant restriction on DWI and reduced ADC values denoting the ischemic nature of the lesion. Initial non-contrast T1 shows bright signal spots within the infarction denoting hemorrhagic transformation. Post contrast T1 shows patchy peripheral enhancement, which is a common finding due to excess perfusion. On MRA there is evident abrupt cut-off of the proximal M1 segment of the right MCA, there is also attenuation of A1 segments of both ACA.

Case Discussion

Large stroke at the territory of the right MCA reflecting bright FLAIR signal with a significant restriction on DWI and reduced ADC values denoting the ischemic nature of the lesion. Initial non-contrast T1 shows bright areas within the infarction denoting cortical petechial haemorrhages (not to be confused with haemorrhagic transformation). Post contrast T1 shows peripheral patchy enhancement, which is a common and expected finding due to excess perfusion. On MRA there is evident abrupt cut-off of the proximal M1 segment of the right MCA, there is also attenuation of A1 segments of both ACA which could be due to atherosclerosis or due to vascular spasm.

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Case information

rID: 40779
Case created: 3rd Nov 2015
Last edited: 19th Dec 2016
Inclusion in quiz mode: Included

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