Haemorrhagic transformation of left middle cerebral artery territory infarct

Case contributed by Mr Andrew Murphy

Presentation

Suspected haemorrhagic transformation after lysis and clot retrieval.

Patient Data

Age: 50 years
Gender: Male

Left MCA territory infarct with an involvement of the anterior/mid insular cortex and M1, M2 and M4 MCA cortical territories.

Haemorrhagic transformation with parenchymal haematoma in the left inferior frontal gyrus, 26 x 21 mm, without significant mass effect.Tiny petechial haemorrhages are also seen in the left middle frontal gyrus. The parenchymal haematomas appear unchanged on virtual noncontrast imaging and there is no evidence of attenuation on the iodine map - this is consistent with haemorrhage rather than contrast staining

Regional mass effect evident with sulcal effacement within the infarct zone. No midline shift or brain herniation.

Case Discussion

Iodine maps and virtual non-contrast imaging via dual energy CT is an effective method in differentiating hemorrhagic transformation from iodinated contrast staining following interventional procedures such as endovascular clot retrieval. 

Diagnostic report courtesy of Dr Charlie Hsu.

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Case information

rID: 55489
Case created: 9th Sep 2017
Last edited: 11th Sep 2017
Inclusion in quiz mode: Included
Institution: Princess Alexandra Hospital

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