Hemorrhagic transformation of left middle cerebral artery territory infarct
Presentation
Suspected hemorrhagic transformation after lysis and clot retrieval.
Patient Data
Left MCA territory infarct with an involvement of the anterior/mid insular cortex and M1, M2 and M4 MCA cortical territories.
Hemorrhagic transformation with parenchymal hematoma in the left inferior frontal gyrus, 26 x 21 mm, without significant mass effect.Tiny petechial hemorrhages are also seen in the left middle frontal gyrus. The parenchymal hematomas appear unchanged on virtual noncontrast imaging and there is no evidence of attenuation on the iodine map - this is consistent with hemorrhage 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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