Haemorrhagic transformation of MCA infarct

Case contributed by A.Prof Frank Gaillard


Left hemiplegia.

Patient Data

Age: 60 years
Gender: Male

Dense right MCA M2 segment thromboembolic material is accompanied by abrupt cut-off on the CTA, with comparatively mildly reduced MCA branch filling evident distally. The remainder of the intra-cranial circulation lies within normal limits, as do the aortic arch origins, cervical carotid and vertebral arteries, with no significant atheroma, stenosis or dissection demonstrated. Subtle hypodense blurring in the right insular region is compatible with early subacute infarction, with preserved grey-white differentiation elsewhere.

Unfortunately, there is now haemorrhagic transformation of the acute right MCA territory infarct, with large hyperdense central right cerebral haematoma measuring approx 7.2 x 4.8 x 3.0 cm (52 mL). This is associated with right cerebral sulcal/lateral ventricular effacement, up to 5 mm leftward midline shift, moderate IVH and mild/early hydrocephalus. Right MCA M2 segment and branches remain very hyperdense.

Case Discussion

This patient had been treated wtih tPA thrombolysis. They unfortunately succombed to the ICH.

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Case information

rID: 23522
Published: 20th Jun 2013
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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