Hemorrhagic transformation of MCA infarct

Case contributed by Dr Yair Glick


Left-sided hemiparesis.

Patient Data

Age: 80 years
Gender: Male

Initial CT brain

Extensive acute fronto-temporo-parieto-occipital infarct in the right MCA territory with gyral effacement. Ipsilateral MCA dot sign (M2 thromboembolus).
Old lacunar infarct in left frontal corona radiata.
Small, old infarct in right cerebellar hemisphere.
Calcified plaque in cavernous segment of ICA bilaterally.


CT brain 9 days later

Subacute right MCA territory infarct with severe surrounding edema exerting mass effect on the right ventricle and subfalcine herniation.
Gyriform hyperdensity in the infarct territory represents petechial hemorrhagic infarction and fogging. 


CT 10 days later

Numerous linear and punctate foci of hemorrhagic transformation.

Case Discussion

This case exemplifies, in the same patient, the appearance of

  • acute MCA territory infarct with MCA dot sign
  • subacute MCA infarct with laminar necrosis
  • eventual hemorrhagic transformation thereof
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Case information

rID: 55787
Published: 26th Sep 2017
Last edited: 5th Oct 2020
Inclusion in quiz mode: Included
Institution: Hillel Yaffe Medical Center

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