Hemorrhagic infarct with gyral enhancement

Case contributed by Naim Qaqish
Diagnosis certain

Presentation

Right sided neurological deficit.

Patient Data

Age: 60 years
Gender: Male

There is evidence of recent hemorrhagic infarct in the left parietal and occipital region showing cortical enhancement following IV contrast administration.

There is also evidence of a small fresh infarct in the same hemisphere in the parietal, occipital and temporal regions.

Both CP angles appear normal.

Neck MRA

mri

There is evidence of subtotal stenosis at the origin of the left internal carotid artery from the left common carotid artery. The stenosis is also involving the left external carotid artery.

The rest of the neck vessels including the vertebral arteries appear patent.

Case Discussion

This is a 60-year-old man, presenting through ER with a right-sided neurological deficit. Brain MRI was done showing typical appearances of recent infarction in the left parietal, temporal and occipital regions with some of them showing hemorrhagic transformation. Non-enhanced brain CT was not done, however, it is an important pitfall for cortical laminar necrosis to be mistaken for subarachnoid hemorrhage.

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