Presentation
Follow up CT 2 hours post right terminal ICA, M1 and A1 clot retrieval which was performed 4.5 hours after symptom onset. Initial external CT not available.
Patient Data
There is cytotoxic edema of the right cerebral hemisphere with loss of grey-white matter differentiation and mild effacement of the right lateral ventricle, in keeping with acute MCA and ACA ischemia, with sparing of the right PCA territory. The left ACA territory also shows loss of grey-white matter differentiation. No midline shift or uncal herniation. No hydrocephalus.
The right MCA and distal ICA is hyperdense suggesting re-thrombosis.
Hyperdensity within the medial right temporal lobe posterior to the hyperdense MCA.
Conclusion
Acute ischemia in the right cerebral hemisphere involving the right MCA and ACA and left ACA territories. Hyperdense right MCA suggesting re-thrombosis.
Small hyperdensity in the medial right temporal lobe which may represent a focus of hemorrhagic transformation or contrast staining from the prior angiogram.
Case Discussion
Re-thrombosis is a complication of clot retrival.
The patient died 2 days later.
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