Ischemic infarction with hemorrhagic transformation

Case contributed by Yaïr Glick

Presentation

Stuporous, irresponsive, pupils unequal, systolic blood > 200 mmHg.

Patient Data

Age: 90 years

Extensive edema involving almost the entire right cerebral hemisphere (except for medial temporo-occipital parenchyma), with sulcal effacement and subfalcine herniation up to 20 mm that significantly narrows the right and third ventricles and causes dilatation of the occipital and temporal horns of the left ventricle. Intraparenchymal hematoma measuring 3.4 x 2.0 x 4.2 cm centered in the right basal ganglia - hemorrhagic transformation. Blood in third ventricle. Several stripes of right frontal subarachnoid hemorrhage (SAH), mostly parafalcine.
Hyperdense right MCA (M1-M2) (not just on background of edema but hyperdense to contralateral MCA), representing intraluminal thrombus.
Right calcified petroclival meningioma.
Coarse atheromatous calcification of cavernous carotids and right vertebral artery (V4).

Case Discussion

Classical case of ischemic intracranial infarction with hemorrhagic transformation.

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