Presentation
Wake-up stroke with aphasia, confusion, and right-sided hemiparesis.
Patient Data
mild subcortical white matter hypodensity in the territory of the left middle cerebral artery.
mild loss of grey-white differentiation
occlusion of the M2 segment of the left middle cerebral artery
restricted diffusion in the superficial territory of the left middle cerebral artery with mild FLAIR hyperintensities involving the same territory
occlusion of the middle cerebral artery at the level of the M1/M2 junction (loss of normal flow void and high signal on FLAIR, hypointense thrombus on gradient echo)
increased hypodensity in the superficial territory of the left middle cerebral artery
no hemorrhagic transformation
mild mass effect with minimal midline shift
Case Discussion
A case of wake-up stroke that turns out to be a late hyperacute ischemic stroke. There was no indication of mechanical thrombectomy or thrombolysis for this patient.