Presentation
Right hemiparesis
Patient Data
MRI images demonstrate typical features of a left middle cerebral artery territory infarction with small areas of hemorrhage, mass effect and contralateral midline shift. The abnormal signal involves the left temporal and left parietal lobes as well as the left basal ganglia. Multiple areas of hemorrhage are well seen on SWI, correspond to hemorrhagic infarction (ECASS type HI1).
A subtle abnormal signal of the right basal ganglia is seen on DWI and ADC map...finding that is consistent with right lateral lenticulostriate hyperacute infarction.
Another small right temporal cortical area of high signal on DWI and low signal on ADC map corresponding to hyperacute infarction.
Abnormal confluent sheets of a periventricular high signal with facilitated diffusion in keeping with small vessel ischemia.
The right tempro-parietal subdural hygroma is evident on DWI and ADC maps.
Case Discussion
Hemorrhagic transformation of infarcts (ECASS HI1) are characterized by small hemorrhage at the margin of the infarct, not exerting mass effect.
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