Left middle cerebral artery territory infarct

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

Right hemiplegia.

Patient Data

Age: 75 years
Gender: Male

Post intravenous thrombolysis in the mobile stroke unit. Occluded left carotid T and M1 artery with an established small infarction and large ischemic penumbra.

 Angiography shows a supraclinoid ICA occlusion.

A triaxial system (Neuron Max, Sofia 6+ and Velocity microcatheter) was used. Two passes using a 4 mm x 25 mm Trevo device (plug and pull) produced good revascularization. No angiographic complications.

CT 24 hours later

ct

Subtle loss of grey-white matter differentiation at the insular cortex is compatible with established infarct.  Mild left convexity sulcal effacement suggestive of cerebral edema.  No evidence of hemorrhagic transformation. No acute intracranial hemorrhage is seen elsewhere.  

MRI 48 hours later

mri

A moderate to large left MCA territory infarct including the left head of caudate nucleus and left lentiform nucleus.  No additional territorial infarct.

Case Discussion

Despite early intravenous thrombolysis and endovascular clot retrieval, a substantial MCA infarct is present, predicted by perfusion core. 

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