Left posterior cerebral artery territory infarct

Case contributed by Henry Knipe
Diagnosis certain

Presentation

GCS 8. Hypertensive.

Patient Data

Age: 67
Gender: Male

No evidence of established acute ischemia. No intracranial hemorrhage. 

Near total occlusion of the left vertebral artery at its origin with further occlusion, likely thrombo-embolus in the mid/upper V1 segment.

Abrupt truncation of the left P2/P3 segment. 

Acute diffusion restriction within the left thalamus, posteromedial temporal lobe and to a lesser extent in the anterior occipital lobe in keeping with acute infarct from previously demonstrated left P2/P3 segment occlusion. Further focus of restricted diffusion in the left corona radiata (Se 2 Im 24) in keeping with an acute infarct.

Case Discussion

CT brain can be essentially normal in acute ischemia, in retrospect there is a hyperdense left P2/P3 segment on the non-contrast CT, which correlates with the filling defect (i.e. thrombo-embolus) on the CTA COW. MRI DWI confirms the distribution for PCA territory stroke. 

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