Presentation
Known hypertensive patient presents with dizziness, weakness and vomiting. Has a history of previous hemorrhagic stroke.
Patient Data
There is an extensive T2/FLAIR hyperintensity involving the inferior aspect of the left cerebellar hemisphere, the cerebellar tonsils and the inferior cerebellar vermis. Subtle hypodensity is observed on T1 and there is restricted diffusion on DWI/ADC. No evidence of blooming is seen on GRE to suggest hemorrhagic transformation. There is mass effect in the form of subtle rightward midline shift with obliteration of the 4th ventricle.
There are patchy areas of T2 and FLAIR hyperintensity scattered in the subcortical, deep and periventricular white matter of both cerebral hemispheres consistent with leucoaraiosis.
The signal void area in the right thalamus on all sequences which showed blooming artifact on GRE represents the site of previous hemorrhagic stroke.
Features are those of acute left cerebellar infarction - posterior inferior cerebellar artery (PICA) territory.
Case Discussion
MRI features of acute ischemic stroke are classically depicted in this patient.
Low signal intensity on ADC and hyperintensity on DWI indicating restricted diffusion, high signal on T2/FLAIR and hypointense signal on T1W sequences are findings pointing to acute ischemic stroke.
Accurate timing of ischemic stroke is important in order to identify those patients who will benefit from thrombolytic and neuro-interventional therapies.
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