Malignant MCA infarction

Case contributed by Dr Stefanos Generalis


Acute right motor deficit and aphasia.

Patient Data

Age: 85 years
Gender: Female

Non-contrast CT and CTA - 1:30 h from event.

Hyperdense left middle cerebral artery sign, without other signs of parenchimal damage.

CTA shows no contrast filling in MCA territory.

Findings are consitent of left MCA infarct.

DSA (angiography)

Angiography after IV thrombolysis

IV thrombolysis was instituted with Alteplase after 2 hours of the event and patient was refered to mechanical thrombolytic therapy.

DSA images took 4:30 hour from ictus shows M1/M2 thrombus with only an anterior temporal branch filling.

Procedure was unsuccessful due to bovine arch and impossible selective cathetherization of the internal carotid artery.


Next day non-contrast CT

Next day CT demonstrates MCA territory infarct, with large edema and hemorrhagic transformation.

Case Discussion

This is a classic case of proximal MCA thrombus leading to malignant cerebral infarction (a term used to refer to an extensive/complete MCA territory infarction accompanied by space-occupying mass effect, usually leading to a poor outcome).

Unfortunately, the patient died 4 days after the event.

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Case information

rID: 46049
Published: 21st Jun 2016
Last edited: 20th Oct 2019
Inclusion in quiz mode: Included