Massive encephalomalacia

Case contributed by Dr Nikola Todorovic


The patient complains of the mild dizziness and sensations of pulsations on the back of the head. He has a history of the massive stroke and craniotomy 4 years ago.

Patient Data

Age: 45
Gender: Male

Postoperative sequelae.

There is an almost complete destruction of the left hemisphere parenchyma with massive encephalomalacia which has a signal intensity of the CSF in all sequences and mild surrounding gliosis.

There is also an area in the pons, parasagittally on the left which follows signal intensity of the CSF and also represents a smaller area of the encephalomalacia.

The left lateral ventricle is enlarged, especially the body and the posterior horn. The fourth ventricle is also enlarged and more pronounced also the third ventricle.

There is an irregularly shaped area in the right cerebellar hemisphere with hyper signal intensity on T2 and FLAIR and hypo signal intensity on T1 which probably represents an old ischemic lesion.

Case Discussion

Follow-up examination for the patient with a history of a large stroke. Note, that the PCA territory is also involved suggesting the patient had a fetal origin of the PCA

Four years ago the patient had an ischemic stroke which complicated with haemorrhage and threatening subfalcine herniation and underwent urgent left craniotomy for decompression. He had a complete occlusion of the left ICA.

Afterwards, he underwent the rehabilitation but the right facial nerve palsy, right side spastic hemiparesis, and motoric aphasia persist.


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Case information

rID: 54001
Published: 18th Jun 2017
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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