MCA infarct and hemicraniectomy

Case contributed by Prof Peter Mitchell

Presentation

NIHSS 18, headache, dysarthria, facial droop, left hemiparesis. Received iv tPA. Transferred for endovascular clot retrieval.

Patient Data

Age: 60 years
Modality: CT
Early stroke Right MCA
Modality: CT

ICA M1 occlusion. Note hyperdense artery and demarcated infarct.

Modality: CT
Decompressive craniectomy.
Modality: CT
ICA and M1 have recanalised, but large established MCA territory infarct with mass effect. Hemicraniectomy can be lifesaving, but mandates careful discussion with family and account of prior wishes of person regarding quality of life issues.

Case Discussion

Received IVtPA at regional centre and transferred for consideration of endovascular clot retrieval. On arrival 7 hours post onset, clinical deterioration, direct to CT where extensive established infarct (ASPECTS 3) as contraindication for ECR at late time period.
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Case Information

rID: 45388
Case created: 24th May 2016
Last edited: 22nd Mar 2017
Inclusion in quiz mode: Included

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