MCA infarct with perfusion

Case contributed by RMH Core Conditions

Presentation

Hemiplegia

Patient Data

Age: 67
Gender: Male
CT

NON-CONTRAST

No acute haemorrhage. Loss of grey-white differentiation at the caudate head and insula ribbon. Hyperdense left M1 segment. 

CTA COW

Filling defect in the left M1 segment in keeping with acute thrombus. 

CT

Perfusion

There is a large region of reduced CBV, CBF and time to peak perfusion affecting the whole left cerebral hemisphere. This is in keeping with a large left MCA infarct. A very small region of mismatch reduced time to peak perfusion is suggestive of only a tiny penumbra.

Conclusion

Findings are in keeping with a large left hemispheric infarct.

CT

Expected evolution of known left MCA territory infarct with left cerebral hemisphere loss of grey-weight differentiation with oedema and positive mass effect. Hyperdense left MCA again demonstrated. No haemorrhagic transformation. 

Case Discussion

This cases demonstrates acute changes with acute MCA territory infarct:

  • hyperdense MCA sign
  • loss of grey-white differentiation, seen earliest in the insular cortex and basal ganglia

Perfusion imaging is more commonly performed to calculate the presence and size of the ischemic penumbra (i.e. cerebral parenchyma at risk of infarction but not yet infarcted) through which various interventions (e.g. thrombolysis, clot retrieval, etc) can be considered for treatment with the aim of improved outcomes. 

PlayAdd to Share

Case information

rID: 28678
Case created: 7th Apr 2014
Last edited: 19th Dec 2015
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.