MCA infarction

Case contributed by A.Prof Frank Gaillard

Presentation

Left hemiplegia

Patient Data

Age: 50 years
Gender: Male
CT

CT brain Day 0

The right middle cerebral artery is hyperdense and there is subtle blurring and swelling of the cortex in the MCA territory. 

CTA demonstrates occlusion of the M1 segment on the right. 

MRI

MRI Brain Day 1

MRI demonstrates infarction of the inferior division of the MCA territory on the right as well as the right ACA territory. The basal ganglia are also infarcted due to occlusion of the lenticulostriate perforators. 

CT

CT Brain Day 3

The regions seen to demonstrate restricted diffusion on DWI have become well demarcated and hypodense. Significant mass effect is now present with midline shift and obstruction of outflow of the left lateral ventricle. There is petichial haemorrhagic transformation involving the right lentiform nucleus. 

CT

CT Brain Day 5

A decompressive craniectomy has been performed with some improvement in the degree of midline shift. An extradural collection is present. 

CT

CT Brain Day 10

Swelling is abating and parts of the infarcted tissue have almost returned to normal density - so called fogging phenomenon

CT

CT Brain Day 21

Negative mass effect is now present with concavity of the decompressive craniectomy site.

Case Discussion

This case demonstrates typical progression of a very large infarct treated with decompressive craniectomy, often a life saving maneuverer. 

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Case information

rID: 23523
Case created: 20th Jun 2013
Last edited: 1st Nov 2015
Inclusion in quiz mode: Included

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