Presentation
Acute right-sided hemiplegia (< 48 hours) in hypertensive patient.
Patient Data
Large infarct in the distribution of the left middle cerebral territory of low signal on T1, high signal on T2 and FLAIR with restricted diffusion. A hemorrhagic component of the caudate head and lentiform nuleus is noted on the GE sequence. MRA shows occlusion of the left internal carotid artery (ICA) and middle cerebral artery (MCA).
Small vessel chronic ischemic changes are noted.
Small cavernoma of the right corona radiata (type II according to Zabramski classification of cerebral cavernomas).
Small extra-axial cystic lesion of the right parietal region of CSF signal on all sequences suggestive of an arachnoid cyst.
Case Discussion
MRI of an acute left middle cerebral artery (MCA) territory infarct with occlusion of the ICA and MCA.
The MCA territory is the most commonly affected in cerebral infarction, due to its size and the direct flow from the ICA into the MCA, providing the easiest path for thromboembolism.
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