Occluded left internal carotid artery with cerebral acute infarction (mainly along the vascular territory of the MCA)

Case contributed by Amr Farouk


62 years old patient presented with loss of consciousnesses.

Patient Data

Gender: Female
  •  A large ill-defined hypodense area is seen in the left frontoparietal region, cortical and subcortical in location exerting a mild mass effect in the form of the effacement of the overlying cortical sulci.
  • Mild dilatation of the cerebral ventricles with no midline shift or deformity.
  • Prominent cortical sulci and extra axial CSF spaces.
  • Large temporoparietal, and to less extent frontal cortical and subcortical areas of high signal on T2 & FLAIR WIs with restricted diffusion is seen exerting a mass effect in the form of the effacement of the cortical sulci & mild compression of the left lateral ventricle. A similar signal is seen involving the left caudate & lentiform nuclei.
  • No intracerebral or extra-axial hematoma.
  • Normal appearance of the brain stem and cerebellum.
  • Non-visualization of the intracranial portion of the left internal carotid artery & left middle cerebral artery M2 & M3 segments on MRA images with loss of their normal signal void pattern on conventional MR images.

Case Discussion

The middle cerebral artery is the largest branch of the internal carotid. The artery supplies a portion of the frontal lobe and the lateral surface of the temporal and parietal lobes, including the primary motor and sensory areas of the face, throat, hand and arm, and in the dominant hemisphere, the areas for speech. In addition, they supply part of the internal capsule and basal ganglia.

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