Old watershed infarct and incidental silent sinus syndrome

Case contributed by Bálint Botz
Diagnosis almost certain

Presentation

Right upper limb hemiplegia. IC bleeding/ischemia?

Patient Data

Age: 65 years
Gender: Male

Left parieto-occipital old watershed infarct in the MCA-PCA border territory, with smaller areas in the left basal ganglia and corona radiata showing status post prior infarcts. 

Global cortical atrophy predominantly affecting the parietal cortex. 

Status post left ICA stent implantation (partially visualized).

Incidental volume loss of the right maxillary sinus, which is filled with dense content. Resultant subtle right-sided enopthalmos. 

Also subtle edge of image anatomical variation: Currarino A anomaly (unfused posterior arch of the atlas). 

Case Discussion

Typical presentation of and old watershed area infarct and smaller MCA area old infarcts which were all stemming from an unstable left ICA plaque and stenosis (subsquently treated with endovascular stent implantation). 

The silent sinus syndrome and the atlas anomaly were incidental findings. 

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