Proximal right MCA M1 segment embolic occlusion

Case contributed by Dr Tim Phillips

Presentation

Acute left-sided weakness of the face and upper limb greater than lower limb, sensory inattention, dysarthria. NIHSS 14. Onset 90 minutes earlier.

Patient Data

Age: 80 years
Gender: Female
CT

Non contrast CT 90 minutes post onset

Hyperattentuation of the right MCA M1 segment just distal to its origin from the ICA.

Hypoattenuation of the ipsilateral insular cortex.

Subtle hypoattenuation of the ipsilateral lentiform nucleus.

Background chronic appearing cerebral involution and white matter hypoattenuation.

ASPECTS = 8.

CT

CT Angiogram

Complete occlusion of the right MCA M1 segment just distal to the ICA bifurcation.

DSA (angiography)

Cerebral DSA and mechanical thrombectomy

Baseline DSA demonstrating complete occlusion of the proximal right MCA M1 segment.

DSA with stent-retriever in situ (Stryker TREVO XP 6 x 25 mm) highlighting the clot.

DSA post retrieval demonstrating re-perfusion.

modified TICI 2C

CT

CT brain 24 hours later

The previously demonstrated MCA M1 thrombus has been removed. Expected maturation of previously demonstrated right insular cortex and lentiform nucleus infarction. No new infarction demonstrated. No haemorrhage.

Case Discussion

Good demonstration of hyper-acute non-contrast CT findings in MCA embolic stroke.
DSA images demonstrating the MCA M1 clot and its removal with mechanical thrombectomy.

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Case information

rID: 56974
Case created: 1st Dec 2017
Last edited: 2nd Dec 2017
Inclusion in quiz mode: Included
Institution: NIISwa

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