CT Brain - CTA and Perfusion
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Ill-defined hypoattenuation within the posterosuperior aspect of the right frontal lobe involving the precentral gyrus and within the centrum semiovale most consistent with acute ischaemic change. Other regions of parenchymal hypoattenuation within the right cerebral hemisphere involving the anterior limb of the right internal capsule and posterosuperior cortex of the right parietal lobe have a more chronic appearance and may represent old ischaemic change.
No acute intra-axial or extra-axial haemorrhage. No intracranial mass or mass effect. Brainstem and cerebellum are unremarkable.
Acute thrombus with occlusion of the M1 segment of the right MCA. Normal contrast opacification of the ACAs, PCAs and left MCA. Normal circle of Willis anatomy. Normal contrast opacification of the common carotids, internal carotids, vertebral and basilar arteries.
Matched cerebral blood flow defect within the posterosuperior right frontal lobe and centrum semiovale suggestive of established infarct, increased T-max throughout the MCA territory consistent with surrounding penumbra. Evaluation of the deep white matter within the right cerebral hemisphere is difficult due to what appears to be regions of established chronic ischaemic change on non-contrast imaging. Calculated cerebral blood volume defect measuring 22.6 ML and perfusion defect measuring 63.9 ML, calculated mismatch ratio of 2.8. The anterior MCA distribution with increased T-max is not included in the automated calculation of the perfusion defect volume.
Impression: Acute thrombus with occlusion of the M1 segment of the right MCA with a perfusion defect consistent with a large region of penumbra within the MCA territory.
On the non-contrast CT brain there is an area of ill-defined hypoattenuation in the posterosuperior right frontal lobe and centrum semiovale consistent with acute ischaemia. Other regions of hypoattenuation within the right cerebral hemisphere have a more chronic appearance and may represent chronic ischaemic change.