Right MCA Infarction (teaching)

Case contributed by UoE Radiology

Presentation

Left sided weakness (hemiparesis)

Patient Data

Age: 80
Gender: Male

Admission CT

ct

Hyperdense right MCA.

There is subtle loss of gray-white mater interface in the right basal ganglia (blurred basal ganglia sign). Also, insular ribbon sign is seen. 

No evidence of hemorrhage.

Calcification at both internal carotid arteries at the bottom of the scan.

Follow up CT (three days later)

ct

Extensive ischemic changes in the right MCA distribution with general hypodensity and loss of grey-white matter differentiation. Also evidence of infarct in the left MCA territory.

Case Discussion

This case shows the acute and sub-acute signs of infarction.

The symptoms described (contralateral hemiparesis) are typical for MCA strokes but can be mimicked by other diagnoses, so a good and timely clinical history, examination and imaging are important.  Other symptoms that can occur with MCA strokes include:

  • contralateral hemisensory loss
  • hemianopia
  • aphasia: if dominant hemisphere
    • expressive in anterior MCA territory infarction (Broca's area),
    • receptive in posterior MCA stroke (Wernicke's area),
    • or global with extensive infarction
  • neglect: non-dominant hemisphere

 

Thanks to Dr Sajoscha Sorrentino for contibuting this case.  The original is available here.

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