Presentation
Confusion, headache and left visual neglect.
Patient Data
Reported as normal (albeit at 3am by night shift).
Subtle loss of grey-white matter differentation in the right occipital and temporal lobes corresponding to the PCA territory. No hemorrhage. On the fine reformats, a dense right PCA is present indicating acute thrombosis (see arrowed image).
2mm thickness reformat of the thins shows a dense right PCA.
There is an evolving low attenuating region within predominantly white matter involving the right medial temporal lobe with cortical extension into the right occipital lobe. This corresponds to the right PCA territory. There is associated effacement of adjacent cortical sulci. There is no midline shift. There is a subtle dense right P2 indicating arterial thrombus. The ventricles are of normal size. No hemorrhage.
Conclusion
Subacute right PCA stroke.
Case Discussion
Subtle signs of early cerebral infarction on the initial scan.
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