Subacute brain infarct

Case contributed by Prashant Mudgal


Slurred speech and altered sensorium.

Patient Data

Age: 45 years
Gender: Female

Multiple well-defined areas which are hypointense on T1 (images not available) and hyperintense on T2, FLAIR and DWI are seen involving the right cerebral peduncle, splenium of corpus callosum, bilateral thalami and white matter of bilateral frontoparietal lobes.

There is mild intravascular and cortical enhancement following gadolinium injection.

Imaging features are suggestive of subacute infarct.

Case Discussion

Detection of different patterns of contrast enhancement can help in determining the age of infarct. There are two patterns of MR contrast enhancement in the acute phase of ischemic stroke-intravascular enhancement and cortical enhancement.

In a study of evolution of contrast enhancement pattern during first week of acute infarct, it is proven that Intravascular enhancement is detectable from day 1  and cortical enhancement starts from day 2 and intensity increases as with the age of infarct during the first week of onset of symptoms 1.

After the first few days, there is a well-known phase of parenchymal contrast enhancement caused by leakage of contrast material across the disrupted blood-brain barrier.

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