Presentation
The disease progressed over 3 days, presenting with insomnia, gait disturbances, difficulty in interaction, and advancing to left-sided hemiplegia.
Patient Data
Scattered cerebral infarctions in the right hemisphere, predominantly in the temporal region, are observed in the subacute phase. These appear as high signals on DWI with corresponding low signals on ADC (indicating diffusion restriction), scattered low signals on SWI with corresponding high signals on Phase (suggesting hemorrhage), and heterogeneous enhancement in the affected brain regions after contrast administration.
On MRA, proximal stenosis of the M1 segment of the right middle cerebral artery is noted.
On vessel wall MRI (VM-MRI), eccentric wall thickening of the proximal M1 segment of the right middle cerebral artery is noted, with strong post-contrast enhancement, causing moderate luminal stenosis.
Differential diagnoses include atherosclerotic plaque and vasculitis.
Some distinguishing features between ICAD and vasculitis are listed in the diagram.
On vessel wall MRI, the main distinguishing features include:
intracranial atherosclerotic disease (ICAD): eccentric wall thickening, often with heterogeneous enhancement
vasculitis: concentric wall thickening with homogeneous enhancement
Diagram created by Lam Van Le
Case Discussion
The imaging and clinical findings are consistent with subacute cerebral infarction due to MCA stenosis, possibly caused by ICAD.
Case co-author: Consultant specialist Tran Quyet Thang, Military Hospital 175, Vietnam.
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