Subacute cerebral infarction - with MR spectroscopy

Case contributed by Dr Ahmed Abd Rabou

Presentation

Sudden onset of dysarthia and disturbed conscious level 5 days ago

Patient Data

Age: 45 years old
Gender: Male

An ill defined cortical and subcortical lesion of altered signal is seen involving the left inferior frontal gyrus centered on pars triangularis (Broca's area). The lesion displays low T1, bright FLAIR signal intensity and mixed signal on DWI/ADC. On post contrast study the lesions shows gyral pattern of enhancement. There is no significant mass effect. MRS reveals mild reduction of NAA and marked elevation of lactate peaks. No significant rise of Cho peak.

Diagnosis: Subacute infarction of inferior frontal gyrus involving Broca's area at the territory of M3/M4 segments of left MCA

Case Discussion

Conventional MRI sequences suggest infarction, cerebritis versus low grade glioma. DWI and ADC are not conclusive because the scan was done on the subacute stage when re-perfusion masked diffusion restriction effect. MRS is more conclusive as there is mild reduction of NAA consistent with neuronal damage and marked elevation of lactate indicative of anerobic metabolism. The non rise of Cho peak excludes neoplastic activity.

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Case information

rID: 36865
Case created: 13th May 2015
Last edited: 28th Dec 2015
Inclusion in quiz mode: Included

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