Subacute hemorrhagic cerebral infarction
72 years old diabetic and hypertensive patient with right-sided weakness and hemiparesis.
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- left fronto-temporal and deep parietal cortical and subcortical patchy area of restricted diffusion with heterogeneously hyperintense DWI and low ADC signal, it shows predominantly hypointense T1 and hyperintense T2 / FLAIR signal intensity with foci of T1 hyperintensity (met Hb signal). The lesion shows some effacement of the related cortical sulci, related to cytotoxic edema.
- small bilateral cerebellar and thalamic foci of encephalomalacia with low T1 and high T2 signal.
- slight dilatation of the ventricular system with patchy peri-ventricular and T2 and FLAIR hypointensity.
MR angiography of the brain shows
- diffuse atherosclerotic changes of the cerebral arteries.
- focal tight stenosis of the M2 segments of the left MCA with relative reduction of its distal arborization.
- markedly attenuated distal left vertebral artery with occlusion its distal most segment as well as multifocal stenosis of the distal right vertebral artery and proximal basilar artery.
- focal tight stenosis of the distal basilar artery is noted as well.
- no aneurysmal dilatation or AV malformation.
Left fronto-temporal and deep parietal subacute hemorrhagic infarction, along the territorial supply of the left MCA. Mild atrophic brain changes with mild peri-ventricular arteriosclerotic leukoencephalopathy as well as bilateral cerebellar and thalamic old lacunar infarctions.