Subacute hemorrhagic cerebral infarction

Case contributed by Mohammad A. ElBeialy


A diabetic and hypertensive patient with right-sided weakness and hemiparesis.

Patient Data

Age: 70 years
Gender: Female
  • 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 periventricular 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

Case Discussion

Left frontotemporal and deep parietal subacute hemorrhagic infarction, along the territorial supply of the left MCA.  Mild atrophic brain changes with mild periventricular arteriosclerotic leukoencephalopathy as well as bilateral cerebellar and thalamic old lacunar infarctions.

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