Subacute hemorrhagic cerebral infarction

Case contributed by Dr Mohammad A. ElBeialy


72 years old diabetic and hypertensive patient with right-sided weakness and hemiparesis.

Patient Data

Age: 70
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 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.

Case Discussion

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.

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Case information

rID: 23557
Published: 23rd Jun 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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