Subfalcine herniation from complete MCA infarct, complicated by ACA infarct

Case contributed by Charlie Chia-Tsong Hsu , 26 Oct 2012
Diagnosis almost certain
Changed by Henry Knipe, 23 Aug 2015

Updates to Case Attributes

Race changed from Caucasian to .
Presentation was changed:
71 year old male with completeComplete left sided hemiparesis.
Body was changed:

Complete right ACA territory infarct can occur as a complication of MCA territory infarct with pronounced - midline shift (subfalcine herniation). The right thalamus is displaced to the left of midline (not shown). Ipsilateral distal ACA is likely to be complicated by the subfalcine herniation with infraction from vasogenic oedema results in stretching and eventual occlusion of the right superior frontal gyrusanterior cerebral artery

The right lateral ventricle is effaced by the mass effect with a "trapped" left lateral ventricle. Periventricular hypodensities at the trigone region of the left lateral ventricle may represent transepenedymal migration of CSF.

Apparent hyperdensities along the region of Sylvian fissure, cortical sulci and M1 segment of MCA may reflect increase cerebral pressure the so called "pseudosubarachnoid sign". Alternatively the hyperdense M1 may represent insitu thrombus. 

  • -<p>Complete right MCA territory infarct with pronounced midline shift (subfalcine herniation). The right thalamus is displaced to the left of midline (not shown). Ipsilateral distal ACA is likely to be complicated by the subfalcine herniation with infraction of the right superior frontal gyrus. </p><p>The right lateral ventricle is effaced by the mass effect with a "trapped" left lateral ventricle. Periventricular hypodensities at the trigone region of the left lateral ventricle may represent transepenedymal migration of CSF.</p><p>Apparent hyperdensities along the region of Sylvian fissure, cortical sulci and M1 segment of MCA may reflect increase cerebral pressure the so called "pseudosubarachnoid sign". Alternatively the hyperdense M1 may represent insitu thrombus. </p>
  • +<p><a title="anterior cerebral artery territory infarct" href="/articles/anterior-cerebral-artery-territory-infarct">ACA territory infarct</a> can occur as a complication of <a title="MCA territory infarcts" href="/articles/middle-cerebral-artery-infarction">MCA territory infarct</a> - <a title="Midline shift" href="/articles/midline-shift">midline shift</a> from vasogenic oedema results in stretching and eventual occlusion of the anterior cerebral artery. </p>

Updates to Study Attributes

Modality was set to CT.
Findings was added:

Complete right MCA territory infarct with pronounced midline shift (subfalcine herniation). The right thalamus is displaced to the left of midline (not shown). Ipsilateral distal ACA is likely to be complicated by the subfalcine herniation with infraction of the right superior frontal gyrus. 

The right lateral ventricle is effaced by the mass effect with a "trapped" left lateral ventricle. Periventricular hypodensities at the trigone region of the left lateral ventricle may represent transepenedymal migration of CSF.

Apparent hyperdensities along the region of Sylvian fissure, cortical sulci and M1 segment of MCA may reflect increase cerebral pressure the so called "pseudosubarachnoid sign". Alternatively the hyperdense M1 may represent insitu thrombus. 

Images Changes:

Image CT (non-contrast) ( update )

Single Or Stack Root was set to .
Perspective was set to Coronal.
Specifics was set to non-contrast.

Image CT (non-contrast) ( update )

Single Or Stack Root was set to .
Perspective was set to Axial.
Specifics was set to non-contrast.

Image CT (non-contrast) ( update )

Single Or Stack Root was set to .
Perspective was set to Axial.
Specifics was set to non-contrast.

Image CT (non-contrast) ( update )

Single Or Stack Root was set to .
Perspective was set to Axial.
Specifics was set to non-contrast.

Image CT (non-contrast) ( update )

Single Or Stack Root was set to .
Perspective was set to Coronal.
Specifics was set to non-contrast.

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