Subfalcine herniation from complete MCA infarct with complicated ACA infarct

Case contributed by Dr Charlie Chia-Tsong Hsu

Presentation

Complete left sided hemiparesis.

Patient Data

Age: 71
Gender: Male

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. 

Case Discussion

ACA territory infarct can occur as a complication of MCA territory infarct - midline shift from vasogenic oedema results in stretching and eventual occlusion of the anterior cerebral artery. 

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Case Information

rID: 19973
Case created: 26th Oct 2012
Last edited: 19th Dec 2015
Inclusion in quiz mode: Included

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