Subtle left middle cerebral artery territory infarct with CT perfusion

Case contributed by Dr Craig Hacking


Acute right hemiparesis. AF.

Patient Data

Age: 75 years
Gender: Female

No intra- or extra-axial collection or hemorrhage demonstrated. There is subtle loss of grey-white differentiation within the left insula cortex. The left MCA is hyperdense. Ventricular size, sulcal pattern and basal cisterns all appear normal. No bony abnormality demonstrated.

Elevated MTT and TMax within the left MCA territory with normal to mildly reduced CBV and CBF in keeping with a small core and large ischemic penumbra.

There is an abrupt occlusive filling defect within the proximal left M2 superior segment in keeping with thrombus.

Four vessel aortic arch anatomy. Common carotid and internal carotid arteries are patent with no dissection. Vertebral arteries are patent with no dissection. Left vertebral artery does not pass through the C6 transverse foramen. Fetal origin to left PCA. No aneurysms identified.


Occlusive thrombus within the proximal left M2 segment with subtle loss of grey-white differentiation. Perfusion imaging demonstrates large ischemic penumbra within the left MCA territory.

Case Discussion

Subtle signs on the non contrast study. Large penumbra with little infarct core on the perfusion. CTA confirmed a thrombus in a left M2 branch.

20 minutes later a thrombus was retrieved angiographically. The patient recovered well.

PlayAdd to Share

Case information

rID: 37826
Published: 24th Jun 2015
Last edited: 27th Sep 2017
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.