Wallerian degeneration post striatocapsular infarct

Case contributed by Dr Balint Botz

Presentation

Multiple prior left-sided ischemic stroke episodes, recently worsening memory, horizontal gaze disturbance. Organic cause?

Patient Data

Age: 50 years
Gender: Male
  • On the left side along the lateral ventricle an elongated about 8 cm long area of marked almost liquor-like T2/FLAIR hyperintensity is visible corresponding to a prior MCA striatocapsular area infarct (territory supplied by M1 perforator end arteries). The prior infarct is surrounded by confluous gliosis. 
  • Resultant ex vacuo dilation of the ipsilateral ventricular system and also marked atrophy of the left cerebral peduncle. 
  • In the anterior medulla an about 5 mm T2 hyperintense lesion can be discerned, possibly representing prior ischemic infarct.
  • On SWI images multiple, bilateral susceptibility artifacts are visible in the basal ganglia and thalami, and also adjacent to the frontal and temporal cortex, representing prior microinfarcts. 
  • Dolichoectatic basilar artery. 
  • Subtle signal inhomogenity of the visualized distal part of the left vertebral artery, CTA recommended for further evaluation. 

Case Discussion

The case demonstrates multiple late sequelae of a prior MCA area striatocapsular ischemic infarction

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

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

 Thank you for updating your details.