Wallerian degeneration post striatocapsular infarct

Case contributed by Dr Balint Botz


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

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