Presentation
Left-sided weakness, previous stroke, hypertension
Patient Data
Large T1-weighted imaging (T1WI) hypointense, T2-weighted imaging (T2WI) hyperintense, fluid-attenuated inversion recovery (FLAIR) central hypointense, and peripheral hyperintense areas with severe volume loss are seen in the right temporal, frontal, and parietal lobes and the lateral part of the capsulo-ganglionic region.
These areas show facilitated diffusion.
Ex vacuo dilatation of the right lateral ventricle is noted.
Mild atrophy with T2-weighted imaging (T2WI) and FLAIR hyperintensity are seen on the right side of the midbrain and pons (along the corticospinal tract).
Impression: chronic middle cerebral artery (MCA) infarct with encephalomalacia, gliosis, and Wallerian degeneration (stage 4).
Case Discussion
Wallerian degeneration is an active process of antegrade degeneration of distal end of axon and myelin sheath secondary to proximal axonal or cell body lesions. It may result from any kind of insult like infarction, haemorrhage, trauma, demyelination or haemorrhage. There are four stages of Wallerian degeneration and the last stage (stage 4) is characterised by atrophy of the white matter tracts.
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