Hemorrhagic MCA infarction

Discussion:

Large stroke at the territory of the right MCA reflecting bright FLAIR signal with a significant restriction on DWI and reduced ADC values denoting the ischemic nature of the lesion. Initial non-contrast T1 shows bright areas within the infarction denoting cortical petechial hemorrhages (not to be confused with hemorrhagic transformation). Post contrast T1 shows peripheral patchy enhancement, which is a common and expected finding due to excess perfusion. On MRA there is evident abrupt cut-off of the proximal M1 segment of the right MCA, there is also attenuation of A1 segments of both ACA which could be due to atherosclerosis or due to vascular spasm.

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