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Case - Subacute Stroke Evaluation (Case 1)

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These are images of a patient who came in with

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some mental status changes and

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intermittent speech changes.

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And you can see this lesion characterized by

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partially restricted diffusion.

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DWI, bright.

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ADC, dark.

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Part of it's sort of isointense on ADC images.

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When you're comparing it with the FLAIR

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abnormality and the sort of wedge

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shape defect on FLAIR,

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that's a little bit bigger than the DWI and ADC

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because, as you can see,

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some parts of this are already

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pseudo normalized in ADC.

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So, it kind of looks like a subacute infarct.

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But let's keep inspecting more

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because it could be some funny tumor.

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And you can see these little

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areas of petechial hemorrhage,

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which would be hemorrhagic infarction 1,

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according to ECA.

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In the area of the restrictive diffusion,

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we also gave contrast,

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and you can see on this contrast

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enhanced scan in that region,

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there's gyroform enhancement throughout that region,

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and we can follow that all the way up.

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We can also look at that in another plane.

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And again,

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you can see the enhancements gyroform,

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which is very classic of both arterial

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and venous infarction.

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This is in an MCA distribution.

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So, we're kind of thinking that this is

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a subacute infarction with swelling,

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gyroform enhancement and petechial hemorrhage.

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And then, we'll take a look at the MRA.

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And you can see on the MRA,

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there's stenosis near the MCA bifurcation.

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There's relatively poor flow related

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enhancement in the MCA territory.

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So, even though patient presented

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in the subacute period,

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it's matching perfectly all the findings

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with a subacute stroke.

Report

Faculty

Pamela W Schaefer, MD, FACR

Professor of Radiology, Vice Chair of Education

Massachusetts General Hospital

Tags

Vascular Imaging

Neuroradiology

Neuro

MRI

MRA

Head and Neck

Brain

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