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Acute cerebral Ischemia- infarction - case study


Middle cerebral artery infarction 
case study by Dr.Eman ragab
DeyeCOM sign = conjugate eye deviation

MCA dot sign = dense M2 within the sylvain fissure

Hyper dense MCA sign 





TERMINOLOGY
• Interrupted blood flow to brain resulting in cerebral ischemia/infarction with variable neurologic deficit

IMAGING
• Major artery (territorial) infarct
○ Generally wedge-shaped; both gray matter (GM), white matter (WM) involved

• Embolic infarcts
○ Often focal/small, at GM-WM interface

• NECT
○ Hyperdense vessel = clot ("dense MCA" sign)

○ Loss of GM-WM distinction in first 3 hours (50-70%)
– "Insular ribbon" sign: GM-WM interface lost
– "Disappearing basal ganglia" sign

○ Calcified embolus
– Don't miss this (high risk of recurrent stroke)

CTA
 Excellent for major vessel occlusions

• MR
○ Parenchymal ± intraarterial FLAIR hyperintensity
○ ↑ intensity on DWI with corresponding ↓ on ADC
○ ↓ CBF, CBV on perfusion MR


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