Presentation
Confusion and expressive aphasia with a sudden onset 1.5 hours ago.
Patient Data
No acute hemorrhage. No mass effect or herniation. Hypoattenuation in the left frontal lobe with the possible blurring of the grey-white differentiation but no definite acute loss. Hyperdense (calcific) vessel in the posterior left Sylvian fissure. No hydrocephalus or extra-axial fluid collections.
Two regions of perfusion abnormality:
left frontal lobe with a wedge-shaped region of decreased CBF with central low decreased CBV and corresponding increased MTT/Tmax
left fronto-parietal region, which is larger with again wedge-shaped region of decreased CBF and decreased CBV extending to the cortex and corresponding increased MTT/Tmax
Venous penetration of the CT angiogram.
Occlusion of left MCA M3 branches in the left frontal lobe and left frontoparietal region with subsequent perfusion anomalies best seen on the MIP reconstruction. Filling defect corresponding with the hyperdense vessel in the posterior left Sylvian fissure.
Dominant right vertebral artery with a very hypoplastic left vertebral artery.
Case Discussion
Acute left MCA territory stroke involving multiple regions in keeping with an embolic cause. Occluded M3 branches with tandem perfusion abnormalities consisting of infarct cores and surrounding ischemic penumbra and early non-contrast changes of acute ischemic stroke in the left frontal lobe.
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