Presentation
Right-sided hemiparesis and slurring of speech.
Patient Data
T1WI hypointense, T2WI and FLAIR hyperintense areas with cortical swelling and expansion are seen in the left temporal and parietal lobes. Few parts of the lesion show facilitated diffusion; however, few parts show diffusion restriction. No significant mass effect is seen except mild compression over the left occipital horn. After contrast administration, gyriform and peripheral enhancement are noted. No blooming is seen.
Impression: Clinical and imaging findings are consistent with a subacute infarct.
Case Discussion
Gyriform enhancement is an abnormal pattern of enhancement that is confined to cortical gray matter and is seen in vascular and inflammatory causes. It is often observed in the reperfusion phase of the subacute stage of an infarct. Sometimes, distinguishing a subacute infarct from other infective or neoplastic conditions can be challenging. Gyral enhancement may be very helpful in those cases. Other conditions associated with gyriform enhancement include migraine, postictal conditions, infective, inflammatory, and neoplastic conditions.
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