Concluded Case

Acute infarction left MCA territory

New case 47yr ,F ,Known DM ,on med, presented with rt sided weakness of 13 hrs duration . Came after evaluation at local hospital.On exam BP 120 / 80 mmhg . Global dysphasia ,Rt sided flaccid weakness with gr 0 / 5 power DTRs Hypoactive with 0 plantar rt side.Spontaneously moving left side with intact DTRS. What abnormality in theft brain?

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Concluded answer
Thanks Curofy and all others. CT brain : Massive wedge shaped hypodensity noted in the left frontoparietotdmporal region with extension to left caudate nucleus and lentiform nucleus suggestive of ACUTE INFARCTION LEFT MCA TERRITORY. Ref to Neurosurgeon on the day of admission ,decompressive craniectomy done.Still in the hospital ,getting rehabilitation care including speech therapy
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It's a left MCA territory infarct. Start with medical management. As per NICE guidelines , intervention evidence review November 2018, following is the criteria for surgical intervention: Consider decompressive hemicraniectomy (which should be performed within 48 hours of symptom onset) for people with acute stroke who meet all of the following criteria: 1.clinical deficits that suggest infarction in the territory of the middle cerebral artery, with a score above 15 on the National Institutes of Health Stroke Scales (NIHSS) 2. decreased level of consciousness, with a score of 1 or more on item 1a of the NIHSS 3. signs on CT of an infarct of at least 50% of the middle cerebral artery territory: with or without additional infarction in the territory of the anterior or posterior cerebral artery on the same side, or 4. with infarct greater than 145cm3 , as shown on diffusion-weighted MRI scan.
more details needed for NIHSS score, but looking at the details provided, there is a strong evidence for decompressive craniectomy.
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I agree
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Malignant mca infarction.. right mca stem occlusion... pt may require decompressive craniotomy
Valuable opinion
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New case.
Thanks Curofy and all others. CT brain : Massive wedge shaped hypodensity noted in the left frontoparietotdmporal region with extension to left caudate nucleus and lentiform nucleus suggestive of ACUTE INFARCTION LEFT MCA TERRITORY. Ref to Neurosurgeon on the day of admission ,decompressive craniectomy done.Still in the hospital ,getting rehabilitation care including speech therapy
Mam please upload post op CT
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Large ischemic stroke in the Left MCA territory with extensive edema and mild MLS. Pt is out of the tPA window. Mechanical thrombectomy may be an option if thrombotic, stenting if related to stenosis. Continuing treatment will be monitoring for hemorrhaging conversation, rehab, and eventual anticoagulation if thrombotic.
Thank you doctor
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Left MCA infarct . options of thrombolysis is already gone .some areas of inferior division are still getting good blood supply.start ecospirin 75 mg od and watch for haemorrhagic transformation .no need of surgery yet
Thank you doctor
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Mca dense sign acute infarct in territory of left MCA with mass effect
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Acute Infarction in the Left MCA territory
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Looks like massive infarct
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