Concluded Case

Bilateral MCA hemorrhagic infarctions

51 yr,M , presented with acute onset of rt sided weakness with difficulty to communicate on 28 th august at 16:30 hrs ,while walking up from afternoon nap.Denied having any headache / vomiting / vertigo. Immediately taken to local hospital admitted and MRI brain was done and thrombolized with tenectaplase, then developed worsoning of symptoms in the form of deterioration in the level of concious and hence intubated and mechanically ventilated and then trasferred for further management. Known DM,type2 on insulin for 10yrs,hypertensive on med for 5 yrs. On exam BP 140/ 70 mmhg ,on ventilator, pupils 2mm,DTRs hypoactive,medically paralysed.Plantars 0 bilaterally.. During the hospital stay he received antiplatelets,statin ,DVT prophylaxis,continued insulin and antihypertensive,rehabilitation care. Tracheostomy done,well stabilised and transferred back to nearby hospital at his residence as per the request of relatives. What abnormalityin the MRI brain?.

LikeAnswersShare
Concluded answer

Thanks for all answeres. Discussion - What abnormality in the MRI ? T2/ FLAIR hyperintensity with gyral swelling swelling noted in the left fronto- temporo- parietal cortex,subcortical white matter,corona radiate,caudate nucleus,internal capsule with diffusion restriction.Ateas if blooming noted inthe lentiform nucleus which appears hyperintenseh T1WI. T2/ FLAIR hyperintensity with diffusion restriction and irregular areas of blooming noted in the Rt temporo- parietal lobe .Gyral swelling with effacement of the adjacent sulcal space. Linear blooming areas also noted MRA - No flow related enhancement noted beyond the M1 segment of Lt MCA with abrupt cut off of the vessel. Imp : Acute left MCA infarct with hemorrhagic teansformation. Acute infart Rt MCA branch with hemorrhagic transformation. * Occlusion of M1 segment of LT MC A

All Answers

Thanks for all answeres. Discussion - What abnormality in the MRI ? T2/ FLAIR hyperintensity with gyral swelling swelling noted in the left fronto- temporo- parietal cortex,subcortical white matter,corona radiate,caudate nucleus,internal capsule with diffusion restriction.Ateas if blooming noted inthe lentiform nucleus which appears hyperintenseh T1WI. T2/ FLAIR hyperintensity with diffusion restriction and irregular areas of blooming noted in the Rt temporo- parietal lobe .Gyral swelling with effacement of the adjacent sulcal space. Linear blooming areas also noted MRA - No flow related enhancement noted beyond the M1 segment of Lt MCA with abrupt cut off of the vessel. Imp : Acute left MCA infarct with hemorrhagic teansformation. Acute infart Rt MCA branch with hemorrhagic transformation. * Occlusion of M1 segment of LT MC A

Definitely lt thalamic& cistern Ischemic stroke Mediastinal shift to left Cerebral oedema Bleeder in rt cistern Cerebral artery region Follow up with mri Opinion of neurosurgeon

Thank you doctor
0

A left middle cerebral arterial ischaemic infarct . There is effacement of cistern . Timely thrombolysis with tenectaplase has need done

Ischaemic stroke Left mca territory Rt posterior division of MCA territory Probably cardioembolic ? MRA left distal MCA not visible

Valuable opinion
0

Left MCA territory infarct Mild midline shift Why did the patient worsen after thrombolysis with tenectaplace ? Dr Manorama Rajan will be able to explain . Hemorrhagic infarct ,??

Ischemic stroke

Lt MCA territory infarct, mainly inferior division....effacement of cistern....mild shift....follow up MRI brain with angiography. Required...

Thank you doctor
0

Diseases Related to Discussion

Cases that would interest you