Concluded Case

Acute stroke Rt MCA with Craniectomy

New case 58 yr,M, presented with acute onset of left sided weakness noted on 20th August at 6 am, while waking up in the morning. He was perfectly alright till 19th at 23.00hrs,and went to sleep and the sleep was uninterrupted.By 9 PM he was assessed by the local hospital. He was there for 4 hrs CT brain was done and then trasferred to our hospital and arrived our ER at14.00 hrs. He is a known hypertensive 4 yrs on amlodipine. Not on any antiplatelets. On exam BP 140/ 90 mmhg. Concious ,dysarthic,rt sided hemianopia ,rt facial weakness the gr 3/5 power rt side. DTRS hyperactive rt side with dulling of all modalities of sensations .Admitted in the stroke unit and requsted all blood work up and MRI brain with MRA and started med as per stroke protocol.He deteriorated in the next day and the rt sided power became 0/ 5 and hence ref to Neurosurgeon. Surgery done and last film after surgery. For diagnosis and which artery is involved?

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Thanks Dr Anand for the correct answer. MRI brain shows large area of restricted diffusion in the Rt posterior frontal region,centrum semiovale,corona radiate,capsuloganglionic region including caudate,lentiform ,internal capsule& rt frontal speculum and anterior temporal region. MRA shows non visualisation of Rt MCA. Inaddition old asymptomatic lacunes left periventricular, caudate region. Also old gliotic atea Rt posterir frontal. Imp Acute stroke Rt MCA . Old lacunes left. Rt posterior frontal gliotic area,probably old stroke ,asymptomatic. Patient on antiplatelets,neuroprotective ,active homenphysio with gait training.

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Thanks Dr Anand for the correct answer. MRI brain shows large area of restricted diffusion in the Rt posterior frontal region,centrum semiovale,corona radiate,capsuloganglionic region including caudate,lentiform ,internal capsule& rt frontal speculum and anterior temporal region. MRA shows non visualisation of Rt MCA. Inaddition old asymptomatic lacunes left periventricular, caudate region. Also old gliotic atea Rt posterir frontal. Imp Acute stroke Rt MCA . Old lacunes left. Rt posterior frontal gliotic area,probably old stroke ,asymptomatic. Patient on antiplatelets,neuroprotective ,active homenphysio with gait training.

Nice case mam It looks like a recurrent stroke mam! What is that gliotic area looking more hypodense above the fresh stroke..? Rt MCA artery

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