Presentation
Admitted with dysarthria and mouth deviation for the last 12 hours.
Patient Data
A large area of hypoattenuation with loss of gray-white matter differentiation involving the left parietal and insular cortex, corresponds to acute ischaemic stroke. CTA shows complete occlusion of the left ICA.
FU brain CT after 4 days of...
FU brain CT after 4 days of Rx with dual anti-platelet Rx
Prominent hypodensity involving the left parietal and insular cortex corresponds to early subacute ischaemic stroke.
New subarachnoid haemorrhage in left parietal convexity, separate from the stroke area.
The patient was clinically stable. On follow-up CT on the next day, the findings were stable and the patient was discharged after several days with a recommendation to perform a follow-up CT in the next two weeks.
FU CT 10 days after the initial clinical presentation
The left parietal area of stroke is much less prominent compared to previous examinations, as a result of the fogging phenomenon. In a post-contrast study, gyral enhancement is shown in the stroke area. These findings are typical for the subacute phase of ischaemic stroke.
The left parietal subarachnoid haemorrhage resolved.
Case Discussion
Convexal subarachnoid haemorrhage occurs within the surface sulci of the brain, without involving the basal cisterns or ventricles.
Internal carotid artery occlusion is one of the rare causes of convexal subarachnoid haemorrhage. The proposed mechanism is the fragility of collateral pial vessels with subsequent rupture. The antiplatelet therapy, as well as a possible reperfusion injury, may contribute to the development of convexal subarachnoid haemorrhage in the setting of ischaemic stroke in patients with occlusive disease of the internal carotid artery.
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