Presentation
Aphasia and left hemiparesis with onset ca. 50 min earlier. ECG-verified atrial fibrilation with no previous antiaggregants or anticoagulation.
Patient Data
Right-sided hyperdense MCA sign and loss of grey-white interface in the lentiform and caudate nuclei as early ischemic signs. ASPECTS 8. No hemorrhage or mass. Concomitant cerebral microangiopathy noted.
Angiogram confirms right M1 occlusion.
Hemorrhage/contrast staining areas (HCA) in the basal ganglia. Residual contrast in intracranial arteries without evident occlusion of the right MCA.
Hypodense right caudate and lentiform nuclei with residual scattered singular hyperattenuations. Initial mass effect on the right frontal horn.
Case Discussion
Acute MCA infarct, indicated for IV tPA and clot retrieval.
Immediate post-mechanical thrombectomy study after complete recanalization (TICI 3) demonstrates typical hemorrhage/contrast staining area in the right MCA vascular territory, in keeping with intra-arterial reperfusion therapy. No signs of cortical involvement.
Twenty-four-hour follow-up NCCT shows near complete resolution of hyperattenuating areas. No massive hemorrhagic transformation evident.
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