Neuro_MR_Brain: 54 F, left MCA syndrome.

MRI BRAIN STROKE PROTOCOL WITH AND WITHOUT CONTRAST:

CLINICAL HISTORY: 54-year-old, SIR transfer, left MCA syndrome.

FINDINGS:

Parenchyma: Small volume of acute infarct is seen involving the posterior left putamen and external capsule, and caudate body. No evidence of hemorrhage. No mass effect.

Ventricles and extra-axial spaces: Blooming GRE signal in the entire left M1 segment compatible with clot.

Orbits: Normal.

Visualized paranasal sinuses: Clear.

Mastoid air cells: Clear.

Bones: Normal.

Additional comment: None.

INTRACRANIAL CIRCULATION:

Anterior circulation: There is cut off of the proximal left M1 segment, mild flow related signal is seen within left MCA branches and sylvian fissure, suggesting reconstitution via collaterals. Visualized right internal carotid artery, right M1 and A1 segments are widely patent. There is a patent anterior communicating artery. Small right posterior communicating artery is seen. Left posterior communicating artery is hypoplastic or absent.

Posterior circulation: No flow-limiting stenosis or dissection.

PERFUSION:

ASL demonstrates marked delayed perfusion to the left MCA territory. Bolus perfusion shows perfusion delay to the entire left MCA territory, most notable centrally, with relatively preserved CBV/CBF, significantly larger territory than diffusion abnormality compatible tissue at risk.

IMPRESSION:

1. Acute infarcts in the left basal ganglia and external capsule with a larger volume of tissue at risk in the MCA territory. Associated occlusive clot in the left M1 segment.

(Left M1 occlusion, went to thrombectomy)