Neuro_MR_Brain: 72 M, left MCA syndrome.

MRI BRAIN STROKE PROTOCOL WITH AND WITHOUT CONTRAST:

 

CLINICAL HISTORY: 69-year-old male patient with concern for acute stroke.

 

BRAIN:

 

Parenchyma: Small regional acute infarct with diffusion restriction in the left posterior insular region. No acute hemorrhage is seen on the GRE sequence, although the sequence is motion degraded. 

 

Ventricles and extra-axial spaces: Appropriate for age.

 

Orbits: Normal.

 

Visualized paranasal sinuses: Clear.

 

Mastoid air cells: Clear.

 

Bones: Normal.

 

Additional comment: None.

 

INTRACRANIAL ANGIOGRAM:

 

Anterior circulation: On the TOF MRA, there is mild irregularity of the petrous and cavernous segment of the left ICA, which is likely due to atherosclerotic disease. The left M1 segment is patent. There is an abrupt cutoff of the left M2 segment, consistent with thrombus. There is paucity of vessels in the left M3 and M4 territory. The right ICA, right MCA, bilateral anterior cerebral arteries, anterior communicating artery demonstrate no significant findings.

 

Posterior circulation: No flow-limiting stenosis or aneurysm. Left dominant vertebrobasilar system. 

 

Dural venous sinuses: Patent.

 

Additional comment: None.

 

PERFUSION: 

Left MCA territory hypoerfusion on ASL.  The bolus perfusion study demonstrates reduced CBV, CBF, and prolonged Tmax in the left MCA distribution. There is a large left MCA distribution diffusion/perfusion mismatch, that is not quantified automatically due to the small infarct core. 

 

IMPRESSION:

1. Acute ischemic left insular infarct with a large area of tissue-at-risk in the left MCA distribution. Acute thrombus is directly visualized in the left M2 segment.