PMC8214006_01
(A) Axial and (B) coronal images of the unenhanced computed tomography (CT) scan of the brain showed an acute left middle cerebral artery (MCA) infarction, which manifested as cortical and subcortical hypodensity with loss of gray-white matter differentiation and cortical swelling involving the left frontal, parietal, and temporal regions (asterisk); hyperdense MCA signs were also noted (arrow). (C) Axial and (D) axial maximum intensity projection (MIP) images of the CT angiogram of the brain showed complete occlusion of the left supraclinoid internal carotid artery and proximal MCA (arrows). (E) Brain CT demonstrated the presence of a malignant MCA infarction with hemorrhagic transformation, causing significant midline shifting and mass effect. (F) Postoperative CT.
IMCRJ-14-401-g0001.jpg
PMC8214006_01_IMCRJ-14-401-g0001.jpg
f0001
An initial unenhanced computed tomography (CT) of the brain was performed, which showed a large left middle cerebral artery (MCA) territory cortical and subcortical hypodensity suggestive of acute MCA infarction (Figure 1A and B). The cerebral CT-angiogram confirmed a total abrupt cut off at the left M1 segment of MCA (Figure 1C and D) with multiple filling defects in the left common carotid artery (Figure 2A-E). An urgent brain CT was ordered and showed further progression of the left MCA territory edema with new hemorrhagic components, causing midline shift and mass effect (Figure 1E). Left craniotomy decompression was done by the neurosurgery team (Figure 1F), and antihypertensives were subsequently administered.
(A and B) coronal and (C and D) Axial images of the computed tomography (CT) angiogram of the neck showed multiple hypodense peripheral fungating filling defects within the left common carotid artery (arrows). (E) Axial imaging of the CT angiogram of the neck showed complete occlusion of the distal left external carotid artery and facial arteries (dotted arrows), compared with the normally opacified vessels on the right side (arrowhead).
IMCRJ-14-401-g0002.jpg
PMC8214006_01_IMCRJ-14-401-g0002.jpg
f0002
The cerebral CT-angiogram confirmed a total abrupt cut off at the left M1 segment of MCA (Figure 1C and D) with multiple filling defects in the left common carotid artery (Figure 2A-E).