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Puncture wound (yellow arrow) on the palate.
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There was a puncture wound on the right side of his palate that was not actively bleeding but hyperemic (Figure 1).
Images A-D: Non-contrast axial brain CT shows a large wedge shaped ischaemic infarction in the right fronto-parietal lobe and right basal ganglia with loss of grey white matter differentiation involving the right middle cerebral artery territory. Dense right middle cerebral artery seen in image D in keeping with thromboembolism.
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A CT-scan revealed a large wedge shaped ischemic infarction involving the right MCA territory (Figure 2).
Images A-C: Diffusion weighted imaging (DWI). Images D-E: ADC maps. Image F-G: TOF brain angiography. MR imaging of the brain show diffusion restriction of the right fronto-parieto-temporal lobe with involvement of the right basal ganglia on DWI. There is corresponding low signal intensity on ADC map images suggestive of acute large right middle cerebral artery territory infarction. TOF angiography of the brain shows occlusion of the petrous, cavernous and cerebral part of the right internal carotid artery (ICA) and the distal M1 branch of the right middle cerebral artery (MCA) secondary to thromboembolism.
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The circle of Willis was intact with normal flow (Figure 3).