PMC4533419_01
A computed tomography scan obtained at the time of admission showed no intracranial hemorrhage. Note the faint low-density ischemic lesion in the right middle cerebral artery territory.
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A computed tomography (CT) scan demonstrated no hemorrhagic lesions (Fig. 1).
Computed tomography revealed diffuse subarachnoid hemorrhage associated with intra-Sylvian and intra-parenchymal hematomas in the right frontal lobe. The territory of the right middle cerebral artery is seen as a low-density lesion suggestive of cerebral infarction.
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SAH associated with intra-Sylvian and intraparenchymal hematomas in the right frontal lobe (Fig. 2). She was introduced to our department. CT showed a low-density lesion in the territory of the right MCA suggesting cerebral infarction associated with SAH (Fig. 2).
Three-dimensional computed tomography angiography demonstrated occlusion of M2 portion of the right middle cerebral artery and irregular dilatation at the bifurcation (upper). Lower is higher magnified image of the region of interest on the upper image (square).
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Three-dimensional (3D)-CT angiography revealed occlusion of the M2 portion of the right MCA (Fig. 3).
A: Autopsy specimen of the whole brain. Note the diffuse subarachnoid hemorrhage with an intra-Sylvian hematoma and occlusion by a thrombus of the M2 portion of the right MCA. B: Hematoxylin-eosin staining diagnosed arterial dissection in the intermediate membrane of the right MCA bifurcation and showed a thrombus filling the arterial lumen. C: Gram staining showed a colony of Gram-positive micrococcus involved in bacterial infection in the thrombus located in the occlusive lesion of the M2 portion (D). MCA: middle cerebral artery.
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Autopsy revealed diffuse SAH and occlusion of the M2 portion due to filling by a thrombus (Fig. 4A-C). Pathological examination showed dense SAH around MCA bifurcation and thrombosed M2 (Fig. 4C). Inflammatory cells such as neutrophils proliferated and infiltrated into arterial wall around thrombus (Fig. 4C). Gram staining showed remarkable bacterial infection in the thrombus (Fig. 4D).
Hematoxylin-eosin stain (A and C) and Elastica van Gieson stain (B and D) of serial sections demonstrated that internal elastic membrane partially disrupted (arrow in B) and that internal flap and pseudolumen filled with erythrocytes (arrow in C) were observed in the right middle cerebral artery bifurcation.
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Hematoxylin-eosin stain and Elastica van Gieson stain of serial sections demonstrated that internal elastic membrane partially disrupted and that internal flap and pseudolumen filled with erythrocytes were observed in the right MCA bifurcation (Fig. 5).