Basal ganglionic infarction
Disturbed conscious level of 20 hours duration.
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Acute infarction involving the putamen, head and body of caudate nucleus as well as the posterior limb of internal capsule (territory of lateral lenticulostriate artery). It displays bright signal in DWI and low signal in ADC confirming the diffusion restriction status. Together with faintly bright signal in T2 and FLAIR without significant mass effect or hemorrhage. MRA reveals complete occlusion of the right ICA with refilling of the ACA and MCA through circle of Willis.
The basal ganglia receive their blood supply from the medial and lateral lenticulostriate arteries. While the former is a branch from the ACA that supplies the anteromedial head of caudate and anterior limb of the internal capsule, the latter is a branch from the MCA and supplies the putamen, head of caudate and posterior limb of the internal capsule. The thalamus, instead, receives its blood supply from the thalmoperforators arising from the posterior cerebral arteries. This patient is known to have SLE.