Case contributed by A.Prof Frank Gaillard


Headache for investigation.

Patient Data

Age: 70 years
Gender: Male

CT brain

Evidence of old left MCA territory infarct with encephalomalacia and surrounding gliosis. There is ex vacuo dilatation of the left lateral ventricle.  Ventricular size and sulcal pattern is stable.  Further periventricular hypodensities most likely reflect sequelae of chronic small vessel ischemia. Focal hypodensity in the region of the right external capsule is again noted.  


MRI brain

A large area of encephalomalacia is present on the left side involving much of the the temporal lobe, posterior frontal and parietal lobes with surrounding gliosis, consistent with an old MCA territory infarct.  There is associated ex-vacuo dilatation of the left lateral ventricle, and atrophy of the left cerebral peduncle consistent with Wallerian degeneration

No restricted diffusion (rather there is facilitated diffusion) and only a few regions of signal drop out due to blood products are noted. 

Case Discussion

This patient had a remote history of a left MCA infarct. 

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Case information

rID: 22285
Published: 24th Mar 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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