case_images: PMC5287942_01
case_images: MRI of a dermoid cyst rupture with cerebral infarction. T1-weighted MRI 2 days after onset showed a mixed hyperintense lesion in the left temporal region (A, arrow) with hyperintense droplets scattered into subarachnoid space (B, arrow), simultaneously, diffusion-weighted MRI showed high signal in the border zones between the regions of the MCA and the anterior cerebral artery/posterior cerebral artery, indicating watershed infarcts (C, arrows). Five days later, brain magnetic resonance angiography showed a mild stenosis on the left MCA (D, circle) caused by an eccentricity enhanced plaque showed by high-resolution MRI (D, arrow). MRI = magnetic resonance imaging.
case_images: medi-96-e5631-g001.jpg
case_images: PMC5287942_01_medi-96-e5631-g001.jpg
case_images: F1
case_images: Two days after an onset, brain magnetic resonance imaging (MRI) revealed a 4.0 x 3.5 x 3.5 cm ruptured dermoid cyst (Fig. 1A and B) and watershed infarcts in the left hemisphere (Fig. 1C). Five days later, brain magnetic resonance angiography (MRA) demonstrated mild stenosis on the M1 segment of left middle cerebral artery (MCA), and further high-resolution MRI examination showed an unstable atherosclerosis plaque in the left MCA (Fig. 1D).
case_images: TCD and dCA of the patient. TCD (A) showed the peak systolic velocity of the left MCA (upper) and right MCA (lower) at day 2 (blue lines), 6 (white lines), 8 (green lines), 10 (red lines), and 30 (orange lines) days after the stroke, respectively. Corresponding dCA examinations showed the value of gain (B) and the value of phase at different time points (C) (day 6 black lines, day 8 green lines, and day 10 red lines; full lines for the left MCA and dashed lines for the right MCA). The tendency of phase and gain of the left hemisphere are shown in (D). dCA = dynamic cerebral autoregulation, MCA = middle cerebral artery, TCD = transcranial Doppler.
case_images: medi-96-e5631-g002.jpg
case_images: PMC5287942_01_medi-96-e5631-g002.jpg
case_images: F2
case_images: By comparison, the PSV of the right MCA was kept stable at all time points (80-91 cm/s) (Fig. 2A). The gains in the affected (left side) and unaffected hemispheres were 2.40 versus 0.93 (day 6), 2.52 versus 0.87 (day 8), 1.67 versus 0.973 (day 10), and 1.93 versus 0.94 (day 30), respectively (Fig. 2B). The phase difference in the affected hemisphere versus unaffected side was 34.47  versus 28.60  (day 6), 9.08  versus 21.38  (day 8), returned to 22.35  versus 30.18  (day 10) and then remained normal at 30.46  versus 30.89  at the 30-day follow-up (Fig. 2C).