case_images: PMC11817324_01
case_images: (A) Non-enhanced computed tomography of the brain showing a hyperdense artery sign, arteria cerebri media sin. M1 segment (red arrow). The hyperdense artery sign typically indicates acute thrombosis, especially in the presence of corresponding neurological symptoms. (B) Non-enhanced computed tomography of the brain at the basal ganglia level shows unilateral basal ganglia calcinosis, predominantly in the caput nuclei caudati and nucleus lentiforme (red arrow), without perifocal edema or mass effect, suggesting changes in a more likely benign nature. (C) Computed tomography post-contrast on left basal ganglia level in axial and sagittal planes showing a low contrast enhancement vessel venous angioma, which corresponds to developmental venous anomaly (DVA) and is regarded as the underlying cause of basal ganglia calcinosis (red circle and red arrow). (D) Retrospective analysis of the computed tomography angiography (MIP-CTA) images, performed before the MRI and DSA examinations, reveals a small venous angioma (DVA) in the left basal ganglia (red arrows).
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case_images: An acute occlusion of the M2 segment of the left middle cerebral artery (MCA) was identified, accompanied by leptomeningeal collaterals extending to the left brain hemisphere with a Tan collateral score of 3 (Figure 1). At 1 day post-admission, a neuroradiologist reviewed a control follow-up NECT that demonstrated an ischemic lesion localized to the left insula, predominantly involving the left parietal lobe and the superior gyrus of the left temporal lobe (Figure 1).
case_images: Computed tomography perfusion (CTP) after contrast injection shows a large hypoperfusion area in the territory of the left middle cerebral artery (ACM sin) with extensive penumbra-type damage (salvageable brain tissue) and a small core-type lesion in the parietal lobe, comprising less than one-third of the total hypoperfusion volume. The findings suggest the patient could potentially benefit from intravenous thrombolysis. Cerebral blood flow (CBF) 9%; cerebral blood volume (CBV) 23%; mean transit time (MTT) 237%.
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case_images: A subsequent perfusion CT (CTP) was performed, revealing an extensive hypoperfusion zone predominantly consistent with a penumbra-type lesion (Figure 2).
case_images: At 1 day post-admission, a magnetic resonance imaging (MRI) with fluid-attenuated inversion recovery (FLAIR) and T2-weighted sequences reveals acute ischemia in the left insula and left parietal lobe, and upper gyrus of temporal lobe corresponding to the lesion seen on CTP and consistent with the territory of the left middle cerebral artery (MCA), M2 segment (red arrows). Diffusion-weighted imaging (DWI) sequence showing restricted diffusion on left side insula, left parietal, and temporal lobe with low apparent diffusion coefficient (ADC) map value, which corresponds to acute infarction of the middle cerebral artery territory of the left side M2 occlusion (red arrows).
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case_images: Subsequently, MRI of the brain was conducted, which also revealed ischemic signs, as well as unilateral BGC (Figure 3).
case_images: Digital subtraction angiography in LL projection at the level of basal ganglia showing abnormal vessels, which corresponds to developmental venous anomaly angioma in the left area of the basal ganglia, also these changes are seen on CTA and MRI after contrast injection (red arrow).
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case_images: DSA was performed to clarify reasons for unilateral BGC, and it confirmed the presence of a DVA (Figure 4).