case_images: PMC9489348_01
case_images: (a) : MRI brain WO contrast. An MRI of the brain showed an acute infarct without hemorrhage involving the left insula and territory of the left middle cerebral artery. (b) MRI brain W-WO contrast. There is a loss of appropriate signal intensity within the M1 segment of the left MCA for a length of appropriate 9 mm. There is a reconstitution of appropriate signal intensity distal to the aforementioned. There is diminutive signal intensity involving the supraclinoid aspect of the right ICA with appropriate reconstitution distally, which may be artifactual in nature as no restricted diffusion is seen within the right cerebral hemisphere. The parent branches, the ACAs, PCAs, basilar artery, and vertebral arteries appear without significant stenosis. (c) MRI angiogram with head WO contrast. There is a demonstration of restricted diffusion involving the left basal ganglia and portions of the left frontal, parietal, and temporal lobes.
case_images: CRIPE2022-6500488.001.jpg
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case_images: fig1
case_images: MRI of the brain showed an acute infarct without hemorrhage involving the left insula, a territory of the left middle cerebral artery (Figure 1)(a), requiring subsequent transfer to our institution's pediatric intensive care unit (PICU) for further management. The findings of the MRI and MR angiogram are shown in Figure 1.
case_images: (a) : CT scan head WO contrast. A large hypodensity of the left MCA territory, predominantly involving the left frontal lobe, basal ganglia, insula, and left temporoparietal lobes; worsened since the prior MRI study. There is a significant mass effect on the left lateral ventricle. There is an interval development of uncal herniation and anterior subfalcine measuring 7-8 mm towards the right. There is an obliteration of the suprasellar and perimesencephalic cisterns. (b) CT Scan head WO contrast.
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case_images: PMC9489348_01_CRIPE2022-6500488.002.jpg
case_images: fig2
case_images: There was interval development of uncal and subfalcine herniation (Figure 2(a)). On hospital day 13, a follow-up CT scan of the brain without contrast showed interval improvement of edema, midline shift, and mass effect on the lateral and third ventricles (Figure 2)(b).
case_images: Timeline of patient course throughout hospitalization.
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case_images: fig3
case_images: On hospital day 66, the patient continued to show steady improvement in physical and occupational therapies and speech therapy and was discharged in a stable condition to the inpatient rehabilitation center (Figure 3).