case_images: PMC7568088_01
case_images: Top: admission noncontrast CT (NCCT) head demonstrated extensive right MCA territory infarction with hyperdense right MCA M1 segment (short arrow). ASPECT score was 6. CT angiogram confirmed occlusion of the terminal right ICA and right M1 segment (long arrow). Note retrograde flow within the A1 vessel from the contralateral side. Bottom: catheter angiography images (arterial phase) pre and post intra-arterial thrombectomy showing successful recanalization of the terminal ICA and right MCA. TICI score pre- and postintervention was 0 and 3, respectively. ASPECT: Alberta stroke program early CT score; DSA: Digital subtraction angiography, ICA: Internal carotid artery, MCA: Middle cerebral artery, NCCT: Noncontrast CT, TICI: Thrombolysis in cerebral infarction.
case_images: SNI-11-319-g001.jpg
case_images: PMC7568088_01_SNI-11-319-g001.jpg
case_images: F1
case_images: NIHSS score was 21. Noncontrast CT head and intracranial CT angiography demonstrated an extensive right MCA territory infarction with occlusion of the right terminal internal carotid artery (ICA) and right proximal M1 segment middle cerebral artery (MCA) [Figure 1].
case_images: Noncontrast computed tomography (NCCT) and contrast-enhanced MR imaging performed 7 weeks postthrombectomy. T1- and T2-weighted images demonstrate am extensive right-sided multiloculated fluid-filled cavity extending into the right middle cranial fossa, right temporal pole, and right inferior frontal lobe. Trace DWI/ADC images demonstrate prominent diffusion restriction consistent with abscess formation and on post-Gd T1W images there is marked enhancement of the abscess capsule peripherally. Note the high T2-weighted signal change within the surrounding right frontoparietal lobes, and the associated mass effect from the abscess with partial effacement of the right lateral ventricle and midline shift. ADC: Apparent diffusion coefficient; DWI: Diffusion-weighted imaging, T1W: T1 weighted, T2W: T2 weighted.
case_images: SNI-11-319-g002.jpg
case_images: PMC7568088_01_SNI-11-319-g002.jpg
case_images: F2
case_images: MRI was undertaken at 7 weeks posttreatment. MR imaging demonstrated an extensive right frontal cerebral abscess with mass effect and midline shift [Figure 2].