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Ischaemic Changes of Different Anatomical Regions or Vascular Territories

Cerebral infarction involving the middle cerebral artery territory: Malignant middle cerebral artery territory infarct

The set of non-contrast CT scans shown here is from a patient with an acute right middle cerebral artery infarct complicated by severe cerebral oedema and haemorrhagic transformation. One can appreciate the “dense middle cerebral artery sign” on the right side arrow_1. However, the most striking feature is the significant mass effect and “mid-line shift” caused by the cerebral infarction as a result of the severe cerebral oedema. Due to the significant space occupying effect as a result of the cerebral infarction, the patient’s conscious state was impaired as documented by a drop in the Glasgow Coma Scale. The Neurosurgical team was consulted and the patient received an urgent craniectomy to relieve the raised intracranial pressure (this could be appreciated by the absence of skull bone over the right temporal-parietal region arrow_4 ). Unfortunately, the patient succumbed few days after admission. This type of severe cerebral infarction is called “malignant middle cerebral artery territory infarct”.

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