The striatocapsular infarction and its aftermaths

Abstract

Ischaemic stroke syndromes in the vascular territory of middle cerebral artery may have atypical presentation and radiographic findings because of the variable anatomy of that artery. Therefore, misdiagnosis of these syndromes as neoplastic or infectious processes is not uncommon. This case describes a 69-year-old comatose woman who was referred to us as having 'a brain tumour with massive surrounding oedema.' Further work-up revealed that she had a large left-sided lenticular nuclear infarction with some extension into the surrounding areas-the striatocapsular infarction.

Figure 1

Non-contrast brain CT scan of the patient at the level of the basal ganglia approximately 2 days after developing coma. Note the left-sided deep hemispheric hypodense area that fits the site of the lenticular nucleus. The referring physician considered this an oedema surrounding a malignant mass.

Figure 2

T1-weighted MRI with gadolinium of the same patient 4 days after admission. A hypointense coma-shaped area that did not take the contrast; the infracted area consisted of putamen, globus pallidus, anterior limb of internal capsule and head of caudate.

Figure 3

An axial T2-weighted brain MRI image of the patient at the level of the basal ganglia Note the heterogeneous hyperintense signals at the left basal ganglia; the overlying cortex and the adjacent thalamus are spared.

Figure 4

Coronal T2 FLAIR brain MRI image of the patient; note that the abnormal signal of the T2-weighted image did not suppress on the FLAIR film. The left basal ganglia have the bulk of the abnormal signal intensity; note the extension of the signal into the core of the left temporal lobe. The cortical areas and thalamus are not involved.