CT CT 1 week later CT 9 months later

Diagnosis: Evolving right parasagittal infarct

CT findings in stroke during the first 12 hours are usually negative. From 12 to 24 hours, there may be subtle mass effect resulting in sulcal effacement as well as loss of the normal gray-white distinction. From 1 to 3 days the lesion may acquire a typical wedge shaped appearance of low attenuation. Hemorrhage may occur and there is a worsening amount of mass effect. From 4 to 7 days, enhancement may be seen with persistence of mass effect. From 1 to 8 weeks there may be some degree of enhancement while the amount of mass effect diminishes. In the chronic phase after months to years, there is progressive loss of volume and encephalomalacia.

Given the clinical story and the series of exams showing the changes over time, there is no differential here. If only the second examination were available, follow-up would be indicated to rule-out an underlying neoplasm. This patient suffered a stroke secondary to an embolic thrombosis from a myocardial infarction and had a left homonymous hemianopsia. Related Cases

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