Images in Clinical Medicine
Kim Eagle, M.D., Editor
Cerebral Infarction
N Engl J Med 1994; 330:1571June 2, 1994
- Article
Figure 1 Cerebral Infarction.
Computed tomographic scans were obtained in a 77-year-old man with sudden onset of dense left-sided hemiparesis. Noncontrast scans performed 2 1/2 hours after the onset of symptoms (Panel A and Panel B) show early changes in the distribution of the right middle cerebral artery characteristic of an infarct. In Panel A, the normal gray-white differentiation is seen at the insular cortex on the left (arrowheads) but is absent on the right, a finding referred to as the insular ribbon sign. In addition, the right sylvian fissure is effaced relative to the left fissure. The scan in Panel B was taken slightly cephalad to the scan in Panel A. In Panel B, the left-sided sulci are better seen and the cortical gyri have preserved gray-white differentiation (arrowheads). In addition, there is slightly diminished density in the distribution of the right middle cerebral artery, best seen in the frontal and occipital regions (arrows). Follow-up scans at comparable levels obtained two days later because of a progressive decline in the level of consciousness show severe hypodensity in the distribution of the right middle cerebral artery, with a mass effect on the ventricular system and a shift in the midline from right to left (Panel C and Panel D).
Kim Eagle, M.D.
Lawrence E. Ginsberg, M.D.
Daniel W. Williams, III, M.D.
Bowman Gray School of Medicine, Winston-Salem, NC 27157
