Calcified Emboli - Imaging Sign
Look for small calcific emboli with the vessels. These could be acute or chronic but are suggestive of proximal embolic source, such as a ruptured calcified plaque.
ICA Occlusion - Look at the skull base for
Stroke Mimics - This was a Tumor!
Stroke Mimic - Not every hypoattenuation on CT is indicative of acute stroke. Given the preservation of cortical gray white in the insula, and in fact cortical expansion, this was a tumor with underlying vasogenic edema producing this appearance.
Calcified Carotid Plaque - Source of Emboli
Calcified carotid plaques can serve as an embolic source in acute stroke. Although considered more stable than atheromateous plaque, their rupture could lead to vascular occlusion. Given their calcified nature, they are refractory to IV thrombolysis and their retrieval using interventional techniques is more challenging. Given their solid nature, it would not incorporate as a traditional cloth would within the stent retriever and can get be pushed against the intimal wall as the stent opens.
Striatocapsular infarcts involve the striatum (ie the caudate nucleus and putamen), without involvement of the cortex secondary to either a complete or partial proximal MCA occlusion limiting flow to the lenticulostriate arteries.
Classically patients exhibit both cortical (e.g. aphasia, sensory neglect or extinction, apraxia) and subcortical (e.g. upper limb hemiparesis, dysarthria) neurological signs.
Tmax (red) and CBV (blue) demonstrate very increased time of transit of blood, and very low blood volume in the exact same areas. This is no perfusion mismatch here and all the brain tissue has been infarcted with no pneumbra present to save.
Hemorrhagic Transformation in an Infarcted Region
Susceptibility sequences SWI demonstrate diffuse hemorrhagic change within an area of previous Infarct. With corresponding diffusion DWI restriction in the right panel.