Subchapter: Head (Read entire chapter)
Diagnosis: Acute right MCA infarctNon contrast head CT (top left) shows in the right frontal lobe loss of corticomedullary (gray-white matter) differentiation, also known as ribbon sign. There is also mild associated parenchymal swelling with effacement of the sulci and gyri (dotted black arrows). Contrast enhanced head CT (top right) demonstrates absent perfusion involving the right MCA territory. This appears to be larger than 1/3 of the MCA territory, which does not make it amendable anymore for lysis therapy. Time to peak (TTP) image (bottom left) demonstrates delayed perfusion to the right MCA territory. Maximum intensity projection (MIP) image shows an abrupt cut-off at the distal M1 segment of the right middle cerebral artery (MCA), consistent with occlusion.
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