Confounding Imaging Findings in Subacute-Chronic Cerebral Infarction

Abstract

Imaging findings which appear during the course of subacute and chronic cerebral infarct and which can lead to confusion for diagnosis is presented in a series of six patients. These include: luxury perfusion, fogging effect, hemorrhagic transformation, Wallerian degeneration, diaschisis, laminar cortical necrosis and encephalomalacia with exvacuum dilation.Keywords: Subacute infarct; Chronic infarct; Luxury perfusion; Fogging effect; Hemorrhagic transformation; Wallerian degeneration; Diaschisis; Laminar cortical necrosis; Laminar cortical necrosis encephalomalacia; Exvacuum dilation are found, due to luxury perfusion effect ( Figure 1A,B). This effect confounds the real diagnostic of ischemic stroke and the images were interpreted as a brain tumor. Case 2Seventy-one-year-old female patient who presented sudden right hemiplejia and loss of consciousness. CT was performed 4 hours after the event and was considered normal. Due to unfavorable evolution, the study was repeated after 8 days (Figure 2A,B) and after 13 days ( Figure 2C). In A and B an infarct of the right MCA can be seen, with mass effect on the neighboring ventricle (which is collapsed) and slight displacement of the midline. Hyperdensity within the affected vascular territory follows the organization of gyri, contrasting with IntroductionAfter occlusion of a cerebral artery, imaging studies confirm cerebral infarction during hyper acute and acute phases [1][2][3]. This allows engaging in therapeutic decisions with the aim of reducing damaged tissue and thus the subsequent sequels.Nevertheless, imaging findings can occur during subacute and chronic phases of cerebral infarction that could disguise or mimic other neurological processes. Although these findings have been described in the literature, in many occasions they are overlooked and can originate confusion when conducting imaging diagnosis. Among these are: luxury perfusion, fogging effect, hemorrhagic transformation, Wallerian degeneration, diaschisis, laminar cortical necrosis and encefalomalacia with exvacuum dilation [4][5][6][7][8][9].During the subacute-chronic phase of cerebral infarction, many physicians can inform the images as negative and may even not associate these imaging findings with primary ischemic damage, interpreting them as independent events, thus modifying the diagnosis The object of this work was to describe the occurrence of these imaging findings in a series of six patients with cerebral infarction during the subacute-chronic phase. The description of the subjects is represented in Table 1. Case Presentation Case 1Three-year-old female patient with left hemiparesis and previous diagnosis of brain tumor. After a simple ( Figure 1A) and contrasted ( Figure 1B) CT scan performed between day 3-7 an increased density in the territory irrigated by the MCA and gyriform enhancement