TCD systolic spikes in a malignant MCA infarct.
BACKGROUND
Malignant MCA infarction results in significant space occupying effect and intracranial pressure (ICP) increment. Due to the high mortality rate in such patients, the term malignant MCA infarction was coined.


METHODS
We studied a patient who developed a sudden onset of slurred speech, right hemiplegia, and decreased level of arousal. Two days later CT scan showed a massive cerebral infarct, involving the left MCA territory.


RESULTS
A transcranial Doppler exam showed a normal flow pattern in the right hemisphere, but in the left hemisphere systolic spikes without diastolic flow were observed in internal carotid artery, anterior cerebral artery, as well as in the MCA.


CONCLUSIONS
The pathophysiologic mechanisms leading to BD might asymmetrically begin in cerebral hemispheres in malignant MCA infarcts.
Perez-Nellar
Jesus
J
Hermanos Ameijeiras Hospital, Service of Neurology, Havana, Cuba. jesus.perez@infomed.sld.cu
Scherle
Claudio
C
Machado
Calixto
C
D001783:Blood Flow Velocity; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000502:physiology; D002560:Cerebrovascular Circulation; D003422:Critical Care; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007427:Intracranial Pressure; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000502:physiology; D013599:Systole; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial