Patient with left sided weakness, gaze deviation and neglect.
Stroke
Based on the left sided weakness with the additional cortical signs (neglect) and gaze deviation, finding are most concerning for a right middle cerebral artery territory lesion.
Non Contrast Head CT: No hemorrhage or signs of edema.
CTA: There is a clot within the right middle cerebral artery. The cervical vessels are patent.
Subsequent CT shows evidence of hemorrhagic conversion.
The patient was taken to the interventional suite for right middle cerebral artery mechanical thrombectomy. The patient however had reperfusion injury with hemorrhagic transformation. The patient was taken to the OR for decompressive craniectomy.
The patient was found to have afib.
Right Middle Cerebral Artery stroke with hemorrhagic conversion.