Concluded Case

FOCAL CEREBRAL ARTERIPATHY ASSOCIATED WITH COVID 19

Title 14 yr old boy with left sided weakness. Chief complaint 14 yr old boy presented with rt sided head ache followed by left sided weakness of one day duration. He developed head ache one day prior to left sided weakness. Head ache was moderate intensity with outt vomiting or blurring of vision.No seizure. Past history Denied having any previous history of any medical illness. He is completely immunized boy Vitals. Afebrile at admission. Vitals stable. BP90/60 mmhg.HR 92/ mt. Respiratory rate28/ mt. Physical exam Concious ,communicating well. No field deficits. Normal pupils. Left sided UMN facial weakness. Left sided power gr3/5 with left pyramidal signs and intact sensations.No bruit overcthe carotids or vertebrals. Other systems including musculoskeletal were normal. Investigations. WBC 14,000/ CRP 42,Blood biochemistry, vasculitis screening,fasting homocystein all with in the normal limits. RT PCR for COVID- 19 was +ve. MRI brain with MRA done. CT angiogram was also done Diagnosis. Keeping for discussion / Case Conclusion Management-: Keeping for discussion/ conclusion. Questions. What abnormality in the MRI Brain and MRA? What is the final diagnosis?

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Concluded answer

82 people viewed the case ,no body answered MRI Brain findings: Areas of diffusion restriction showing T2/ FLAIR showing hyperintensity in the head and body of Rt csudate nucleus, lentiform nucleus,insular cortex and adjacent frontotemporal lobes. MRA: Aortic arch - Origin of three major arteries the innominate,left common carotid and left subclavian artery from aortic archappear normal Carotid system: Both common caroticds appear normal.Both carotid bulb appear normal.Mild signal attenuation ( luminal narrowing) is noted in the Rt ICA distal tobifurcation. Bilateral intracranial ICA: Loss of flow related signals noted in the Rt Petros ICA- occlusion attenuated luminogeam in cavernous and supraclinod ICA.Rt MCA M1 segment is attenuated in caliber. Bilateral ACA& LT MCA Normal. Imp: Rt ICA territory infarction. All vasculitis screening were normal . The only abnormality in investigations- +ve RT PCR forCOVID

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82 people viewed the case ,no body answered MRI Brain findings: Areas of diffusion restriction showing T2/ FLAIR showing hyperintensity in the head and body of Rt csudate nucleus, lentiform nucleus,insular cortex and adjacent frontotemporal lobes. MRA: Aortic arch - Origin of three major arteries the innominate,left common carotid and left subclavian artery from aortic archappear normal Carotid system: Both common caroticds appear normal.Both carotid bulb appear normal.Mild signal attenuation ( luminal narrowing) is noted in the Rt ICA distal tobifurcation. Bilateral intracranial ICA: Loss of flow related signals noted in the Rt Petros ICA- occlusion attenuated luminogeam in cavernous and supraclinod ICA.Rt MCA M1 segment is attenuated in caliber. Bilateral ACA& LT MCA Normal. Imp: Rt ICA territory infarction. All vasculitis screening were normal . The only abnormality in investigations- +ve RT PCR forCOVID

82 people viewed the case ,no body answered MRI Brain findings: Areas of diffusion restriction showing T2/ FLAIR showing hyperintensity in the head and body of Rt csudate nucleus, lentiform nucleus,insular cortex and adjacent frontotemporal lobes. MRA: Aortic arch - Origin of three major arteries the innominate,left common carotid and left subclavian artery from aortic archappear normal Carotid system: Both common caroticds appear normal.Both carotid bulb appear normal.Mild signal attenuation ( luminal narrowing) is noted in the Rt ICA distal tobifurcation. Bilateral intracranial ICA: Loss of flow related signals noted in the Rt Petros ICA- occlusion attenuated luminogeam in cavernous and supraclinod ICA.Rt MCA M1 segment is attenuated in caliber. Bilateral ACA& LT MCA Normal. Imp: Rt ICA territory infarction. All vasculitis screening were normal . The only abnormality in investigations- +ve RT PCR forCOVID

82 people viewed the case ,no body answered MRI Brain findings: Areas of diffusion restriction showing T2/ FLAIR showing hyperintensity in the head and body of Rt csudate nucleus, lentiform nucleus,insular cortex and adjacent frontotemporal lobes. MRA: Aortic arch - Origin of three major arteries the innominate,left common carotid and left subclavian artery from aortic archappear normal Carotid system: Both common caroticds appear normal.Both carotid bulb appear normal.Mild signal attenuation ( luminal narrowing) is noted in the Rt ICA distal tobifurcation. Bilateral intracranial ICA: Loss of flow related signals noted in the Rt Petros ICA- occlusion attenuated luminogeam in cavernous and supraclinod ICA.Rt MCA M1 segment is attenuated in caliber. Bilateral ACA& LT MCA Normal. Imp: Rt ICA territory infarction. All vasculitis screening were normal . The only abnormality in investigations- +ve RT PCR forCOVID

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