A case of brain infraction that demonstrated left hemiplegia at onset

Akitoshi Inoue 1, Shu Yamada 2, Masahiro Yamamoto 3, Hiroyuki Sugihara 4

1 Junior Resident, Kohka Public Hospital
2 Department of Internal Medicine, Kohka Public Hospital
3 Department of Central Clinical Laboratory, Kohka Public Hospital
4 Department of Pathology, Shiga University of Medical Science

  A man in his 80’s complained of left hemiplegia, dysphagia and dysarthria. Four days after he had fallen at home, he was transported by ambulance to our hospital due to gradually progressive muscle weakness on the left side of the body. He was diagnosed as having brain infarction in the territory of the right middle cerebral artery based on neurological findings and computed tomography. He was hospitalized under the medical treatment for brain infarction. On the 16th day of the hospitalization, he developed a fever. Since blood chemistry demonstrated inflammatory reaction and the elevation of biliary enzymes, we suspected a biliary tract infection, and administrated antibiotics intravenously. On the 17th day of hospitalization, the patient died.
  Autopsy disclosed lobar pneumonia in the right lower lobe and the absence of fatal biliary tract infection. The pneumonia may have induced sepsis and was considered as the direct cause of death. Examination of the fixed brain demonstrated revealed many acute and subacute infarcts. Here we report temporal changes of the infarcts by comparing the histological findings at autopsy to the corresponding magnetic resonance images taken on the 4th day of hospitalization.

Key words : brain infarction, magnetic resonance imaging, time course