Vessel Wall Magnetic Resonance Imaging in a Case of Post-traumatic Multifocal Striatocapsular Hemorrhagic Infarction

Area of Science:

• Neurology
• Radiology
• Trauma Surgery

Background:

• Post-traumatic striatocapsular infarction is a rare condition, typically affecting the middle cerebral artery (MCA) territory.
• Hemorrhagic infarction in this region following head trauma is exceptionally uncommon.

Observation:

• A 25-year-old female sustained a mild head injury in a motorcycle accident.
• Initial imaging revealed multifocal acute hemorrhagic infarctions in the right caudate head, anterior limb of the internal capsule, and globus pallidus.
• Angiography showed irregularities in the right MCA's lenticulostriate arteries, with vessel wall imaging confirming patency but highlighting the supply to infarction sites.

Findings:

• The patient presented with unilateral multifocal striatocapsular hemorrhagic infarctions.
• Vessel wall imaging excluded dissection but demonstrated the specific lenticulostriate arteries supplying each infarction.
• The study postulates damage to multiple lenticulostriate arteries as the cause of these injuries.

Implications:

• This case expands the understanding of rare post-traumatic brain injuries.
• It highlights the utility of advanced imaging like vessel wall MRI in diagnosing complex vascular insults.
• The findings suggest a potential mechanism for multifocal striatocapsular hemorrhagic infarction secondary to trauma affecting small perforating arteries.