3 Tesla T2^*-weighted MRI demonstrating an intra-MCA embolus in a young adult with cerebral embolism

Abstract

We report a case of cerebral embolism with a patent foramen ovale and atrial septal aneurysm. A 28-year-old man was admitted to our hospital due to left hemiparesis, sensory loss and dysarthria. He had a past history of migraine with aura, and he sometimes drove for long distances. Upon arrival at hospital, he presented with an unsteady gait and his NIHSS was 0. He underwent a 3 Tesla brain MRI at 2 hours after the onset. Diffusion-weighted images showed a high intensity area in the right corona radiata and insula. T2^*-weighted images revealed a dot signal with a very low intensity on the right MCA, suggesting an embolus in the MCA. Funicular low signals in the right parietal lobe were regarded as medullary veins enhanced by increased deoxyhemoglobin. These findings were important since they could indicate an ischemic lesion. On MRA and cerebral angiography, the right MCA was actually seen to be occluded in the M2 portion. Transesophageal echocardiography demonstrated a patent foramen ovale and atrial septal aneurysm with right to left shunt. 3 Tesla T2^*-weighted MRI was thus useful for assessing the mechanism of the cerebral ischemic events.