Stroke Chameleon: Acute Bilateral Middle Cerebral Artery Infarct Complicated with Acute Pulmonary Oedema

Authors

  • Kamarul Aryffin Baharuddin Universiti Sains Malaysia
  • Nurlina Wanshah Universiti Sains Malaysia
  • Sanihah Abdul Halim Universiti Sains Malaysia
  • Fattah Rahiman Ghazali Universiti Sains Malaysia

DOI:

https://doi.org/10.31436/imjm.v24i04.2680

Keywords:

bilateral infarction, middle cerebral artery, acute pulmonary edema

Abstract

Acute bilateral middle cerebral artery (MCA) infarctions are an extremely rare event. However, it can cause disruption of bilateral corticothalamic networks leading to coma.  Detection of this condition is challenging as the early ischemic signs found on the non-contrast CT (NCCT) is depending on comparison between infarcted region and its normal counterpart. We report a case of 60-year-old man presented with acute comatose state and pulmonary oedema secondary to hypertensive emergency. His NCCT brain showed acute infarction of bilateral MCA territories. His acute pulmonary oedema subsequently resolved with the treatment. However, he succumbed to his  illness and its complications on day 7 of admission. In this case report, we explore the strategy to improve detection of bilateral infarction on NCCT and navigating the differential diagnosis of comatose state and acute pulmonary oedema brought about by the hypertensive emergency.

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Published

01.10.2025

How to Cite

Baharuddin, K. A., Wanshah, N., Abdul Halim, S., & Ghazali, F. R. (2025). Stroke Chameleon: Acute Bilateral Middle Cerebral Artery Infarct Complicated with Acute Pulmonary Oedema. IIUM Medical Journal Malaysia, 24(04). https://doi.org/10.31436/imjm.v24i04.2680