Case 231

Medical History

58 years old, female, patient attended the emergency room reporting sudden discomfort and loss of strength in the lower limbs followed by a fall from her own height. She reports chronic arterial hypertension, dyslipidaemia and thrombophilia (deficiency of antithrombin III). She uses Losartan and aspirin. Physical exam: good general state, vigilant, oriented in time and space, afebrile, hypertensive (180;110mmHg), absence of meningeal signs, left hemiplegia with hyperreflexia and plantar reflex indifferent to the left. It was requested a computed tomography (CT) of the cranium without contrast, a magnetic resonance (MRI) and an angioresonance of the cranium.

Image 1: Cranial computed tomography (CT) without contrast, axial plane.

 

Image 2: T1-weighted magnetic resonance (MRI) image of the cranium, sagittal plane, after the contrast.

 

Image 3: cranial angioressonance, venous phase, axial and sagittal plane. 


Question:
Based on the clinical history and in the imaging studies presented, it is possible to conclude that the cause of the lesion was:

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