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47岁女，既往偏头痛，因左侧头部突发性疼痛和左侧手臂中度无力入院。症状出现5小时后进行CT平扫，发现右侧大脑中动脉前干（图A，箭头）和大脑前动脉前干支配的区域出现线状高密度影。此外亦可见脑水肿的早期征象，包括大脑中动脉和大脑前动脉支配的区域出现轻微低密度影伴灰白质分界消失，以及脑沟消失（图B，箭头）。四小时后，患者陷入昏睡状态，并出现左侧肢体完全性瘫痪。图C为症状出现9小时后的脑部CT扫描，大脑中动脉和大脑前动脉支配的区域可见大面积非出血性梗死，脑水肿加剧，脑中线右向左移位（图C，箭头），左侧脑室受压（图D，星号）。患者在发病21小时候接受了针对额顶骨区域的去骨瓣减压术（图E和F）。术后逐渐康复，但6周后死于肺炎。
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A 47-year-old woman with a history of migraine was admitted to the hospital with acute-onset headache on the left side of her head and mild weakness of her left arm. Computed tomography (CT) of the brain without the use of contrast material was performed 5 hours after symptom onset and showed linear areas of hyperdensity in the first segment of the right middle cerebral artery (Panel A, arrow) and the first segment of the anterior cerebral artery. There were early signs of cerebral edema, including subtle low attenuation with loss of gray–white differentiation and effacement of sulci in both the right middle-cerebral-artery and anterior-cerebral-artery territories (Panel B, arrows). Four hours later, the patient became drowsy, and complete paralysis of the left side developed. A CT scan of the brain 9 hours after symptom onset showed large, nonhemorrhagic infarcts in the middle-cerebral-artery and anterior-cerebral-artery territories, with increased edema, mild right-to-left midline shift (Panel C, arrows), and some trapping of the left lateral ventricle (Panel D, asterisk). A total of 21 hours after symptom onset, the patient underwent decompressive craniectomy of the frontoparietal region (Panels E and F). She had a gradual recovery but died 6 weeks later from pneumonia.
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