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Selected axial CT images through the brainstem demonstrate loss of volume in the left side of the midbrain and pons. An old left MCA territory infarct is noted involving the corticospinal tracts.
This patient had a previous left middle cerebral artery territory infarct with resultant Wallerian degeneration of the corticospinal tracts. This results in reduction in volume of the ipsilateral cerebral peduncle and flattening of the left side of the pons.