Bilateral MCA (Middle Cerebral Artery) infarct following basal ganglia hemorrhage is a rare entity. We report a 52 year old lady with history of altered sensorium and weakness in right side of body for one day with past history of uncontrolled diabetes mellitus. On examination GCS (Glasgow Coma Scale) was E3V1M5 with right side hemiplegia. NCCT (Non Contrast Computed tomography) head showed left gangliocapsular hemorrhage with intraventricular extension. The patient was managed conservatively. The patient deteriorated three days after (GCS E1V1M1) and repeat NCCT head showed left basal ganglia hematoma with hypodensity in bilateral MCA territory suggestive of infarct. MRI brain confirmed CT findings of bilateral MCA infarct. Carotid doppler of neck vessels revealed a fibrofatty plaque at posterior wall of the carotid bulb on the left side extending into left ICA causing approximately 50% luminal compression. 2D ECHO revealed no clot or vegetations. The patient expired 1 day after. The clinical and radiological features of this rare entity are discussed.

Keywords: Bilateral; Infarct; Hemorrhage.