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Acute ischemic stroke

Quail JFQ - MedPix (2009)

View Article: MedPix Image - MedPix Case

Affiliation: University of Minnesota Medical School

ABSTRACT

Diagnosis: Acute ischemic stroke

History: 82-year-old woman with history of significant coronary and peripheral artery disease with sudden onset of headache and left-sided weakness during a peripheral arterial interventional procedure in the cardiology catheterization lab.

Findings: Stroke protocol consisted of noncontrast head CT, CT perfusion mapping, and CTA of the head and neck. Initial noncontrast head CT scan demonstrated no evidence of intracranial hemorrhage. No dense middle cerebral artery sign or evidence of loss of gray and white matter differentiation. There was subtle asymmetry of right parietal sulci compared to left. CT perfusion demonstrated abnormally prolonged MTT (mean transit time), in a wedge-shaped configuration, involving the distal M3 distribution of the right MCA in the right posterior parietal lobe and posterior frontal lobe. Cerebral blow flow (rCBF) in these two regions was also mildly diminished. Cerebral blood volume (rCBV) in these two regions was relatively normal; however, within the centers of the two wedge-shaped areas of abnormal perfusion there were small areas of decreased blood volume. The summary tissue at risk map indicates a small region of core infarct with a larger region of penumbra. CT angiogram of the neck and head demonstrated no proximal occlusion to the anterior or posterior circulation. MRI performed 6 days later demonstrates subacute infarct in the region of ischemia noted acutely with increased flair and diffusion-weighted signal in the area of interest.

Ddx: Ischemic stroke Vasculitis

Dxhow: CT perfusion imaging coupled with history

Exam: Patient presented with acute onset of headache and left-sided weakness.

No MeSH data available.


Axial CT angiography maximal intensity projection demonstrates no proximal small vessel occlusion.  Incidentally noted absence of the right A1 segment.  No large region of asymmetry in the M3 distribution.
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MPX2246_synpic48550: Axial CT angiography maximal intensity projection demonstrates no proximal small vessel occlusion. Incidentally noted absence of the right A1 segment. No large region of asymmetry in the M3 distribution.


Acute ischemic stroke

Quail JFQ - MedPix (2009)

Axial CT angiography maximal intensity projection demonstrates no proximal small vessel occlusion.  Incidentally noted absence of the right A1 segment.  No large region of asymmetry in the M3 distribution.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2246&req=5

MPX2246_synpic48550: Axial CT angiography maximal intensity projection demonstrates no proximal small vessel occlusion. Incidentally noted absence of the right A1 segment. No large region of asymmetry in the M3 distribution.

View Article: MedPix Image - MedPix Case

Affiliation: University of Minnesota Medical School

ABSTRACT

Diagnosis: Acute ischemic stroke

History: 82-year-old woman with history of significant coronary and peripheral artery disease with sudden onset of headache and left-sided weakness during a peripheral arterial interventional procedure in the cardiology catheterization lab.

Findings: Stroke protocol consisted of noncontrast head CT, CT perfusion mapping, and CTA of the head and neck. Initial noncontrast head CT scan demonstrated no evidence of intracranial hemorrhage. No dense middle cerebral artery sign or evidence of loss of gray and white matter differentiation. There was subtle asymmetry of right parietal sulci compared to left. CT perfusion demonstrated abnormally prolonged MTT (mean transit time), in a wedge-shaped configuration, involving the distal M3 distribution of the right MCA in the right posterior parietal lobe and posterior frontal lobe. Cerebral blow flow (rCBF) in these two regions was also mildly diminished. Cerebral blood volume (rCBV) in these two regions was relatively normal; however, within the centers of the two wedge-shaped areas of abnormal perfusion there were small areas of decreased blood volume. The summary tissue at risk map indicates a small region of core infarct with a larger region of penumbra. CT angiogram of the neck and head demonstrated no proximal occlusion to the anterior or posterior circulation. MRI performed 6 days later demonstrates subacute infarct in the region of ischemia noted acutely with increased flair and diffusion-weighted signal in the area of interest.

Ddx: Ischemic stroke Vasculitis

Dxhow: CT perfusion imaging coupled with history

Exam: Patient presented with acute onset of headache and left-sided weakness.

No MeSH data available.