J Clin Neurol.  2010 Mar;6(1):41-45. 10.3988/jcn.2010.6.1.41.

Benign Oligemia Despite a Malignant MRI Profile in Acute Ischemic Stroke

• Bang OY
• Lee KH
• Kim SJ
• Liebeskind DS

• KMID: 2135481
• DOI: http://doi.org/10.3988/jcn.2010.6.1.41

Abstract

BACKGROUND
It has recently been suggested that diffusion and perfusion MRI can identify subgroups likely to benefit or potentially be harmed by reperfusion therapies.
CASE REPORT
We investigated serial MRI data of two patients with occlusion of the proximal middle cerebral artery (MCA). In both cases, acute multiple cortical infarcts evident on diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) showed extensive areas of severe perfusion delays, indicating a malignant MRI profile. However, despite the malignant MRI profiles in these cases, no new ischemic lesions or hemorrhage evolved even in the presence of persistent arterial occlusion, and the patients recovered without sequelae.
CONCLUSIONS
These two cases suggest that time-domain PWI findings should be interpreted with caution in certain scenarios of acute ischemic stroke.

Keyword

stroke; ischemia; perfusion; collaterals; magnetic resonance imaging

MeSH Terms

Diffusion
Hemorrhage
Humans
Ischemia
Magnetic Resonance Imaging
Middle Cerebral Artery
Perfusion
Reperfusion
Stroke

Figure

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  Fig. 1 MRI and CT angiography findings for patient 1 obtained on admission. DWI: diffusion-weighted imaging, FLAIR: fluid-attenuated inversion recovery, CBV: cerebral blood volume.

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  Fig. 2 Follow-up MRI and MR angiography findings for patient 1. DWI: diffusion-weighted imaging, FLAIR: fluid-attenuated inversion recovery.

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  Fig. 3 MRI and angiography findings for patient 2. DWI: diffusion-weighted imaging, FLAIR: fluid-attenuated inversion recovery.

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