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Computed tomography perfusion imaging in spectacular shrinking deficit.

Vivien H Lee¹, Sayona John, Yousef Mohammad

¹Department of Neurological Sciences, Section of Cerebrovascular Disease and Neurological Critical Care, Rush University Medical Center, Chicago, IL 60612, USA. vivien_lee@rush.edu

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association

|August 13, 2010

Summary

Spectacular shrinking deficit (SSD) stroke patients show rapid clinical improvement. Computed tomography perfusion (CTP) imaging reveals a shrinking perfusion defect that lags behind clinical recovery, aiding understanding of SSD.

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Area of Science:

Neurology
Radiology
Stroke Medicine

Background:

Spectacular shrinking deficit (SSD) is a rare stroke syndrome with abrupt onset and rapid improvement.
Understanding the neuroimaging correlates of SSD is crucial for diagnosis and management.

Purpose of the Study:

To investigate the clinical and imaging characteristics of SSD using computed tomography perfusion (CTP) and magnetic resonance imaging diffusion-weighted imaging (DWI).
To correlate the "shrinking" clinical deficit with perfusion abnormalities in SSD patients.

Main Methods:

Retrospective review of 472 ischemic stroke patients from December 2007 to June 2009.
Identified 8 SSD patients with major hemispheric stroke syndrome (NIHSS ≥8) and available CTP data.
Analyzed CTP for perfusion defects (ischemic penumbra) and DWI for final infarct core.

Main Results:

Mean time to dramatic recovery was 3.4 hours; mean time to CTP was 12.7 hours.
All 8 patients showed perfusion abnormalities in the middle cerebral artery (MCA) territory.
Repeat CTP in 4 patients demonstrated resolution of perfusion defects, lagging behind clinical recovery.

Conclusions:

SSD is characterized by a "shrinking" clinical syndrome and a corresponding "shrinking" perfusion pattern on CTP.
CTP imaging helps understand the larger at-risk territory in SSD and its temporal evolution.
The perfusion defect on CTP resolves later than the clinical improvement in SSD.