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Related Experiment Video

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Discrepancy between perfusion- and diffusion-weighted images in ischemic stroke: A case report.

Wook Hur1, Bum Joon Kim2, Byoung-Soo Shin3

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Perfusion CT angiography (p-CTA) can show early signs of stroke, but dynamic imaging changes highlight the need for careful interpretation in acute cerebral infarction cases. A patent foramen ovale was the underlying cause.

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Area of Science:

  • Neurology
  • Radiology
  • Cardiology

Background:

  • Perfusion CT angiography (p-CTA) is increasingly utilized for acute cerebral infarction diagnosis.
  • While effective in differentiating ischemic penumbra and infarct core, its clinical application requires further investigation.

Observation:

  • A healthy 36-year-old man presented with sudden, transient dizziness.
  • Initial CT perfusion suggested left cerebellar infarction, with p-CTA showing delayed transit and increased cerebral blood volume in the left posterior inferior cerebellar artery territory.
  • Neurological examination revealed no abnormalities upon arrival at the emergency room.

Findings:

  • Diffusion-weighted imaging (DWI) several hours later revealed a large right cerebellar infarction, contradicting initial p-CTA findings.
  • The patient developed dysarthria and right-sided limb ataxia prior to DWI.
  • A patent foramen ovale was identified as the embolic source, leading to the stroke.

Implications:

  • This case underscores the potential for rapid, dynamic changes in cerebral infarction imaging within short timeframes.
  • It highlights the importance of considering hemodynamic changes and underlying vascular conditions, such as patent foramen ovale, in stroke diagnosis.
  • The findings suggest that p-CTA results should be interpreted cautiously in conjunction with serial imaging and clinical evolution.