Acute A3 occlusion with ACA ischemic penumbra (CT perfusion)

Case contributed by Craig Hacking
Diagnosis certain


Acute onset right leg weakness. Onset 90 minutes before scan.

Patient Data

Age: 70 years
Gender: Male

No hemorrhage, surface collection, mass effect or midline shift. Grey-white matter differentiation is preserved. Small left A3 dense vessel sign on the thin data set. The ventricles and basal cisterns are symmetric and normal for age.

Three-vessel arch. Tortuous proximal left common carotid artery. Occlusive filling defect in the left mid pericallosal artery. The left vertebral artery is dominant. Dural venous sinuses are normal.

Increased time parameters in the posterior medial left cerebral hemisphere indicating distal left ACA penumbra. No evidence of core infarct.

Case Discussion

No intracranial hemorrhage. Ischemic penumbra of the distal left ACA territory associated with a mid-left pericallosal artery thrombus. No core infarct evident.

The patient was not suitable for mechanical thrombectomy but did receive IV thrombolysis.

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