CT perfusion - hemipontine infarct

Case contributed by Dr Yune Kwong


Acute onset left sided weakness, ataxia, dysarthria.

Patient Data

Age: 60-65 years old
Gender: Female

On the plain CT, hypodensities are seen in the pons and it is not clear if they are artefacts, infarcts or small vessel ischaemic change. There is raised MTT and TTP in the right hemi-pons, with low CBF consistent with ischaemia. The symmetrical CBV would suggest penumbra rather than core. Note that these perfusion changes are not demonstrated by the fused image provided by the software, showing the importance of not relying on these images. 


MRI 8 days after presentation.

Evolution to established acute infarct in the right hemi-pons as predicted by CT perfusion. Old infarct in left hemi-pons noted. 

Case Discussion

One of the traditional pitfalls of CT perfusion is limited coverage of the brain. However with improving multi-detector CT, larger coverage can be obtained (at the cost of increased radiation dose). The posterior fossa can be difficult to analyse due to streak artefacts and the small volume of brain. However, as demonstrated in this case, acute infarcts can also be picked up in the posterior fossa. In the setting of an apparently 'normal' CT perfusion, the brainstem and cerebellar hemispheres should be review areas. 

PlayAdd to Share

Case information

rID: 33151
Published: 2nd Jan 2015
Last edited: 14th Dec 2016
Inclusion in quiz mode: Included

Updating… Please wait.

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.