CT perfusion - lacunar infarct

Case contributed by Dr Yune Kwong

Presentation

Stroke code - acute left sided weakness

Patient Data

Age: 60-65 years old
Gender: Male
CT

Plain CT appears normal. The perfusion parameters show raised MTT/TTP with low CBF, but preserved CBV in the right internal capsule posterior limb/thalamus, consistent with penumbra. Note that the MTT/CBV fusion map does not demonstrate these findings showing the importance of reviewing the perfusion maps. The patient was thrombolysed shortly after the scan. 

MRI

MRI 3 weeks later

MRI shows sub-acute infarct in the abnormal region on CT perfusion.

Case Discussion

CT perfusion maps have low resolution and small infarcts can be easily missed. Also, it can be difficult to determine if a small area of abnormal perfusion represents artefact or infarct. However, as this case demonstrates, small infarcts can be seen with modern machines and software (also, there was good correlation between imaging findings and patient symptoms). 

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Case information

rID: 33152
Case created: 2nd Jan 2015
Last edited: 16th Dec 2015
Inclusion in quiz mode: Included

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