Presentation
Left hemispherial acute onset symptoms (moderate right-sided hemiparesis and aphasia).
Patient Data
Subtle subcortical white matter hypodensity in the left frontoparietal watershed area. Signs of chronic small vessel ischemia.
No CTA was performed (history of adverse reaction to CT contrast material), and systemic thrombolysis was initiated.
Rapid stroke protocol MRI...
Rapid stroke protocol MRI FU with TOF MRA 8 hours later
The infarct core appears hyperintense on FLAIR, while on DWI the signal abnormality is more extensive, indicating a significant mismatch and thus the presence of viable penumbra. The examination was supplemented by a TOF MRA which demonstrates no major vessel occlusion.
Case Discussion
Quick stroke protocol MRI has a limited yield with the two most important sequences being FLAIR (core size) and its comparison with the b=1000 DWI (penumbra). TOF is optional but can be done if the vessel patency has not been assessed by prior CTA for any reasons (e.g. contrast agent adverse reactions).