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AJNR - American Journal of Neuroradiology

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Reversibility of an "Apparent" Infarct on Dynamic Perfusion CT after Lytic Therapy: Comment Regarding Cerebral Blood Flow and Blood Volume Thresholds

A. McKinney^a, C.L. Truwit^a and S. Kieffer^a

^a Department of Radiology
University of Minnesota Medical School and
Hennepin County Medical Center
Minneapolis, Minn

View larger version (36K): [in a new window]   Fig 1. A 75-year-old man underwent a 3-part stroke protocol within 2 hours of the onset of aphasia and right-sided facial and upper extremity weakness. Typical unenhanced CT (A) findings of chronic small vessel ischemic disease revealed neither hemorrhage nor typical findings of acute infarction. CTP showed a wedge-shaped area of nondetectable flow on CBF (B) and CBV (C) maps in the posterior frontal and anterior parietal lobes (gray color represents an unmeasurable number such as 0 or infinity), which would typically suggest infarction with a small penumbra anteriorly. Lytics were given promptly with complete resolution of the patient’s symptoms within minutes. MR imaging DWIs obtained <24 hours later demonstrated no corresponding abnormality (D), and turbo FLAIR images (not shown) confirmed the chronic deep white matter findings.