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AJNR - American Journal of Neuroradiology

Published ahead of print on April 3, 2008
doi: 10.3174/ajnr.A1069

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MR Imaging–Based Decision in Thrombolytic Therapy for Stroke on Awakening: Report of 2 Cases

C. Iosif^a, C. Oppenheim^a, D. Trystram^a, V. Domigo^b and J.-F. Méder^a

^a Departments of Neuroradiology, Université Paris Descartes, Centre Hospitalier Sainte-Anne, Paris, France
^b Departments of Neurology, Université Paris Descartes, Centre Hospitalier Sainte-Anne, Paris, France

View larger version (45K): [in this window] [in a new window]   Fig. 1. Case 1. Before treatment, FLAIR was normal and DWI showed a mildly hyperintense left putamen. Perfusion abnormalities (CBF decrease) existed in the superficial MCA territory, which was normal on DWI (PWI-DWI mismatch). MRA showed a left proximal MCA occlusion. After IA thrombolysis, the flow was restored in the left MCA. A deep MCA infarct with petechiae and a small cortical infarct in the left inferior frontal gyrus (not illustrated) were seen on 24-hour DWI follow-up.

View larger version (47K): [in this window] [in a new window]   Fig. 2. Case 2. Before treatment, FLAIR was normal while DWI showed punctuate hyperintensities in the superficial MCA territory (inset) and a left MCA occlusion. Perfusion abnormalities existed in the superficial MCA territory, consistent with a large PWI/DWI mismatch. 24-hour MR imaging follow-up showed an additional lesion in the left putamen and MCA recanalisation after IA thrombolysis.