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FIG 1. Images from the case of patient 1, an 88-year-old woman.
A, Isotropic trace diffusion image (5900/159/2 [TR/TE/excitations]) shows normal signal (left). Time-to-peak perfusion map (2199/82/35) (right) shows hypoperfusion throughout the left posterior cerebral artery territory. Although these images were obtained within a therapeutic window, no symptoms referable to this distribution were encountered until hours later. The patient was treated "conservatively" in an intensive care unit and received heparin. The results were evident at the 48-hour follow-up examination.
B, Repeat isotropic trace diffusion image shows the progression to infarct rather than ischemia in the left posterior cerebral artery territory (left). A T2-weighted (3500/96/1) image (right) reveals not only infarct but also hemorrhage, with mass effect presumably from the combination of infarct and heparin
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