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Key Image

CT head axial, no contrast

CTA head axial, level of MCA

CT Perfusion, Mean Transit Time color image

CT Perfusion, Blood Volume color image

CT Perfusion, Blood Flow color image

Key Findings

Noncontrast CT head image demonstrates minimal low density change in the right insular ribbon (yellow arrow) compared to the normal left side (white arrow). Finding identified retrospectively.

CTA head through the middle cerebral arteries demonstrates discontinuity in the right MCA (yellow arrow) compared to the normal left.

CT Perfusion image demonstrates an area of increased mean transit time in the right frontal lobe, outlined by the black arrows. The left frontal lobe demonstrates normal low mean transit time.

CT Perfusion image demonstrates a small focus of abnormally decreased blood volume in the right frontal lobe, representing an area of infarction. The surrounding area, within the red circle, represents the area of reversible ischemia, the penumbra. *The penumbra is not seen on this image, rather copied over from the Blood Flow images, shown below with the blue circle.

CT Perfusion image demonstrates decreased blood flow in the right frontal lobe (blue circle). This area represents the area of brain ischemia.

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Diagnosis

Acute right middle cerebral infarction with a large area of reversible ischemia

Discussion

This case is an example of a patient presenting with acute right MCA stroke. Utilizing the CT perfusion images, we can determine that the patient has a small area of irreversible infarction with a large area of reversible ischemia, detailed in Case Findings.

References / Resources

Additional Information:

1. Dahnert*: 302
2. Primer*: 369-372
3. Related Article:

   Hoeffner, EG. "Cerebral Perfusion CT: Technique and Clinical Applications." Radiology June 2004: 231, 632-644.

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