In Reply We thank Luo and colleagues for their interest and comments regarding our article on patients presenting lacunar syndrome with altered brain computed tomography perfusion (CTP) and normal magnetic resonance imaging (MRI) findings.1
They are correct that CTP and MRI were not done simultaneously in the 2 patients, which would have added interesting information on the time course of development of those lesions. We also agree that cytotoxic edema visible on MRI may require some time to develop and that the hypoperfusion seen in CTP must, therefore, exist before the MRI captures the lesion. Consequently, clinical fluctuations may be the result of the progression of the ischemic process leading to a positive follow-up MRI finding.
Rudilosso S, Urra X, Chamorro Á. Computed Tomography Perfusion and Diffusion-Weighted Imaging in Patients With Acute Stroke—Reply. JAMA Neurol. 2016;73(8):1032-1033. doi:10.1001/jamaneurol.2016.1683