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Images in Neurology
April 2009

Devoid of Flow

Arch Neurol. 2009;66(4):536. doi:10.1001/archneurol.2009.7

A 55-year-old, previously healthy woman presented with neglect and left hemiplegia 5½ hours after onset of symptoms. Her deficits did not improve, and brain magnetic resonance imaging performed 36 hours after symptom onset revealed a large right subcortical infarction with cortical sparing. T2-weighted sequences showed an apparent flow void in the proximal right middle cerebral artery (MCA), suggesting normal flow (Figure). However, gradient echo sequences demonstrated a hypointense signal in the right MCA consistent with thrombus. Magnetic resonance angiography subsequently confirmed a right MCA occlusion and demonstrated a cervical internal carotid artery dissection, which was the presumed stroke mechanism. At 3-month follow-up, her neglect had resolved, but she had persistent moderate hemiparesis that affected the arm more than the leg. Her modified Rankin scale score was 3.

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