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Images in Neurology
March 2016

Altered Brain Computed Tomography Perfusion in Patients With Fluctuating Lacunar Syndrome and Normal Magnetic Resonance Imaging

Author Affiliations
  • 1Functional Unit of Cerebrovascular Diseases, Hospital Clinic, Barcelona, Spain
  • 2Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
  • 3Department of Radiology, Hospital Clinic, Barcelona, Spain
  • 4Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Spain
JAMA Neurol. 2016;73(3):348-349. doi:10.1001/jamaneurol.2015.4026

We present the cases of an 83-year-old woman and a 53-year-old man who presented to the emergency service with acute right hemiparesis and right ataxic-hemiparesis within 3 hours from symptom onset. The nonenhanced computed tomography (CT) scan was normal while the CT perfusion (CTP) scan showed a delay in time maps in the left pons and in the left thalamus, respectively (Figure). The first patient was treated with intravenous thrombolysis and partially recovered whereas the second patient recovered spontaneously. In both cases, magnetic resonance imaging within 24 hours of admission did not show any acute ischemic lesion on diffusion-weighted imaging (DWI) (Figure). Both patients had progression of the initial focal deficit (3 days and 1 day after admission, respectively), and a repeated magnetic resonance image (Figure) demonstrated hyperintensities on DWI in the left paramedian and thalamoperforator territories, matching with the previous CTP abnormalities and consistent with mature infarctions.