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Images in Neurology |

Value of Perfusion Computed Tomography in Stroke Mimics

M. Mehdiratta, MD, FRCPC; M. Selim, MD, PhD
Arch Neurol. 2007;64(9):1348-1349. doi:10.1001/archneur.64.9.1348.
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Perfusion computed tomography (CT) is increasingly being used in the diagnosis and management of patients with strokelike symptoms. By providing information about the cerebral blood flow, volume, and mean transit time, the presence of ischemia can be determined and this can aid in clinical decision making, especially surrounding the use of thrombolytics.

We evaluated an 81-year-old woman with atrial fibrillation and an old left hemispheric infarct for sudden onset of right-sided weakness and aphasia. Her eyes were midline. It was unclear if she had a new infarct or focal seizures. Plain CT revealed an old left lenticulostriate infarct without signs of acute stroke, and CT angiogram did not reveal major vascular occlusion. Perfusion CT revealed an increase in cerebral blood flow and cerebral blood volume and a decrease in mean transit time in the left parieto-occipital and corona radiata areas (Figure 1). These findings were in keeping with hyperperfusion, rather than ischemia. Therefore, we did not treat her with thrombolytics. Electroencephalography did not reveal epileptic activity. Subsequent magnetic resonance imaging revealed the presence of enhancing lesions in the same areas (Figure 2). Brain biopsy confirmed the diagnosis of a malignant glioma.

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Figure 1.

Perfusion computed tomography maps of cerebral blood flow (A), cerebral blood volume (B), and mean transit time (C) showing evidence of increased perfusion in the left parieto-occipital area (arrows).

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Figure 2.

T1-weighted magnetic resonance images with gadolinium showing enhancement in the left corona radiata and parieto-occipital areas. Biopsy confirmed glioblastoma multiforme.

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