A 46-year-old woman with sudden headache admitted to our hospital complaining of left hemi paresis hemiparesis. Magnetic resonance imaging (MRI) revealed acute right middle cerebral artery (MCA) territory infarction. MR angiography (MRA) showed a narrowing of the right MCA and MRA original image showed a double lumen in the right MCA, indicating MCA dissection. TTP (time to peak) map of CT perfusion (CTP) images showed peak time delay with corresponding decrease in blood flow of right MCA territory. Conservative therapy was adopted and her symptom was improved gradually. Follow-up CTP image showed steady improvement compared with on admission in accordance with morphological repair of the right MCA dissection.
Dissection of the MCA dissection in is less frequent compared with dissection of the vertebrobasilar system or carotid artery. The diagnosis of MCA dissection is not easy. With advances in noninvasive angiographic diagnostic procedures, this type of dissection is being increasingly recognized. But the sensitivity of the findings of double lumen and intimal flap is not satisfactory. CTP can be one of the useful tools for recognizing morphologic changes indirectly in MCA dissection by detecting cerebral perfusion changes.
