Abstract
We report the case of a 65 year-old woman with acute MCA embolism. Acute stage diffusion weighted MRI showed a limited high intensity area in the left MCA territory, while Tc99mHMPAO SPECT demonstrated hypoperfused area in the entire left MCA territory. She underwent the embolectomy. After the operation, she recovered from aphasia and right hemiparesis. The highintensity area demonstrated by diffusion weighted MRI became overt infarction on T2 weighted MRI taken 1 month later. However, the hypoperfused area where diffusion MRI did not show abnomal high intensity was saved from infarction.
Diffusion weighted MRI (DWI) in acute occlusion of the major cerebral vessels.
We investigated the relation between DWI findings and regional cerebral blood flow (measured by SPECT) in 95 patients with acute stroke. In 87 cases (91.6%), DWI showed an irreversible ischemic lesion in the early stage as a high-intensity area (HIA). The extent of HIA was related to the degree of reduction in cerebral blood flow and to the time from the onset. Thirty-nine patients (out of 95 patients) with major cerebral vessel occlusion were classified into 4 types. Type 1: no HIA, 3 cases; Type 2: limited HIA in perforators area, 9 cases; Type 3: limited HIA in cortex, 11 cases; Type 4: extended HIA, 16 cases.
Reperfusion therapy may be indicated for patients classified into Type 1, 2, and 3. However, patients classified into Type 4 may not be suitable for revascularization therapy.
