Urgent intervention to reduce functional deficits after postoperative stroke.
BACKGROUND
A 67-year-old right-handed man with a history of atrial fibrillation developed sudden aphasia after urological surgery. Initial diffusion-weighted and perfusion-weighted MRI demonstrated an area of hypoperfusion in Broca's area, with minimal infarction.


METHODS
Neurological examination, language testing and brain MRI scans with diffusion-weighted and perfusion-weighted imaging.


METHODS
Acute cardioembolic stroke with minimal infarction in Broca's area and a surrounding region of potentially salvageable, hypoperfused cortex.


RESULTS
Saline-induced hypertension resulting in rapid restoration of cortical perfusion and a resolution of the initial speech and language deficits. The utility of perfusion-weighted imaging in selecting appropriate candidates for urgent treatment of stroke when thrombolysis is contraindicated is discussed.
Lee
Andrew W
AW
Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 126, Baltimore, MD 21287, USA. alee74@jhmi.edu
Davis
Cameron
C
Puttgen
H Adrian
HA
Hillis
Argye E
AE
D000208:Acute Disease; D000368:Aged; D001039:Aphasia, Broca / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D002545:Brain Ischemia / Q000209:etiology / Q000473:pathology / Q000628:therapy; D005625:Frontal Lobe / Q000098:blood supply; D006801:Humans; D006973:Hypertension; D007262:Infusions, Intravenous / Q000379:methods*; D018810:Magnetic Resonance Angiography; D008297:Male; D011183:Postoperative Complications / Q000473:pathology / Q000628:therapy*; D020127:Recovery of Function; D012965:Sodium Chloride / Q000008:administration & dosage; D020521:Stroke / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D013520:Urologic Surgical Procedures
D012965:Sodium Chloride