Benign oligemia despite a malignant MRI profile in acute ischemic stroke.
BACKGROUND
It has recently been suggested that diffusion and perfusion MRI can identify subgroups likely to benefit or potentially be harmed by reperfusion therapies.


METHODS
We investigated serial MRI data of two patients with occlusion of the proximal middle cerebral artery (MCA). In both cases, acute multiple cortical infarcts evident on diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) showed extensive areas of severe perfusion delays, indicating a malignant MRI profile. However, despite the malignant MRI profiles in these cases, no new ischemic lesions or hemorrhage evolved even in the presence of persistent arterial occlusion, and the patients recovered without sequelae.


CONCLUSIONS
These two cases suggest that time-domain PWI findings should be interpreted with caution in certain scenarios of acute ischemic stroke.
Bang
Oh Young
OY
Department of Neurology and the Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Lee
Kwang Ho
KH
Kim
Suk Jae
SJ
Liebeskind
David S
DS
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