Prolonged diffusion-perfusion mismatch after recanalization of occludedmajor cerebral artery: a case report

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  • 閉塞脳主幹動脈の再開通後にdiffusion-perfusion mismatchの遷延が認められた1例

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A diffusion-perfusion mismatch (DPM) has been reported as an ischemic penumbra (tissue at risk) in acute ischemic cerebrovascular disease. We describe prolonged DPM after recanalization of an occluded major cerebral artery. A 67-year-old man was admitted to our hospital with right hemiplegia and total aphasia at 35min after the symptom onset. Electrocardiography showed arterial fibrillation. Magnetic resonance imaging detected fresh infarcts in the left anterior cerebral artery (ACA) area and in the watershed area between the left middle cerebral (MCA) and posterior cerebral arteries. Magnetic resonance angiography (MRA) and CT angiography showed only left ACA occlusion. A CT perfusion study revealed a prolonged mean transit time (MTT) in both the left ACA and the left MCA territory. The patient was treated with heparin and warfarin as he was contraindicated for therapy with the intravenous tissue plasminogen activator because he had a PT-INR 1.88 (>1.7). His symptoms improved on the second hospital day, and the follow-up MRA demonstrated recanalization of the left ACA. A repeated CT perfusion study at 26days after the symptom onset confirmed improvements in the MTT abnormalities. The presence of prolonged DPM on acute ischemic stroke suggested that DPM did not necessarily mean the occlusion of the major cerebral artery. In considering DPM on acute ischemic stroke, it is needed to comprehensively evaluate the clinical ischemic state with the imaging of cerebral vessels.

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