Advanced Imaging Assessment of Posterior Circulation Stroke Before and After Endovascular Intervention
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PRACTICAL PEARL
Advanced Imaging Assessment of Posterior Circulation Stroke Before and After Endovascular Intervention Asif A. Khan • Joseph Gatlin • Hartmut Uschmann Gustavo Luzardo • Razvan Buciuc • Majid Khan
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Published online: 24 August 2010 Ó Springer Science+Business Media, LLC 2010
Abstract Background Perfusion-computed tomography (CTP) is a relatively new technique that allows rapid semiquantitative noninvasive evaluation of cerebral perfusion aiding in the diagnosis of cerebral ischemia and infarction. There is a paucity of data on its application within the posterior circulation, especially, the brainstem. We describe a case of basilar artery thrombosis with cerebellar and brainstem CTP mismatch and discuss possible future applications of CTP for acute posterior fossa circulation and infarction. Methods Case report. Results Successful use of CTP to aid in decision to proceed with neurointervention in acute basilar artery occlusion and confirm its resolution after mechanical clot retrieval. Conclusion Perfusion-computed tomography can successfully be used to define cerebral ischemia and infarction within the posterior fossa and aid in decisions to proceed with neurointervention. Keywords Perfusion-computed tomography Mismatch Basilar Brainstem
Introduction Perfusion-computed tomography (CTP) is a relatively new technique that allows rapid noninvasive qualitative and
A. A. Khan (&) J. Gatlin H. Uschmann G. Luzardo R. Buciuc M. Khan Departments of Neurology, Radiology and Neurosurgery, University of Mississippi Medical Center, 2500 N. State St, Jackson, MS 39216, USA e-mail: [email protected]
semiquantitative evaluation of cerebral perfusion aiding in the diagnosis of cerebral ischemia and infarction [1–3]. There is a paucity of data on its application within the posterior fossa, especially the brainstem [4–9].
Case Report A 48-year-old African-American male with no previous medical history was witnessed to have driven his car off the road. Emergency responders arrived on scene minutes later and noted that he had left sided weakness and severe slurred speech. They transported him to UMC where an acute stroke code was initiated. He arrived an hour after onset of his initial symptoms, and he was hemo-dynamically stable. He was lethargic but fully oriented, with severe dysarthria, accompanied by dense left face, arm, and leg paresis with an NIH stroke scale of 15. In the brief interval between initial assessment and emergent neuroimaging, his respirations became irregular, and his systolic blood pressure dropped to 80, he developed medial rectus palsy on the right and bilateral lateral rectus palsies. He also developed spontaneous jerking limb movements and teeth grinding, which were found to worsen on stimulation. Adventitious passive limb movements or painful stimuli have been described to precipitate a flurry of abnormal movements in patient with similar syndromes and are often misdiagnosed as seizures [10]. At that point, our patient lost airway protection requiring intubation and mechani
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