Board Review 2 – Case 14

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows a patient with a new neurologic deficit and a relatively normal noncontrast head CT. Perfusion, on the other hand, shows an area of decreased CBV, increased MTT, and increased Tmax in the posterior aspect of the left middle cerebral artery (MCA) distribution. There is an associated vessel occlusion on CT angiogram.

The diagnosis is: cerebral ischemia (stroke)

This patient has an area of ischemia in the left MCA territory. Because the CBV is relatively maintained, this tissue is mostly considered penumbra. When there is a significant decrease in volume and flow, it is considered core infarct that is not likely to recover.