Figure 11: 85-year-old male presented 3 hours post-ictus with left hemiplegia.
(A) NCCT demonstrates no hemorrhage and minimal hypodensity in the right MCA territory.
(B) CTA 3D reconstructed image reveals an embolus in the M1 segment of the right MCA (arrow).
(C) CTP shows large CBV/CBF, MTT mismatch. The CBF and MTT maps demonstrate a large perfusion abnormality in the left MCA territory (arrows). The CBV is slightly decreased in this region.
(D) Cerebral angiogram via right internal carotid artery injection reveals a right M1 embolus (arrow).
(E) Cerebral angiogram following thrombolytic therapy shows dissolved clot with restored blood flow to the right MCA territory (arrow).
(F) Follow-up CT 3 days later shows small infarcted region in the right basal ganglia (arrow), corresponding to the region of lowest CBV, reflecting irreversibly injured tissue despite therapy.