Early carotid endarterectomy after ischemic stroke improves diffusion/perfusion mismatch on magnetic resonance imaging: Report of two cases

Satish Krishnamurthy, David Tong, Kevin P. McNamara, Gary K. Steinberg, Kevin M. Cockroft, Bob S. Carter, Christopher S. Ogilvy, Robert J. Dempsey

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


OBJECTIVE AND IMPORTANCE: The functional magnetic resonance imaging techniques of diffusion-weighted imaging and perfusion-weighted imaging allow for ultra-early detection of brain infarction and concomitant identification of blood flow abnormalities in surrounding regions, which may represent brain "at risk." CLINICAL PRESENTATION: We report two patients with acute ischemic stroke associated with ipsilateral high-grade carotid stenosis. The first patient, a 64-year-old woman with a remote history of ischemic stroke and a vertebral artery aneurysm, presented with worsening of her preexisting right hemiparesis. The second patient, another 64-year-old woman with known multiple intracranial aneurysms and bilateral high-grade internal carotid artery stenosis, was admitted for the elective microsurgical clipping of an enlarging giant left carotid-ophthalmic artery aneurysm. Postoperatively, she developed right hemiparesis and mild aphasia. Both patients showed progressive worsening of their neurological deficits in the setting of small or undetected diffusion-weighted imaging abnormalities and large perfusion-weighted imaging defects. INTERVENTION: After prompt carotid endarterectomy, symptoms in both patients resolved or improved. Follow-up magnetic resonance imaging scans demonstrated resolution or significant improvement in the perfusion abnormalities in both patients. CONCLUSION: Carotid endarterectomy in the setting of diffusion-weighted/perfusion- weighted imaging mismatch can lead to improvement in cerebral perfusion as evidenced by resolution of the perfusion-weighted imaging lesion. Diffusion/perfusion magnetic resonance imaging may be useful in identifying patients with severe neuro-logical deficits but without large territories of infarction who may safely undergo early surgical revascularization.

Original languageEnglish (US)
Pages (from-to)238-242
Number of pages5
Issue number1
StatePublished - Jan 1 2003

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology


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