PMC4910610_01
Neuroimaging in the emergency department. Notes: (A) CT brain scan shows the absence of hemorrhage or previous ischemic brain lesions. (B) CT angiography demonstrating normal contrast filling of the intracranial vessels.. Abbreviation: CT, computerized tomography.
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No acute or chronic lesions were present in the brain computerized tomography (CT) (Figure 1A). CT angiography did not reveal any evident thrombus in proximal intracranial vessels (Figure 1B).
CT perfusion scan during the acute phase.. Notes: No asymmetries between both hemispheres are present in the cerebral blood flow (A), volume (B), or mean transit time (C) sequences.. Abbreviation: CT, computerized tomography.
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Perfusion CT showed no volume or medium transit time alterations (Figure 2).
Post-thrombolysis 3T MRI.. Notes: (A) DWI-MRI sequence shows the absence of acute damage to the brain. (B) T1-weighted MRI sequences demonstrate the presence of a small acute subarachnoid hemorrhage in the right occipital lobe (arrow), not present in the emergency CT scan upon admission (C).. Abbreviations: DWI-MRI, diffusion-weighted imaging MRI; MRI, magnetic resonance imaging; CT, computerized tomography; 3T MRI, 3 tesla resolution magnetic resonance imaging..
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A second CT scan 24 hours after treatment with tPA was normal, but later brain magnetic resonance imaging (MRI) showed a convexal subarachnoid hemorrhage in the right occipital lobe, not present in the previous images, inconsistent with the initial symptoms and that went clinically unnoticed (Figure 3).