PMC6814312_01
Brain MRI scan of the study subject at the time of admission. (A) Right fronto-parietal cortico-subcortical hyperintensity in fluid-attenuation inversion recovery (FLAIR) axial images. (B) TCCD revealing increased blood flow velocity (mean value: 210.2 cm/s) with turbulence in the right M1 MCA segment, indicative of vasospasm. (C) Control brain MRI showing newly developed bilateral occipital focal hyperintensities in FLAIR axial images, indicative of ischemic stroke.
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Brain MRI showed an acute cortico-subcortical ischemic lesion in the right fronto-parietal region within the vascular territory of the right middle cerebral artery (MCA) (Figure 1A). TCCD revealed increased blood flow velocity in the right proximal MCA segment, with a mean value of 210.2 cm/s (Figure 1B) [cut-off flow velocity for vasospasm: >120 cm/s in the anterior circulation] and normal values in the other major brain regions. The control MRI revealed two new bilateral lacunar strokes in the occipital lobes (Figure 1C). Treatment with antiplatelet drugs (300 mg followed by 100 mg acetylsalicylic acid) was initiated at admission; paracetamol was used for migraine and verapamil (120 mg three times a day) for migraine prophylaxis and vasospasm.