PMC3015460_01
CT and MRI findings of patient 1. CT perfusion demonstrates an elevated cerebral blood volume (CBV) (a) and cerebral blood flow (CBF) (b) and a decreased mean transit time (MTT) (c) in the left parietal area, compatible with increased perfusion. Noncontrast CT reveals a left parietal hypodensity (d). T1-weighted MRI shows a left parietal hypointense lesion (e) with irregular rim enhancement after gadolinium injection (f)
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Fig1
Noncontrast brain CT showed a left parietal hypodensity (Fig. 1d). Perfusion CT showed abnormalities in the same region, compatible with hyper- rather than hypoperfusion (Fig. 1a-c). MRI demonstrated a lesion, most likely being a high-grade glioma (Fig. 1e, f).
PMC3015460_02
CT and MRI findings of patient 2. Noncontrast CT shows periventricular white matter lesions (a). CT angiography shows a patent right carotid artery (b) and pronounced intracerebral arteries in the right hemisphere (c) Perfusion CT demonstrates an elevated CBV (d) and CBF (e) and a decreased MTT in the right hemisphere (f). MRI 1 day later shows, in comparison to a recent previous MRI (not shown), unchanged periventricular white matter lesions (g) and new hyperintensities in the subcortical white matter on the FLAIR sequence (j) and no hyperintensities on the diffusion-weighted sequence (h, k) or hypointensities on the ADC map (i, l)
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Fig2
On CT angiography, the right internal carotid artery was patent (Fig. 2a, b). CT showed asymmetry between the right and left hemispheres, with increased flow on the right (Fig. 2d-f). Cerebral hyperperfusion syndrome (CHS) was diagnosed and she was treated with antihypertensives.  T2-weighted sequence, but no hyperintensity on the diffusion-weighted sequence or corresponding hypointensity on the apparent diffusion coefficient (ADC) map (Fig. 2g-l). This ruled out new ischaemia and was compatible with CHS.