PMC7332508_01
Diffusion-weighted magnetic resonance imaging revealing hyperintensity in the left motor area.
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F1
MR imaging revealed acute infarction of the left frontal lobe [Figure 1] and bilateral internal carotid artery (ICA) stenosis (Rt: NASCET 90%, peak systolic velocity 425 cm/s and Lt: NASCET 70%, peak systolic velocity 212 cm/s).
(a) Single-photon emission computed tomography (SPECT) revealing a significant decrease in cerebral blood flow (CBF) in the bilateral hemispheres, predominantly on the right side (CBF of middle cerebral artery area, R: 47 ml/100 g/min and L: 50 ml/100 g/min). (b) SPECT showing focal hypoperfusion (white arrow) around an old infarction (CBF of middle cerebral artery area, R: 65 ml/100 g/min and L: 51 ml/100 g/min). (c) SPECT demonstrating gradually normalized CBF in the lesion (CBF of middle cerebral artery area, R: 60 ml/100 g/min and L: 56 ml/100 g/min). (d) SPECT is demonstrating completely normalized CBF of the lesion (CBF of middle cerebral artery area, R: 59 ml/100 g/min, and L: 60 ml/100 g/min).
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F2
After 2 months of rehabilitation, his neurological status improved to a modified Rankin scale score of 0, and single-photon emission computed tomography (SPECT) revealed a decrease in CBF in the right cerebral hemisphere [Figure 2a]. SPECT showed a decrease in CBF around the infarction [Figure 2b]. MR angiography showed a patent left ICA, whereas SPECT indicated a contralateral increase in CBF [Figure 2b]. The CBF improved, and laterality disappeared 2 weeks after surgery [Figure 2c and d].
Time course of changes in cerebrovascular oxygen saturation and blood pressure in our patient.
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F3
The blood flow of both sides equaled 2 weeks later [Figure 3].
(a) Fluid-attenuated inversion recovery images 1 week before surgery with inconspicuous edema of the left frontal lobe. (b) Deterioration of edema the next day after surgery. (c) Almost complete disappearance of edema 2 weeks after surgery.
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F4
Subsequent MR imaging with fluid-attenuated inversion recovery (FLAIR) images revealed a local high-intensity lesion around a previous infarction in comparison with before operation [Figure 4a and b]. FLAIR MR imaging 2 weeks after initial surgery confirmed the complete disappearance of the high-intensity lesion [Figure 4c].