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CASE REPORT
Year : 2020  |  Volume : 6  |  Issue : 3  |  Page : 211-214

Overestimation of core infarct by computed tomography perfusion in the golden hour


1 Department of Neurology and University of Iowa Hospitals and Clinics, Iowa City, IA, USA
2 Department of Neurology; Department of Neurosurgery; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
3 Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

Correspondence Address:
Santiago Ortega-Gutierrez
Department of Neurology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 2155 Roy Carver Pavilion, Iowa City, IA 52242
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bc.bc_7_20

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A nonagenarian patient developed a right middle cerebral artery syndrome during recovery after a right internal carotid artery (ICA) balloon angioplasty. Emergent head computed tomography (CT) revealed no acute ischemic changes; CT angiography (CTA) and CT perfusion (CTP) demonstrated a right ICA occlusion with a large right hemispheric predicted core infarct by cerebral blood flow thresholds and minimal mismatch volume. She underwent complete reperfusion in <45 min from symptom onset. Magnetic resonance imaging brain obtained within 48 h showed a decreased infarct volume as that estimated by CTP. This case emphasizes the limitations of estimating the ischemic core with CTP in the golden hour with ultra-early reperfusion and suggests that CTP thresholds should not be used to exclude patients from treatment in the very early time window.


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