case_images: PMC3015460_01
case_images: 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)
case_images: 415_2010_5690_Fig1_HTML.jpg
case_images: PMC3015460_01_415_2010_5690_Fig1_HTML.jpg
case_images: Fig1
case_images: 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).
case_images: PMC3015460_02
case_images: 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)
case_images: 415_2010_5690_Fig2_HTML.jpg
case_images: PMC3015460_02_415_2010_5690_Fig2_HTML.jpg
case_images: Fig2
case_images: 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.