case_images: PMC10884197_01
case_images: Brain MRI at initial onset showing no apparent lesions (A, DWI; B, FLAIR). MRA shows occlusion of the left posterior cerebral artery (C1, arrow), which was recanalized at the next follow-up 6 months later (C2, arrow). CT perfusion images showing a delay in the time-to-peak map (D1, arrows) and reduced cerebral blood flow (D2, arrows) in the left posterior cerebral artery. MRI, magnetic resonance imaging; MRA, magnetic resonance angiography; CT, computed tomography; DWI, diffusion-weighted image; FLAIR, fluid-attenuated inversion recovery.
case_images: fneur-15-1347646-g001.jpg
case_images: PMC10884197_01_fneur-15-1347646-g001.jpg
case_images: fig1
case_images: DWI and fluid-attenuated inversion recovery (FLAIR) sequences performed on the day the headache started were normal (Figures 1A,B). However, magnetic resonance angiography (MRA) revealed occlusion of the left posterior cerebral artery (PCA) (Figure 1C1). Computed tomography (CT) perfusion revealed a delay in the time-to-peak map and reduced cerebral blood flow in the left occipital lobe (Figure 1D). Follow-up MRA 6 months later revealed recanalization of the occluded left PCA (Figure 1C2).
case_images: FLAIR sequences on MRI performed 10 years after onset showing diffuse brain atrophy, particularly in the bilateral temporal lobes and subtle high signal intensities in the bilateral temporal corticomedullary junction (arrows). Paravertebral high-intensity signal changes were observed a few years earlier than cortical changes (triangles). No abnormally high signal intensity was observed on diffusion-weighted MRI. FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging.
case_images: fneur-15-1347646-g002.jpg
case_images: PMC10884197_01_fneur-15-1347646-g002.jpg
case_images: fig2
case_images: DWI at each episode revealed no abnormalities; however, MRA and CT perfusion demonstrated variable findings, ranging from normal to reduced blood flow in the right or left parietal-temporal lobe (Figure 2). However, no abnormally high signal intensity was observed on DWI (Figure 2).