case_images: PMC7749935_01
case_images: A 53-year-old male found to have small wedge-shaped acute cerebellar infarcts (not shown). (a) TOF MRA images show partial occlusion and severe stenosis of the left V4 segment (white arrow). (b) ASL shows increased intravascular signal corresponding to the occlusion and stenosis (white arrow). (c) Tmax does not show any definite perfusion abnormality.
case_images: JCIS-10-78-g001.jpg
case_images: PMC7749935_01_JCIS-10-78-g001.jpg
case_images: F1
case_images: Subsequent MR [Figure 1] performed revealed bilateral acute cerebellar infarcts, right greater than left, with diminished related enhancement in the left V4 segment on MRA.
case_images: PMC7749935_02
case_images: A 64-year-old male found to have an acute left PICA infarct. (a) DWI shows the extent of the left PICA infarct. (b and c) TOF MRA shows occlusion of the left V4 segment (red arrows). (d) ASL shows increased intravascular signal at or immediately distal to the occlusion (red arrow) in addition to decreased signal corresponding to the core infarct (yellow dashed circle). (e) GRE shows intravascular clot within the mid to distal left PICA (red arrow). (f) Tmax image shows a perfusion delay within the left PICA territory (red arrow).
case_images: JCIS-10-78-g002.jpg
case_images: PMC7749935_02_JCIS-10-78-g002.jpg
case_images: F2
case_images: The patient was sent directly to MRI, which demonstrated an acute left PICA territory infarct [Figure 2] with lack of flow-related enhancement in the vertebral artery on MRA and intravascular clot noted in the distal PICA on GRE.
case_images: PMC7749935_03
case_images: An 89-year-old female with an acute left cerebellar and medullary infarct. (a) DWI shows infarcts within the left posterior medulla and cerebellum (white arrow). (b) TOF MRA shows occlusion of the left v4 segment (white arrow). (c) GRE shows corresponding intravascular clot (yellow arrow). (d and e) ASL shows increased intravascular signal within the occluded vessel (red arrow). (f) Tmax shows perfusion delay within the visualized left cerebellum.
case_images: JCIS-10-78-g003.jpg
case_images: PMC7749935_03_JCIS-10-78-g003.jpg
case_images: F3
case_images: MR showed acute left cerebellar infarcts with intravascular clot on GRE and occlusion of the left vertebral artery on MRA [Figure 3].
case_images: PMC7749935_04
case_images: A 68-year-old male an acute right PICA infarct. (a) DWI shows the extent of the infarct. (b) TOF MRA shows occlusion of the right V4 segment (red arrow). (c) ASL shows increased intravascular signal immediately proximal to the occlusion (yellow arrow). (d and e) GRE shows intravascular clot corresponding to the occlusion (blue arrow). (f) Tmax shows a corresponding right cerebellar perfusion delay.
case_images: JCIS-10-78-g004.jpg
case_images: PMC7749935_04_JCIS-10-78-g004.jpg
case_images: F4
case_images: MR revealed an acute right cerebellar infarct with both intravascular clot and occlusion of the right vertebral artery and distal right PICA [Figure 4].
case_images: PMC7749935_05
case_images: A 48-year-old female with the left occipital infarcts. (a) DWI shows multiple infarcts within the left occipital lobe (yellow arrow). (b and c) TOF MRA shows the occlusion of a distal left P3 branch (yellow arrows). (d) GRE shows a punctate focus thought to represent intravascular clot (blue arrow). (e) ASL shows a focus of increased signal at the occlusion site (white arrow). (f) Tmax delay is noted in the medial left occipital lobe (yellow arrow).
case_images: JCIS-10-78-g005.jpg
case_images: PMC7749935_05_JCIS-10-78-g005.jpg
case_images: F5
case_images: Subsequent MRI revealed small acute left occipital infarcts with a faint susceptibility corresponding to the medial occipital branch of the left PCA on GRE, representing tiny clot [Figure 5].
case_images: PMC7749935_06
case_images: A 79-year-old male with the left thalamic infarcts. (a) DWI shows the punctate infarcts within the left dorsolateral thalamus. (b) GRE shows intravascular clot within the left P2 segment (white arrow). (c) ASL shows increased intravascular signal distal to the left P2 occlusion (white arrow). (d) Tmax delay is demonstrated within the left medial occipital lobe in the left PCA territory (yellow arrow).
case_images: JCIS-10-78-g006.jpg
case_images: PMC7749935_06_JCIS-10-78-g006.jpg
case_images: F6
case_images: Intravascular clot and lack of flow-related enhancement were both detected and consistent with partial occlusion of the parietooccipital branch of the left PCA [Figure 6].
case_images: PMC7749935_07
case_images: A 59-year-old male with infratentorial infarcts. (a) DWI shows infarcts involving the cerebellar hemispheres bilaterally and vermis. (b) TOF MRA shows compete and partial occlusions (red arrow) of the right and left (yellow arrow) V4 segments, respectively. (c)ASL shows increased intravascular signal within the bilateral V4 segments (right V4, red arrow; left V4, yellow arrow). (d) Tmax was motion degraded and partially evaluated the infratentorial brain, limiting diagnostic evaluation, but showed questionable abnormality in the infarcted regions (white arrows).
case_images: JCIS-10-78-g007.jpg
case_images: PMC7749935_07_JCIS-10-78-g007.jpg
case_images: F7
case_images: MRI, however, demonstrated bilateral inferior cerebellar acute infarcts [Figure 7].
case_images: PMC7749935_08
case_images: A 60-year-old female with acute kidney injury who was found to have a left PCA infarct. (a) DWI shows acute infarcts in the left anterior thalamus with involvement of the posterior limb of the internal capsule as well as the left hippocampal tail. (b) TOF MRA shows an abrupt cutoff representing the occlusion. (c) GRE shows corresponding intravascular clot. (d) ASL shows increased intravascular signal both proximal and distal to the left P1 occlusion (red/white and blue arrows respectively) in addition to decreased signal in the left medial occipital lobe (yellow arrow).
case_images: JCIS-10-78-g008.jpg
case_images: PMC7749935_08_JCIS-10-78-g008.jpg
case_images: F8
case_images: MRI then demonstrated acute left thalamic and hippocampal tail infarcts [Figure 8].
case_images: PMC7749935_09
case_images: A 54-year-old male with acute kidney injury found to have a left PCA infarct. (a) DWI shows the extent of the left PCA infarct. (b) TOF MRA shows the abrupt cutoff of the left P2 segment compatible with occlusion (blue arrow). (c) GRE shows corresponding intravascular clot (white arrow). (d) ASL shows increased intravascular signal proximal to the left P2 occlusion (white arrow) with decreased signal in the left medial occipital lobe (yellow arrow).
case_images: JCIS-10-78-g009.jpg
case_images: PMC7749935_09_JCIS-10-78-g009.jpg
case_images: F9
case_images: Due to acute kidney injury, MRI was performed without IV contrast and revealed an acute left PCA territory infarct with intravascular clot and occlusion of the P2 segment of the left PCA on GRE [Figure 9].