Arterial spin-labelled perfusion MRI demonstrates early spontaneous recanalisation of clot after cardiogenic embolism

Description

A 71-year-old man with atrial fibrillation was presented to the emergency department 30 min after the sudden onset of disturbance of consciousness. On examination, he showed a disturbance of consciousness (Glasgow Coma Score: E4V2M5) and severe right hemiplegia, which subsequently improved, and he finally presented with moderate sensory aphasia alone. CT of the head showed no haemorrhage. Diffusion-weighted MRI (DW-MRI) of the brain showed a high-intensity spot lesion in the left insular cortex (figure 1A). Arterial spin-labelled (ASL) perfusion MRI showed hyperperfusion in the same area (figure 1B). Based on the dramatic improvement of symptoms and narrower infarction lesion on MRI than was initially anticipated, spontaneous recanalisation of a clot in the left middle cerebral artery was suspected, and oral rivaroxaban was initiated. On day 9, CT showed a mild haemorrhagic lesion on the left temporal lobe cortex (figure 2). On day...

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