Fig. 3.
Demonstration of ischemia-reperfusion injury using serial multimodal MRI. a A 68-year-old woman with untreated atrial fibrillation presenting with aphasia, hemianopsia, right-sided weakness and sensory loss. The patient was treated with intravenous tPA followed by mechanical recanalization with MERCI device (AOL 3, TICI 2a). Serial change in Tmax shows improved perfusion; the perfusion deficit (Tmax >6 s) changed from 17.9 to 7.1 ml with resultant cell death (FLAIR) in spite of improved perfusion at follow-up day 5. b A 78-year-old woman with untreated paroxysmal atrial fibrillation presenting with left-sided hemiparesis, neglect and dysarthria. The patient was treated with intravenous tPA followed by mechanical recanalization with Penumbra device (AOL 2, TICI 2b). Serial change in Tmax shows improved perfusion; the perfusion deficit (Tmax >6 s) changed from 16.5 to 3.4 ml with resultant hemorrhagic transformation (GRE) in spite of improved perfusion at follow-up day 5.