MR Perfusion-Diffusion Mismatch in Acute-Recurrent Ischemic Stroke: Quantitative and Qualitative Progression from Malignant to Misery Profile

We report the use magnetic resonance perfusion to image penumbra, in a patient with acute ischemic stroke as a tool to differentiate candidates forendovascular therapy. A 62-year-old man with three episodes of acute-recurrent ischemic stroke related to infective endocarditis underwent brain MRI on days 1st, 8thand 15th; his perfusion profiles evolve from malignant to misery on days 8thand 15th. Because conventional MRI is relatively insensitive to changes of acute ischemia, it should be supplemented with DWI-PWI sequences to identify patients in the hyperacute-ischemic phase that would benefit from thrombolysis.