A case of hemodynamic brain infarction A limitation of positron emission tomography in the prediction of prognosis in a patient with severe extracranial carotid stenosis

• Published in: Japanese Journal of Stroke Vol. 17; no. 1; pp. 80 - 84
• Main Authors: Numata, Satoshi, Nagao, Tetsuhiko, Ibayashi, Setsuro, Sadoshima, Seizo, Fujishima, Masatoshi
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 25.02.1995
• Subjects: border zone; carotid artery disease; hemodynamic brain infarction; positron emission computed tomography (PET)
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.17.80

A 77-year-old woman experienced vertigo when she stood up at midnight. Duplex ultrasonography and digital subtraction antiography revealed severe stenosis (70%) at the proximal portion of the right internal carotid artery. Ambulatory blood pressure monitoring demonstrated a significant fall in blood pressure during the night. In spite of the carotid lesion, cerebral blood flow (CBF), oxygen extraction fraction and cerebral metabolic rate for oxygen (CMRO2), as determined by positron emission tomography (PET), were all within normal limits. Thus, the administration of ticlopidine (100 mg/day) was started. However, two weeks after the PET study, she developed extensive borderzone infarction in the right cerebral hemisphere, which most likely resulted from a hemodynamic catastrophe. The second PET study demonstrated a decrease in CBF with a matched reduction in CMRO2 in the affected cerebral hemisphere. This case suggests the limitation of PET in the prediction of prognosis in patients with severe stenotic lesions in major cerebral artereis.