Computed tomography perfusion ischemic core underestimation: a perfusion scotoma case

An 82 yo man with aphasia and right-side weakness per formed NCCT and single-phase CTA from 2.5 h from symptoms onset in spoke center that showed a large paren chymal hypodensity referring to acute ischemic stroke with ASPECT score of 6 (Insula, M2, M3, M6 segments) due to distal M1 cerebral artery occlusion. 3.5 h later, neuro imaging study protocol with NCCT, multi-phase CT-Angi ography and CT-Perfusion in hub center was repeated. CT Perfusion was realized with OLEA Perfusion Software that defne total hypoperfused tissue with Tmax>6 s and infarct core with rCBF<40%. A spontaneous partial vascular reca nalization with leptomeningeal vasodilatation occurred and CTP showed a little ischemic core (3,8 ml) and large penum bra (108,5 ml). 3 days after, NCCT uphold the ischemic core size. This case shows a typical Perfusion Scotoma with underestimation of ischemic core volume>6 h from symp tom onset due to early reperfusion from partial recanaliza tion as well as luxury perfusion