2109 - CT Perfusion : similar appearances, different diagnoses

Published Date: 01st May 2024

Publication Authors: Liaretidou. A, Elnagi. F, Rusu. C

Background and aims
CT brain perfusion (CTP) scans are frequently used by stroke centres to assess stroke patients. In increasing availability of CTP we have found that their diagnostic value is high in both assessing mismatch volumes in ischaemic areas, and offering alternative diagnoses. Our aim is to illustrate the importance of correlation between CTP, clinical presentation and the findings of unenhanced CT/MRI brain and CT/MR angiogram.

Methods
We have reviewed two cases of patients presenting with stroke-like symptoms with similar looking CTP scans on admission. We have examined their initial clinical presentations and imaging, including unenhanced CT head, CT angiogram and MRI brain.

Results
Both CTP scans showed hyperperfusion indicative of seizure activity. In the first case, the patient’s clinical presentation was more in keeping with seizure activity and subsequent MRI brain excluded stroke as the cause of his symptoms. In the second case, the patient’s clinical presentation was more in keeping with stroke and despite CTP not identifying a mismatch he was appropriately treated with intravenous thrombolysis with subsequent MRI brain confirming pontine infarcts.

Conclusions
In depth analysis of these two cases illustrates the importance of correlating CTP imaging with clinical presentation and other forms of imaging including unenhanced CT head, MRI brain and CT/MR angiogram to diagnose and differentiate hyperacute stroke from mimics and treat patients appropriately.

Liaretidou, A; Elnagi, F; Rusu, C. (2024). 2109 - CT Perfusion : similar appearances, different diagnoses. European Stroke Journal. 9(Suppl 1), pp.501-502. [Online]. Available at: https://doi.org/10.1177/23969873241245672 [Accessed 6 February 2026]