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Stroke Overview

(Left) Lateral gross pathology

shows a chronic MCA infarct

with hemorrhage and

encephalomalacia in the

frontal operculum ﬇ and

temporal lobe ſt. (Right) Axial

DWI MR shows restriction in

left MCA territory with

preservation of the basal

ganglia. The MCA territory is

the most common location for

ischemic stroke.

(Left) Axial CT perfusion

cerebral blood flow (CBF)

color map shows a large area

of decreased blood flow ﬇ in

the left hemisphere related to

hyperacute MCA ischemia.

(Right) Axial CT perfusion

cerebral blood volume (CBV)

color map in the same patient

shows a much smaller area of

decreased blood volume ﬇.

The CBV is a marker for the

ischemic core. This CBF/CBV

mismatch correlates with the

presence of a large ischemic

penumbra, which suggests the

patient would benefit from

intraarterial thrombolytic

therapy or clot retrieval.

(Left) The MCA (red) supplies

the lateral aspects of the

frontal/temporal lobes; ACA

(green), the medial

hemispheres; PCA (purple) the

occipital & inferior temporal

lobes. Watershed zone ſt is

the border between the major

vascular territories. (Right)

Axial FLAIR MR shows multiple

hyperintense foci ſt in the

watershed zones between the

major areas (MCA, PCA, ACA)

related to acute ischemia from

hypoperfusion; posterior

confluence where all 3

vascular distributions meet at

the vertex ﬇ is vulnerable to

cerebral hypoperfusion.

Brain: Pathology-Based Diagnoses: Malformations,

Trauma, and Stroke

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