Presentation
Right limb weakness but has been drinking and states he fell several hours before.
Patient Data
No intra- or extra-axial collection or hemorrhage demonstrated. Hyperdense basilar tip and left P1/2 segments. Loss of grey-white differentiation in the left PCA territory.
Perfusion imaging shows a small infarct core in the left PCA territory with larger area of ischemic penumbra.
Filling defect within the very distal basilar artery extending into the left P1/2 segments. Opacification of the left P3/4 segments via left PComA. Both PICAs, AICAs, SCAs and right PCA are patent.
There is a large area of increased diffusion restriction within the left occipital lobe, left medial temporal lobe, left thalamus and left cerebral peduncle, in keeping with the known left PCA territory stroke.
Case Discussion
Acute left PCA territory ischemic stroke with mismatched infarct core / ischemic penumbra. Filling defect in the very distal basilar artery and proximal left PCA.