Peter Barker

Publication Detail

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Urgent intervention to reduce functional deficits after postoperative stroke.

Andrew W Lee; Cameron Davis; H Adrian Puttgen; Argye E Hillis (Profiled Authors: Hans Puttgen; Argye Hillis-Trupe)

Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 126, Baltimore, MD 21287, USA. alee74@jhmi.edu
Nature clinical practice. Neurology 2007;3(3):173-7.

BACKGROUND: A 67-year-old right-handed man with a history of atrial fibrillation developed sudden aphasia after urological surgery. Initial diffusion-weighted and perfusion-weighted MRI demonstrated an area of hypoperfusion in Broca's area, with minimal infarction. INVESTIGATIONS: Neurological examination, language testing and brain MRI scans with diffusion-weighted and perfusion-weighted imaging. DIAGNOSIS: Acute cardioembolic stroke with minimal infarction in Broca's area and a surrounding region of potentially salvageable, hypoperfused cortex. MANAGEMENT: Saline-induced hypertension resulting in rapid restoration of cortical perfusion and a resolution of the initial speech and language deficits. The utility of perfusion-weighted imaging in selecting appropriate candidates for urgent treatment of stroke when thrombolysis is contraindicated is discussed.

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