Abstract
This report details the case of a 21-year-old male with approximately 48 hours of aphasia and a CT perfusion scan that showed left hemispheric severe hypoperfusion across vascular territories following an episode of unwitnessed collapse. The patient presented with agitation following an unwitnessed collapse which led to a brief 30 second water submersion. He had no significant medical history but did use marijuana daily. An initial CT head non contrast was normal. His agitated behaviour was soon recognised as being in the setting of severe aphasia. A subsequent CT perfusion scan within hours of symptom onset showed striking, widespread left hemispheric hypoperfusion. On day 1 of admission, an EEG showed left hemispheric slowing and an MRI scan showed an area of diffusion restriction in the corpus collosum, consistent with cytotoxic lesion of the corpus collosum (CLOCC). The patient had no residual symptoms by day 3 of admission. A follow up MRI scan approximately one month later showed resolution of the previously seen CLOCC. This case fits best with a post-ictal phenomenon. Perfusion defects due to seizure are well recognised as a hyperperfusion change but hypoperfusion in the acute post ictal period is also possible. CT Perfusion provides a useful tool for the evaluation of acute neurological presentations, however the full spectrum of abnormal findings in non-stroke aetiologies is still being defined. Careful interpretation of vascular territories together with clinical correlation is required to ensure appropriate management.
