Migrating Susceptibility Vessel Sign in Posterior Circulation Stroke

      A 95-year-old woman with atrial fibrillation was admitted with acute onset of disturbed consciousness. On admission, neurological deficits rapidly improved and completely disappeared. The prothrombin time–international normalized ratio was 1.4 although she was medicated with warfarin (2.5 mg/day). Brain magnetic resonance (MR) imaging with diffusion-weighted imaging (DWI) findings on admission were normal, but MR angiography (MRA) detected basilar-top occlusion, and susceptibility-weighted imaging (SWI) confirmed the susceptibility vessel sign at the basilar top (Figure, A and E). Cardioembolic stroke was diagnosed and the warfarin dose was increased from 2.5 to 3 mg/day.
      Figure thumbnail gr1
      FigureConsecutive changes in susceptibility vessel sign at 0, 18, and 48 hours, and 7 days after admission with corresponding magnetic resonance angiography findings. Magnetic resonance angiography shows occlusion (arrowhead, A) and recanalization (arrowhead, B) of the basilar artery, as well as partial (arrowhead, C) and full recanalization (D) of left posterior cerebral artery. Corresponding susceptibility-weighted image shows low signal intensity at basilar top (arrow, E), migration, as well as a reduction in size (arrow, F, G) and resolution (H).
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