Usefulness of multiphase computed tomography angiography in a patient with transient ischemic attack in the hyperacute phase: A case report

Abstract

Rationale:Patients with transient ischemic attack (TIA) have the possibility of developing stroke in the future. To prevent recurrent TIA or future stroke, identifying the cause of TIA is important. However, about two-third of patients with TIA have negative findings on diffusion-weighted imaging (DWI).We present a case of TIA, the cause of which was identified using multiphase computed tomography angiography (MCTA) in the hyperacute phase of the disease.Patient Concerns:The patient was a 57-year-old man who was admitted to the emergency department for right-side weakness persisting for 1hour.Diagnoses:Occlusion of the proximal M3 segment of the left middle cerebral artery territory was found on the initial MCTA.Outcomes:The weakness completely resolved at 2hours after symptom onset, and there was no acute infarction on the initial diffusion-weighted magnetic resonance imaging (MRI) on the same day. Follow-up MCTA on the next day showed recanalization of the left M3 segment. Follow-up diffusion-weighted MRI showed focal acute infarction in the left middle cerebral artery territory.Lessons:MCTA could identify distal occlusion of the anterior circulation in patients with cardioembolic TIA in the hyperacute phase with negative DWI findings.