Hyperintense Acute Reperfusion Marker on FLAIR in a Patient with Transient Ischemic Attack

Abstract EN

The hyperintense acute reperfusion marker (HARM) has initially been described in acute ischemic stroke.

The phenomenon is caused by blood-brain barrier disruption following acute reperfusion and consecutive delayed gadolinium enhancement in the subarachnoid space on fluid attenuated inversion recovery (FLAIR) images.

Here we report the case of an 80-year-old man who presented with transient paresis and sensory loss in the right arm.

Initial routine stroke MRI including diffusion- and perfusion-weighted imaging demonstrated no acute pathology.

Follow-up MRI after three hours demonstrated subarachnoid gadolinium enhancement in the left middle cerebral artery territory consistent with HARM that completely resolved on follow-up MRI three days later.

This case illustrates that even in transient ischemic attack patients disturbances of the blood-brain barrier may be present which significantly exceed the extent of acute ischemic lesions on diffusion-weighted imaging.

Inclusion of FLAIR images with delayed acquisition after intravenous contrast agent application in MRI stroke protocols might facilitate the diagnosis of a recent acute ischemic stroke.