The Deception of Mass Effect: Subacute Posterior Cerebral Artery Infarction Presenting as a Mimic of Acute Middle Cerebral Artery Syndrome

Clinical data from 3 related cases sheds light on the complex presentation of subacute posterior cerebral artery strokes mimicking acute middle cerebral artery (MCA) syndrome. An expert witness in the field of interventional and diagnostic radiology defended a primary care physician against litigation for an alleged missed diagnosis using multimodality imaging to age a cerebrovascular event. The use of basic computerized tomography and magnetic resonance imaging physics principles are applied to determine whether a patient is outside the treatment window for thrombolytic administration or endovascular intervention. In the defended case, earlier stroke recognition would not have changed the patient’s outcome under question as he was deemed to have a completed infarct prior to presenting to the primary care physician’s (PCP’s) office, making the patient ineligible from acute stroke thrombolytic or endovascular treatment.