Urgent intervention to reduce functional deficits after postoperative stroke

Background: A 67-year-old right-handed man with a history of atrial fibrillation developed sudden aphasia after urological surgery. Initial diffusion-weighted and perfusion-weighted MRI demonstrated an area of hypoperfusion in Broca's area, with minimal infarction. Investigations: Neurological examination, language testing and brain MRI scans with diffusion-weighted and perfusion-weighted imaging. Diagnosis: Acute cardioembolic stroke with minimal infarction in Broca's area and a surrounding region of potentially salvageable, hypoperfused cortex. Management: Saline-induced hypertension resulting in rapid restoration of cortical perfusion and a resolution of the initial speech and language deficits. The utility of perfusion-weighted imaging in selecting appropriate candidates for urgent treatment of stroke when thrombolysis is contraindicated is discussed.