Transient Ischemic Attack and Ischemic Stroke in Danon Disease with Formation of Left Ventricular Apical Thrombus despite Normal Systolic Function

Figure 1

Axial unenhanced head CT scan (a) on the stroke windows (40/40 HU) demonstrated a low attenuation area in the right insular cortex (arrow). On CT angiography with coronal Minimal Intensity Projection (b) and reconstructed 3D (c) images, complete circle of Willis was identified with no gross findings of occlusion. The mean transit time (MTT) (d) showed no significant asymmetry. The cerebral blood volume (CBV) map (e) and the cerebral blood flow (CBF) map (f) demonstrated a slight asymmetry with increased CBV and CBF, respectively, in the posterior right frontal region just above the subinsular cortex extending along the anterior aspect of the subinsular cortex (arrow). The time to drain (TTD) map (g) revealed asymmetrically delayed blood drainage from the left posterior frontal region including the entire subinsular cortex (arrow). Luxury perfusion following cerebral infarction is the most likely diagnosis in the presence of changes on the unenhanced portion of the CT examination.

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