Fig. 1

Standard brain imaging and symptom timeline. a Perfusion head CT-scan performed on arrival in the emergency department (day 0). The Time-To-Maximum (TMax, color code at bottom left) was prolonged predominantly in the right internal occipital region and the right thalamus while the cerebral blood volume remained normal overall (not shown), thereby defining a penumbra. b Brain images performed upon neurological aggravation (day 1 and day 2). Perfusion head CT-scan (B1) (day 1) showing increased TMax (i.e. penumbra) in the right posterior cerebral artery (PCA) vascular territory (color code at bottom left) due to new occlusion of the right PCA. A conventional arteriography performed at day 2 in order to repermealize the previously occluded right vertebral (B2, anterior view of the right subclavian artery angiography with ostial occlusion of the right vertebral artery, red arrow) by thrombectomy, allowed visualization of the PCA occlusion (B3, lateral view of the right vertebral artery and the basilar artery with the occluded P1 segment of the right posterior cerebral artery, red arrow). The Diffusion Weight Imaging sequence of brain Magnetic Resonance Imaging done subsequently the same day showed several restriction areas in the cerebellum (B4), right hippocampal and parahippocampal regions (B5), right lingual gyrus (B6), right occipital lobe (B7), right thalamus (B7, red arrow) and minor involvement of the right internal capsule (B7, yellow arrow), confirming acute ischemic lesions. (C) 3 T Brain Magnetic Resonance Imaging (10 weeks after stroke). On the T1 sequence (the section shown is approximately on the same level as on the B7 panel), the occipital lesion is not visible anymore, contrary to the right thalamic residual lesion (red arrow). Bottom panel: The timeline of the main clinical finding evolution (until the end of follow up, grey horizontal arrow) in parallel with respective brain imaging (letters in () next to time points correspond to figures in upper panels) and management strategies. Color codes relate to different treatment places, in relation with respective time points (ED at day 0 in dark red; tertiary hospital at day 1–2 post-stroke in orange; ambulatory follow up from week 9–10 until the 15th month, in purple), symptoms (symptoms of interest are in bold) and brain imaging (left-right arrows below brain imaging panels relate to the same timeline as in the text boxes below), while vertical black arrows correspond to change of management place (admission, transfer or discharge). Initial symptoms that persisted through the follow up are written in black. Detailed description of macrosomatognosia and sensory deficits was done during stationary neurorehabilitation. Macrosomatognosia and sensory deficits significantly decreased 6 months after stroke