Cerebral infarction is the result of cerebrovascular insufficiency and itself creates complex changes in cerebral hemodynamics. To allow recognition of patterns of change in regional cerebral blood flow (r-CBF) caused by cerebral infarction, the authors present an atlas of Tc-99m hexamethylpropyleneamine oxime (Tc-99m HMPAO) SPECT brain scan sections for a variety of strokes demonstrating typical vascular territorial involvements and evolution of morphologic and r-CBF change. Sections from MRI or CT are shown with SPECT images of the stroke lesion for comparison of the complementary information provided by regional cerebro-perfusion and by morphology. Examples of SPECT during acute, subacute, and chronic stages of stroke are provided. To illustrate the temporal evolution of stroke and accompanying changes in the “stroke penumbra,” case examples of acute tissue necrosis, luxury perfusion, ischemia, and diaschisis are presented. Methods for semiquantitative analysis of morphologic versus r-CBF defect size after acute stroke are described. How brain SPECT scans conducted during Diamox initiated cerebrovascular stress tests can complement the information obtained from baseline studies and assist in the interpretation of r-CBF abnormalities is also demonstrated.