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Related Experiment Videos

Normal diffusion-weighted MRI during stroke-like deficits.

H Ay1, F S Buonanno, G Rordorf

  • 1Stroke Service of the Neurology Department, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.

Neurology
|June 17, 1999
PubMed
Summary
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Normal diffusion-weighted MRI (DWI) in stroke patients may indicate a stroke mimic or an ischemic event. Hemodynamic-weighted MRI (HWI) can help identify early ischemic changes not visible on DWI.

Area of Science:

  • Neurology
  • Radiology
  • Neuroimaging

Background:

  • Diffusion-weighted MRI (DWI) is crucial for diagnosing acute ischemic stroke.
  • DWI abnormalities typically confirm ischemic brain injury.
  • However, normal DWI findings can occur in patients with stroke-like deficits.

Purpose of the Study:

  • To investigate patients presenting with stroke-like deficits but normal DWI in suspected brain regions.
  • To determine the underlying causes of these deficits.

Main Methods:

  • Reviewed 782 consecutive patients with stroke-like deficits and normal DWI in implicated brain areas.
  • Analyzed clinical and radiological data for pathophysiological diagnosis.
  • Utilized hemodynamic-weighted MRI (HWI) for perfusion assessment.

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Main Results:

  • 63% of patients had cerebral ischemic events; 37% had stroke mimics (e.g., migraine, seizures, tumor).
  • Ischemic events included lacunar and hemispheric syndromes, with some diagnosed via follow-up imaging or TIA.
  • HWI revealed decreased perfusion in regions that later showed infarction.

Conclusions:

  • Normal DWI necessitates exploring non-ischemic causes for stroke-like symptoms.
  • Over half of these patients ultimately have an ischemic cause.
  • HWI aids in detecting early symptomatic brain ischemia not yet evident on DWI, especially for small infarcts.