Hyperacute ischemic stroke missed by diffusion-weighted imaging

We present two cases of hyperacute ischemic stroke that were initially missed by diffusion-weighted imaging; abnormalities in locations corresponding to focal neurologic deficits were discovered by MR angiography and perfusion-weighted imaging. Within hours, follow-up diffusion-weighted scans revealed partial conversion of the hypoperfused regions to complete stroke. These cases illustrate the potential for a nonresolving stroke-in-evolution to go undetected by diffusion-weighted imaging at hyperacute timepoints.