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Diffusion- and perfusion-weighted MRI in a patient with a prolonged reversible ischaemic neurological deficit
T Neumann-Haefelin1, H J Wittsack, F Wenserski
1Department of Neurology (ZNN 95-1), Goethe-Universität, Frankfurt, Germany. tnh@rz.uni-frankfurt.de
Abstract:
We report acute and follow-up diffusion- and perfusion-weighted MRI (DWI, PWI) findings in a patient with a prolonged reversible ischaemic neurological deficit. PWI 12 h after the patient was last seen to be without symptoms revealed a large perfusion deficit in the left posterior MCA territory with a relatively inconspicuous and much smaller abnormality on DWI. Follow-up showed resolution of abnormalities on both DWI and PWI, and conventional MRI was normal, apart from a very slight abnormality, visible only on FLAIR images, at the centre of the initially DWI-positive region. These findings demonstrate the utility of PWI when be used in combination with DWI to investigate the pathophysiology of transient ischemic syndromes.
Insights
Diffusion- and perfusion-weighted MRI (DWI, PWI) can detect perfusion deficits in transient ischemic syndromes. Combining DWI and PWI is useful for investigating reversible ischemic neurological deficits.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Transient ischemic syndromes (TIS) present diagnostic challenges.
- Diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) are advanced MRI techniques.
Observation:
- A patient with prolonged reversible ischemic neurological deficit underwent acute and follow-up MRI.
- Perfusion-weighted imaging (PWI) 12 hours after symptom resolution showed a large perfusion deficit in the left middle cerebral artery (MCA) territory.
- Diffusion-weighted imaging (DWI) revealed a smaller, inconspicuous abnormality in the same region.
Findings:
- Follow-up MRI demonstrated complete resolution of abnormalities on both DWI and PWI.
- Conventional MRI was largely normal, with only a subtle FLAIR abnormality at the core of the initial DWI lesion.
- The findings highlight a significant perfusion deficit disproportionate to the DWI abnormality.
Implications:
- Perfusion-weighted imaging (PWI) is valuable for assessing the extent and duration of ischemic effects in TIS.
- Combining DWI and PWI enhances the understanding of the pathophysiology of transient ischemic syndromes.
- These advanced MRI techniques aid in diagnosing and managing patients with reversible ischemic neurological deficits.