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Late resolution of diffusion-weighted MRI changes in a patient with prolonged reversible ischemic neurological
1Department of Diagnostic Radiology, University of Cologne, Cologne, Germany. karsten.krueger@uni-koeln.de
Background:
Reduced apparent diffusion coefficients (ADCs) correlate with cerebral ischemia. The combination of ADC with techniques to measure cerebral perfusion may help to assess the effect of treatment.
Case Description:
The authors describe a patient who experienced an acute stroke with hemianopia, consequently treated with intravenous recombinant tissue plasminogen activator. Positron emission tomographic imaging and MRI, including diffusion-weighted MRI, were performed during and shortly after treatment with recombinant tissue plasminogen activator and 34 to 35 hours later. Cerebral perfusion of the left occipital region was reduced to 74%. Diffusion-weighted MRI detected a territory of restricted water movement in the corresponding area. Further magnetic resonance sequences did not show any pathologies. In follow-up, positron emission tomography demonstrated reperfusion. The volume of diffusion and ADC abnormalities detected by MRI decreased markedly. A few hours later, the patient recovered completely. A third MRI examination 10 days later showed normal findings.
Conclusions:
In a patient with prolonged reversible ischemic neurological deficit, resolution of early diffusion changes corresponded to cerebral reperfusion and to the recovery of clinical symptoms.
Insights
Early diffusion changes on MRI indicating restricted water movement in stroke patients can reverse, correlating with improved cerebral perfusion and complete clinical recovery after treatment.
Area of Science:
- Neuroimaging
- Stroke research
- Diffusion-weighted MRI
Background:
- Reduced apparent diffusion coefficients (ADCs) are linked to cerebral ischemia.
- Combining ADC with perfusion imaging aids in evaluating treatment efficacy.
Observation:
- A patient with acute stroke and hemianopia received recombinant tissue plasminogen activator (rt-PA) treatment.
- Diffusion-weighted MRI revealed restricted water movement, while positron emission tomography showed reduced cerebral perfusion.
- Follow-up imaging demonstrated reperfusion and a decrease in diffusion abnormalities.
Findings:
- Resolution of diffusion changes on MRI corresponded with cerebral reperfusion.
- The patient experienced complete clinical recovery, aligning with the resolution of imaging abnormalities.
Implications:
- This case highlights the potential for early diffusion changes in stroke to be reversible.
- It underscores the utility of advanced neuroimaging techniques in monitoring stroke treatment and recovery.