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[False negative diffusion in acute ischemic stroke].

S Pedraza¹, M T Osuna, A Dávalos

¹Unidad de RM-IDI, Servicio de Radiología, Hospital Josep Trueta, Girona, España. spedraza@retemail.es

Revista De Neurologia

|July 23, 2002

Summary

Diffusion Weighted Imaging (DWI) can miss early signs of acute ischemic stroke, especially in the posterior circulation. Delayed diagnosis is possible due to reduced DWI sensitivity within the first 24 hours.

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Area of Science:

Neurology
Radiology
Medical Imaging

Background:

Magnetic resonance imaging (MRI) advancements aid early acute ischemic stroke diagnosis.
Diffusion Weighted Imaging (DWI) is recognized for high sensitivity and specificity in acute ischemia detection.

Observation:

A 70-year-old woman with hypertension and dyslipidemia presented with vertigo, neck pain, and gaze issues.
Clinical diagnosis suggested Wallenberg's syndrome (lateral medullary infarction), but initial DWI (10 hours post-symptoms) was normal.
Persistent neurological deficits prompted a repeat MRI, confirming a lateral medullary infarction.

Findings:

DWI sensitivity is diminished within the initial 24 hours following ischemic events.
False-negative DWI results are more common in smaller infarctions, particularly in the posterior brain regions.

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Implications:

Clinical suspicion for stroke should persist despite initial negative DWI, especially in posterior circulation cases.
Repeated neuroimaging may be necessary for accurate diagnosis of acute ischemic stroke when initial DWI is inconclusive.
Understanding DWI limitations is crucial for timely and accurate diagnosis of acute ischemic stroke.