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[Intracerebral hematoma associated with reduced apparent diffusion coefficient mimicking acute stroke]

B Randoux1, B Marro, D Dormont

  • 1Service de Neuroradiologie, Groupe hospitalier Pitié-Salpêtrière, Paris. bruno.randoux@caramail.com

Journal of Neuroradiology = Journal De Neuroradiologie
|March 8, 2003
PubMed

Insights

Acute stroke imaging can be challenging. Restricted diffusion on MRI may indicate ischemia, but careful interpretation with susceptibility-sensitive sequences is crucial to rule out underlying hematoma.

Area of Science:

  • Neurology
  • Radiology
  • Neuroimaging

Background:

  • Acute ischemic stroke diagnosis relies heavily on neuroimaging.
  • Diffusion-weighted imaging (DWI) is sensitive to early ischemic changes.

Observation:

  • A 67-year-old patient presented with acute hemiplegia.
  • MRI revealed a basal ganglia lesion with restricted apparent diffusion coefficient (ADC), suggestive of acute ischemia.
  • However, susceptibility artifacts on echo planar T2W images raised suspicion for hematoma, later confirmed by CT.

Findings:

  • Restricted ADC values in acute stroke can be mimicked by hematoma.
  • Magnetic susceptibility artifacts on specific MRI sequences (T2*W, T2W) are key indicators for differentiating ischemia from hemorrhage.
  • Correlation of DWI findings with CT is essential for accurate diagnosis.

Implications:

  • Accurate differentiation between ischemic stroke and intracranial hemorrhage is critical for timely and appropriate treatment.
  • Clinicians should consider hematoma in the differential diagnosis of basal ganglia lesions with restricted diffusion, especially when susceptibility artifacts are present.
  • Integrating multiple imaging sequences and modalities improves diagnostic accuracy in acute neurological events.

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