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Acute stroke syndrome with fixed neurological deficit and false-negative diffusion-weighted imaging
Wei Wang1, Steven Goldstein, Mark L Scheuer
1Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. wangw@arnett.com
Summary
Diffusion-weighted imaging (DWI) can miss acute ischemic stroke. A negative initial brain DWI does not rule out cerebral ischemia, as demonstrated in a case with delayed imaging findings.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Diffusion-weighted imaging (DWI) is a primary tool for detecting acute ischemic stroke.
- However, false-negative DWI results can occur, potentially delaying diagnosis and treatment.
Observation:
- A patient presented with severe neurological deficits, including global aphasia and hemiparesis.
- The initial brain DWI performed within 27 hours of symptom onset was negative for acute ischemia.
Findings:
- The patient's neurological deficit persisted despite the negative initial DWI.
- A follow-up magnetic resonance imaging (MRI) study 7 days later revealed a large area of restricted diffusion in the left middle cerebral artery and anterior cerebral artery territories, confirming a cortical stroke.
Implications:
- This case highlights the possibility of false-negative DWI in acute ischemic stroke.
- Delayed neuroimaging may be necessary in patients with persistent neurological deficits and initially negative DWI findings.
- It underscores the importance of considering clinical presentation alongside imaging results for accurate stroke diagnosis.