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Stroke with negative brain magnetic resonance imaging
M J Alberts1, M E Faulstich, L Gray
1Division of Neurology, Duke University Medical Center, Durham, N.C. 27710.
Background And Purpose:
Magnetic resonance imaging (MRI) of the brain is replacing computed tomography in the diagnostic evaluation of acute ischemic strokes. Past studies have suggested that MRI may not visualize all acute strokes, but few clinical details were included. To better understand the clinical characteristics of strokes not detected by MRI, we collected and reviewed case histories of several patients with acute stroke who had negative MRI scans.
Methods:
Patients with a clinical diagnosis of stroke and negative brain MRI scans were ascertained from hospital records dating from 1989 to mid-1991. Patients with transient ischemic attacks, postictal paralysis, functional examinations, central nervous system infections, other nonstroke diagnoses, or equivocal findings were excluded. The MRI scans were performed with a GE Signa 1.5-T magnet in an axial plane (spin-echo repetition time/echo time: 500 msec/20 msec; 2,500 msec, 30 msec/80 msec). One patient received contrast material.
Results:
We identified seven patients with clinically diagnosed ischemic stroke and negative brain MRI scan. Six of seven patients were scanned within 7 days of symptom onset and two patients within 24 hours. One patient was scanned 3 months after symptom onset. The strokes not detected by MRI were clinically localized to the cortex (n = 3), brain stem (n = 3), and subcortical/lacunar area (n = 1). One patient underwent two MRI scans, one with gadolinium.
Conclusions:
These cases, while selected, illustrate some potential limitations of MRI for diagnosing stroke.
Insights
Magnetic resonance imaging (MRI) may not detect all acute ischemic strokes, even when performed within 24 hours of symptom onset. This study highlights potential limitations of MRI in diagnosing certain stroke types.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Brain magnetic resonance imaging (MRI) is increasingly used for diagnosing acute ischemic strokes.
- Previous studies indicated potential limitations of MRI in detecting all acute strokes.
- Clinical details of strokes missed by MRI were previously scarce.
Observation:
- Seven patients with clinically diagnosed ischemic stroke and negative brain MRI scans were identified.
- Six patients were scanned within seven days of symptom onset; two were scanned within 24 hours.
- Strokes were localized to the cortex, brain stem, and subcortical/lacunar areas.
Findings:
- Despite advanced imaging techniques, MRI may fail to detect acute ischemic strokes.
- Negative MRI scans can occur even with prompt imaging (within 24 hours).
- Specific stroke locations (cortex, brain stem, subcortical) were associated with missed diagnoses.
Implications:
- Clinicians should consider potential MRI limitations in acute stroke diagnosis.
- Negative MRI results do not definitively exclude stroke, especially in specific locations.
- Further research is needed to improve MRI sensitivity for all stroke types.
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