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Published on: March 3, 2021
Reduction of diffusion-weighted MRI lesion volume after early moderate hypothermia in ischemic stroke
Christian Berger1, Peter Schramm, Stefan Schwab
1Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. christian_berger@med.uni-heidelberg.de
Background:
Large areas of restricted diffusion in the middle cerebral artery (MCA) territory are highly predictive of severe and potentially space-occupying MCA stroke. A reduction of diffusion-weighted MRI (DWI) lesions occurs in 20% to 40% of acute stroke patients with early reperfusion.
Methods:
We report of a patient with a severe stroke syndrome who was treated with early moderate hypothermia but not thrombolysis.
Results:
The initially large DWI deficit of the whole MCA territory contrasted to the relatively small final lesion restricted to the basal ganglia on MRI and computed tomography scan.
Conclusions:
This case describes an unexpected reduction of a DWI lesion after early moderate hypothermia and spontaneous recanalization 3 days after stroke onset. We discuss potential reasons for the unexpected DWI lesion reduction.
Insights
Early moderate hypothermia in a stroke patient unexpectedly reduced the diffusion-weighted imaging (DWI) lesion size. This case highlights potential benefits of hypothermia and spontaneous recanalization in acute ischemic stroke.
Area of Science:
- Neuroscience
- Radiology
- Emergency Medicine
Background:
- Large diffusion-weighted imaging (DWI) lesions in the middle cerebral artery (MCA) territory predict severe stroke.
- A significant reduction in DWI lesion size is observed in 20-40% of acute stroke patients with early reperfusion.
Observation:
- A patient with a severe stroke syndrome was treated with early moderate hypothermia, without thrombolysis.
- Initial DWI showed a large deficit in the entire MCA territory.
Findings:
- The final MRI and CT scans revealed a lesion restricted to the basal ganglia, significantly smaller than the initial DWI deficit.
- Spontaneous recanalization occurred 3 days after stroke onset, coinciding with the DWI lesion reduction.
Implications:
- Early moderate hypothermia may contribute to a reduction in infarct size in acute ischemic stroke.
- This case suggests hypothermia could be a potential therapeutic strategy in select stroke patients, warranting further investigation.
