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Delayed signal detection by diffusion-weighted imaging in brainstem infarction.

M Begemann¹, A Silvers, C Tang

¹Department of Neurology, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association

|October 2, 2007

Summary

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Diffusion-weighted MRI (DW MRI) may miss early signs of brainstem infarction. Repeat diffusion-weighted imaging (DWI) days later can reveal abnormalities, aiding diagnosis.

Area of Science:

Neurology
Radiology
Medical Imaging

Background:

Diffusion-weighted magnetic resonance imaging (DW MRI) is a standard for acute hemispheric infarction.
Its effectiveness in diagnosing acute brainstem infarction is less understood.

Purpose of the Study:

To investigate the diagnostic utility of DW MRI in acute brainstem infarction.
To determine the optimal timing for detecting brainstem infarcts using DW MRI.

Main Methods:

Case series of 3 patients with suspected brainstem infarction.
Initial DW MRI performed 5-15 hours post-symptom onset.
Follow-up DW MRI conducted 2-5 days later.

Main Results:

Initial DW MRI scans were negative for abnormalities in all 3 cases.

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Repeat DW MRI scans, performed days later, showed abnormalities in the expected brainstem regions.

Abnormalities detected by DWI appeared to develop later in brainstem infarcts compared to hemispheric infarcts.

Conclusions:

DW MRI may have a delayed sensitivity for detecting acute brainstem infarction.
Initially negative DWI results in suspected brainstem infarction warrant follow-up imaging.
Repeat DWI studies can be crucial for diagnosing brainstem infarcts when initial scans are inconclusive.