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Updated: Jul 11, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
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.
Abstract:
Diffusion-weighted magnetic resonance imaging (DW MRI) is a sensitive and specific technique for imaging acute hemispheric infarction. Its utility in the diagnosis of acute brainstem infarction has not been well studied. We present 3 cases of brainstem infarction in which DW MRI performed 5 to 15 hours after symptom onset failed to reveal any abnormality. Repeat diffusion-weighted imaging (DWI) 2 to 5 days later did demonstrate an abnormality in the clinically appropriate region in each instance. This suggests that the time course to the development of abnormalities detectable by DWI may be longer in brainstem than in hemispheric infarctions. Therefore, repeat studies after initially negative DWI might be useful in the diagnosis of brainstem infarctions.
Insights
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.
- 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.
