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Updated: Jul 3, 2026

A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
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Diffusion-negative MRI in acute ischemic stroke: a case report.

Rahul Rathakrishnan1, Vijay K Sharma, Bernard Pl Chan

  • 1Division of Neurology, Department of Medicine, National University Hospital, Singapore. drvijay@singnet.com.sg.

Cases Journal
|July 31, 2008
PubMed
Summary

Diffusion-weighted imaging (DWI) can miss early acute ischemic stroke, particularly in the posterior circulation. Repeat imaging and clinical evaluation are crucial for accurate diagnosis, especially when initial DWI scans are negative.

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Diffusion-weighted magnetic resonance imaging (DWI) is a sensitive tool for early acute ischemic stroke diagnosis.
  • DWI is used in stroke centers for screening patients eligible for thrombolysis.

Purpose of the Study:

  • To highlight the limitations of early DWI in diagnosing acute ischemic stroke.
  • To emphasize the importance of clinical assessment in stroke diagnosis.

Main Methods:

  • Case report of a 49-year-old Chinese man with negative initial DWI.
  • Follow-up DWI performed 4 days after symptom onset.

Main Results:

  • Initial DWI was negative 12 hours after symptom onset.
  • Repeat DWI after 4 days revealed an acute medullary infarction despite static neurological symptoms.

Conclusions:

  • DWI may not be 100% sensitive in the very early stages of stroke, especially in posterior circulation.
  • Clinical assessment remains paramount until a more sensitive and specific diagnostic modality is available.