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Diffusion Imaging in the Rat Cervical Spinal Cord
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False-negative diffusion-weighted MRI in acute cerebellar stroke.

Shinya Morita1, Masanobu Suzuki, Keiji Iizuka

  • 1Department of Otolaryngology, Kushiro City General Hospital, 1-12 Shunkodai, Kushiro, Hokkaido, Japan. shinyamorita@yahoo.co.jp

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Summary

False-negative diffusion-weighted MRI scans can occur in acute cerebellar infarction. Physicians should monitor nystagmus periodically and consider repeat MRI after 24 hours for atypical cases.

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Area of Science:

  • Neurology
  • Radiology
  • Emergency Medicine

Background:

  • Acute cerebellar infarction can present with vertigo and dizziness.
  • Initial diffusion-weighted magnetic-resonance imaging (DW-MRI) may yield false-negative results in hyperacute ischemic stroke.
  • Peripheral vestibular disorders are common mimics of cerebellar infarction.

Purpose of the Study:

  • To increase physician awareness of false-negative DW-MRI findings in acute cerebellar infarction.
  • To emphasize the importance of periodic nystagmus observation in patients with acute vertigo.
  • To guide repeat MRI timing in suspected cases.

Main Methods:

  • Retrospective review of eight patients with acute vertigo/dizziness and normal initial MRI.
  • Periodic observation of spontaneous and positional nystagmus (6-24 hours post-onset).
  • Repeat MRI performed >24 hours after symptom onset in select cases.

Main Results:

  • Three patients showed periodic changes in nystagmus.
  • Four patients had persistent vertigo, nausea, and vomiting after nystagmus resolution.
  • Repeat MRI detected cerebellar infarction in four patients due to atypical nystagmus patterns.

Conclusions:

  • Consider false-negative DW-MRI in acute vertigo/dizziness suggestive of stroke.
  • Periodic nystagmus observation is crucial.
  • Repeat MRI >24 hours post-onset is recommended for atypical nystagmus patterns.