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Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
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"Invisible" brain stem infarction at the first day

Yohei Tsuyusaki1, Ryuji Sakakibara1, Masahiko Kishi1

  • 1Department of Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|May 10, 2014
PubMed
Abstract

Insights

Early stroke detection is crucial. Invisible brain stem infarction (IBI) may not appear on initial MRI, but serial imaging can reveal these smaller, medullary lesions, aiding timely treatment.

Area of Science:

  • Neurology
  • Radiology
  • Neuroimaging

Background:

  • Serial diffusion-weighted MRI (DW MRI) can reveal lesions not visible on day 1.
  • Clinical features of "invisible" brain stem infarction (IBI) on day 1 require delineation.

Purpose of the Study:

  • To define and characterize clinical features of IBI.
  • To identify patient subgroups prone to IBI.

Main Methods:

  • Retrospective study of 212 stroke patients.
  • Defined IBI by clinical improvement and serial DW MRI findings (high signal intensity, low ADC).
  • Analyzed lesion size, location, and associated symptoms.

Main Results:

  • IBI identified in 6 patients, exclusively in the brain stem (17%).
  • DW MRI visibility typically occurred by day 3/4; initial signal changes were minimal.
  • IBI lesions were smaller (2.7 mm²) and often located in the dorsolateral medulla, with more sensory disturbance and less dysarthria.

Conclusions:

  • Smaller stroke volume, medullary location, and sensory disturbance are associated with IBI.
  • Recognizing IBI is vital for early stroke management using MRI criteria.
Keywords:
Strokebrain stemdiffusion-weighted imagemagnetic resonance imaging

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