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Reversible diffusion weighted imaging hyperintensities during the acute phase of ischemic stroke in pediatric

Goichiro Tamura1, Satoshi Ihara2, Nobuhito Morota2

  • 1Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan. g-tamura@umin.ac.jp.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|March 15, 2016
PubMed
Abstract

Insights

Reversible diffusion-weighted imaging (DWI) hyperintensities in acute ischemic stroke were observed in a pediatric moyamoya disease patient. This suggests potential for recovery with prompt treatment, challenging previous assumptions about irreversible damage.

Area of Science:

  • Neurology
  • Pediatric Stroke
  • Neuroimaging

Background:

  • Moyamoya disease is a leading cause of pediatric ischemic stroke, particularly in East Asia.
  • Diffusion-weighted imaging (DWI) hyperintensities with decreased apparent diffusion coefficient (ADC) values typically indicate irreversible ischemic damage.
  • The reversibility of acute DWI hyperintensities in pediatric moyamoya disease stroke has not been previously documented.

Observation:

  • A 3-year-old girl presented with acute speech impairment and hemiplegia.
  • Imaging revealed acute cerebral infarction consistent with moyamoya disease, showing DWI hyperintensities.
  • Follow-up MRI demonstrated significant resolution of DWI hyperintensities within 4 days.

Findings:

  • The study reports the first case of reversible DWI hyperintensities over a wide cortical area in pediatric moyamoya disease.
  • The initial ADC values in reversible lesions were less severely decreased than in irreversible ones.
  • The patient achieved ambulation within days, despite subsequent cortical thinning observed on FLAIR imaging.

Implications:

  • This case suggests that extensive DWI hyperintensities in acute pediatric moyamoya disease stroke may be reversible with appropriate treatment.
  • It highlights the potential for recovery and challenges the notion that such findings always represent permanent ischemic damage.
  • Further research is warranted to explore treatment strategies and prognostic factors for reversible lesions in moyamoya disease.
Keywords:
ADCDWIIschemic strokeMoyamoyaReversible

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