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[Ischemic stroke despite normal brain MRI: about a case].

Glorien Lemahafaka1, Ansoumane Camara1, Lala Rajaonarison2

  • 1Service de Neurologie, Centre Hospitalier de Pontarlier, France.

The Pan African Medical Journal
|February 4, 2017
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Summary

A normal brain MRI can miss early ischemic stroke. Repeating diffusion-weighted imaging (DWI) with fine cuts can detect small infarcts missed by standard MRI, aiding timely thrombolysis treatment.

Keywords:
Strokebrain MRIbrain ischemia

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Magnetic Resonance Imaging (MRI) is the standard for diagnosing ischemic stroke.
  • However, MRI's sensitivity is not always 100% for acute ischemic stroke detection.

Observation:

  • A case study revealed a patient with ischemic stroke despite an initially normal brain MRI.
  • This normal finding during the early stroke phase can create uncertainty regarding thrombolysis, a critical treatment for cerebral embolism.

Findings:

  • Repeating MRI with fine-cut, high-b-value (2000 s/mm²) diffusion-weighted imaging (DWI) enabled early detection.
  • This advanced DWI technique identified small-volume infarcts not visible on conventional MRI sequences.

Implications:

  • Early detection of subtle infarcts is crucial for appropriate and timely thrombolytic therapy.
  • Advanced DWI sequences improve diagnostic accuracy in challenging ischemic stroke cases.
  • This highlights the importance of advanced imaging techniques when clinical suspicion remains high despite initial negative results.