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Stroke syndromes associated with DWI-negative MRI include ataxic hemiparesis and isolated internuclear

Jennifer Watts1, Brad Wood1, Andrew Kelly1

  • 1Fremantle Hospital and Health Service, Fremantle, Western Australia.

Neurology. Clinical Practice
|February 24, 2018
PubMed

Insights

This study found that acute stroke patients with negative diffusion-weighted imaging (DWI) on MRI were often diagnosed with posterior circulation or lacunar strokes. These DWI-negative stroke cases commonly presented as ataxic hemiparesis or isolated internuclear ophthalmoplegia.

Area of Science:

  • Neurology
  • Radiology
  • Neuroimaging

Background:

  • Diffusion-weighted imaging (DWI) is a sensitive MRI technique for acute stroke detection.
  • However, some clinically definite strokes may not show abnormalities on DWI.
  • Identifying stroke subtypes with negative DWI is crucial for accurate diagnosis.

Purpose of the Study:

  • To identify stroke syndromes that are more likely to present with negative diffusion-weighted imaging (DWI) on MRI.
  • To analyze the characteristics of clinically definite acute stroke cases with DWI-negative MRI findings.

Main Methods:

  • Retrospective review of 701 patients who underwent MRI for suspected stroke.
  • Identification of patients with clinically definite stroke and negative DWI findings.
  • Classification of stroke syndromes based on clinical presentation and neuroimaging.

Main Results:

  • 16 patients with clinically definite stroke and DWI-negative MRI were identified.
  • 15 of these 16 cases were classified as posterior circulation or lacunar strokes.
  • The most common syndromes observed were ataxic hemiparesis and isolated internuclear ophthalmoplegia.

Conclusions:

  • Acute stroke can occur with negative DWI on MRI, particularly in posterior circulation and lacunar strokes.
  • Ataxic hemiparesis and isolated internuclear ophthalmoplegia are common presentations of DWI-negative strokes.
  • Clinical suspicion remains vital for diagnosing stroke when initial MRI DWI is negative.

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