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A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia

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Disabling Wake Up Stroke without Lesions on Initial Diffusion Weighted Imaging - Case Report and Clinical

Elke Andrea van de Ven¹, Floor Anne Sophie de Kort², Jan Albert Vos³

¹Department of Neurology, University Medical Centre Groningen, Hanzeplein 1, 9713 Groningen, Netherlands.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association

|December 4, 2020

Summary

Initial diffusion-weighted imaging (DWI) may be negative in acute ischemic stroke cases, even with severe symptoms. Prompt clinical diagnosis is crucial for safe and effective thrombolysis treatment.

Keywords:

Acute ischemic stroke Case report Intravenous thrombolysis MRI Wake up stroke

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Author Spotlight: Integrated Photoacoustic, Ultrasound, and Angiographic Tomography (PAUSAT) for NonInvasive Whole-Brain Imaging of Ischemic Stroke

Author Spotlight: Integrated Photoacoustic, Ultrasound, and Angiographic Tomography (PAUSAT) for NonInvasive Whole-Brain Imaging of Ischemic Stroke

Published on: June 2, 2023

Area of Science:

Neurology
Radiology
Emergency Medicine

Background:

Acute ischemic stroke requires timely diagnosis and treatment for optimal patient outcomes.
Intravenous thrombolysis is a critical intervention for anterior circulation strokes.
Diffusion-weighted imaging (DWI) is a standard MRI sequence for detecting acute ischemic changes.

Observation:

An 86-year-old female presented with acute left-sided hemiparesis and neglect, suggestive of a right hemispheral stroke.
Initial MRI including DWI showed no evidence of acute ischemic changes or large vessel occlusion.
Intravenous thrombolysis was withheld due to the negative initial imaging findings.

Findings:

The patient's neurological deficits persisted, prompting a follow-up MRI three days later.
Follow-up MRI revealed a significant lesion consistent with acute ischemic stroke in the right middle cerebral artery (MCA) territory.
This case highlights the potential for false-negative initial DWI in anterior circulation strokes.

Implications:

Clinicians should consider the possibility of acute ischemic stroke despite negative initial DWI, particularly in the anterior circulation.
Clinical suspicion should guide treatment decisions when imaging is equivocal.
Further research may be warranted to refine diagnostic protocols for stroke detection when initial DWI is negative.