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Updated: Nov 26, 2025
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
False-Negative Initial Magnetic Resonance Imaging in Acute Posterior Circulation Stroke: A Case Report Describing
Christian L Castaneda1, Jee Ah Christina Rhee2, Joon Ha H Woo3
1Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Queens, Flushing, USA.
Abstract:
Locked-in syndrome is defined as quadriplegia and anarthria with the preservation of consciousness. Typically, locked-in syndrome is caused by an insult to the ventral pons secondary to trauma or vascular disease. Presented herein is a case of a locked-in syndrome with an initial MRI with no restricted diffusion and clinical deterioration over the course of four days. Repeat interval MRI demonstrated bilateral pontine ischemia.
Insights
Locked-in syndrome, characterized by paralysis and inability to speak while conscious, can result from brainstem injury. A case revealed delayed MRI findings of pontine ischemia in a patient with locked-in syndrome.
Area of Science:
- Neurology
- Neuroimaging
- Vascular Neurology
Background:
- Locked-in syndrome involves preserved consciousness with quadriplegia and anarthria.
- Ventral pons lesions, often from trauma or vascular events, are typical causes.
- This condition presents diagnostic challenges due to varied initial presentations.
Observation:
- A patient presented with symptoms suggestive of locked-in syndrome.
- Initial magnetic resonance imaging (MRI) showed no restricted diffusion, a common indicator of acute ischemia.
- Clinical deterioration occurred over four days, prompting further investigation.
Findings:
- Repeat interval MRI revealed bilateral pontine ischemia.
- The delayed detection of ischemia highlights potential pitfalls in early diagnosis.
- Pontine ischemia is a critical finding in locked-in syndrome.
Implications:
- This case underscores the importance of serial neuroimaging in suspected locked-in syndrome.
- It suggests that early MRI may not always detect acute pontine ischemia.
- Understanding delayed ischemic changes is crucial for timely diagnosis and management of locked-in syndrome.
