Acute stroke syndrome with fixed neurological deficit and false-negative diffusion-weighted imaging.
Diffusion-weighted imaging (DWI) is sensitive for the detection of acute ischemic stroke. However, a negative DWI study of the brain does not always exclude a patient from the possibility of acute cerebral ischemia. The authors report 1 case in which the patient presented with a fixed ischemic neurological deficit (National Institute of Health Stroke Scale score = 22) that included global aphasia, right hemiparesis, and a right visual field neglect. The initial DWI of the brain within 27 hours of symptom onset was negative. The deficit persisted, and a repeat magnetic resonance imaging study 7 days later showed a large area of restricted diffusion involving the gray matter of the entire left middle cerebral artery and anterior cerebral artery distribution, indicating a large area of cortical stroke.
Wang
Wei
W
Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. wangw@arnett.com
Goldstein
Steven
S
Scheuer
Mark L
ML
Branstetter
Barton F
BF
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004569:Electroencephalography; D005188:False Negative Reactions; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D020521:Stroke / Q000175:diagnosis*; D013577:Syndrome