Early false-negative diffusion-weighted imaging in brainstem infarction.
It has been well established that acute ischemic lesions can be identified with diffusion-weighted imaging before they are detected on computed axial tomography or conventional magnetic resonance imaging sequences. Previous studies examining the sensitivity and specificity of diffusion-weighted imaging for acute stroke have dealt primarily with cortical stroke. Only limited information is available on the accuracy and temporal evolution of findings on diffusion-weighted imaging in patients with brainstem infarction. We present a case of lateral medullary infarction with false-negative diffusion-weighted imaging 16 hours after symptom onset and a brief review of the literature on the utility of diffusion-weighted imaging in early detection of brainstem stroke. Cases with false-negative initial imaging are increasingly more commonly reported in the literature, with initial images being obtained from 0.5 to over 24 hours after symptom onset. This delay in radiographic confirmation of brainstem stroke emphasizes the continuing need for accurate clinical diagnoses, especially in the early hours after symptom onset, when thrombolysis remains a treatment option. Delays in diagnosis and initiation of treatment of brainstem stroke may increase the associated morbidity and mortality.
Frey
Lauren C
LC
Department of Neurology, Columbia-Presbyterian Medical Center, New York, NY 10032, USA.
Sung
Gene Y
GY
Tanabe
Jody
J