title: Diffusion weighted imaging reversibility in the brainstem following successful recanalization of acute basilar artery occlusion.
abstract: Acute basilar artery occlusion (ABAO) is a devastating disease that can produce significant brainstem injury. Pretreatment diffusion weighted imaging (DWI) demonstrating extensive brainstem involvement has been shown to predict a poor outcome regardless of reperfusion. This case report describes a patient presenting with coma secondary to ABAO. MRI at presentation demonstrated significant DWI abnormality in the majority of the bilateral pons. The basilar artery was endovascularly recanalized 8 h after stroke onset, and the patient had a marked clinical recovery with no deficit at 3 months. Follow-up imaging revealed significant reversal of the pontine lesion. This finding of brainstem DWI reversibility cautions against the use of DWI to select ABAO patients for intra-arterial stroke therapy. The degree of apparent diffusion coefficient reduction on pretreatment MRI may not adequately identify which DWI abnormal brainstem tissue is potentially reversible.
authors: Department of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. ajyoo@partners.org
authors: Albert J
authors: AJ
authors: Yoo
authors: Reza
authors: R
authors: Hakimelahi
authors: Natalia S
authors: NS
authors: Rost
authors: Pamela W
authors: PW
authors: Schaefer
authors: Joshua A
authors: JA
authors: Hirsch
authors: R Gilberto
authors: RG
authors: González
authors: James D
authors: JD
authors: Rabinov
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D001488:Basilar Artery / Q000473:pathology / Q000601:surgery*; D001933:Brain Stem / Q000098:blood supply* / Q000473:pathology; D002406:Catheterization, Peripheral; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D015424:Reperfusion; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
chemical_list: D014568:Urokinase-Type Plasminogen Activator