title: A mismatch between the abnormalities in diffusion- and susceptibility-weighted magnetic resonance imaging may represent an acute ischemic penumbra with misery perfusion.
abstract: Susceptibility-weighted imaging (SWI) has recently attracted attention for its ability to investigate acute stroke pathophysiology. SWI detects an increased ratio of deoxyhemoglobin to oxyhemoglobin in cerebral venous compartments, which can illustrate cerebral misery perfusion with a compensatory increase of oxygen extraction fraction in the hypoperfused brain. In this study we make the first case report of blunt cervical trauma leading to a stroke, demonstrating the disparity between diffusion-weighted imaging (DWI) and SWI changes, or DWI-SWI mismatch, in the acute ischemic brain. The area of mismatch between a smaller DWI cytotoxic edema and a larger SWI misery perfusion in our patient matured into a complete infarction with time. The DWI-SWI mismatch may signify the presence of an ischemic penumbra, and provide information about viability of the brain tissue at risk of potential infarction if without early reperfusion.
authors: Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan. Electronic address: mfujioka_2000_99@yahoo.co.jp.
authors: Masayuki
authors: M
authors: Fujioka
authors: Kazuo
authors: K
authors: Okuchi
authors: Asami
authors: A
authors: Iwamura
authors: Toshiaki
authors: T
authors: Taoka
authors: Bo K
authors: BK
authors: Siesjö
mesh_terms: D000062:Accidents, Occupational; D001924:Brain Concussion / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002545:Brain Ischemia / Q000473:pathology* / Q000601:surgery; D020212:Carotid Artery Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000502:physiology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D020521:Stroke / Q000473:pathology* / Q000601:surgery
keywords: Diffusion-weighted imaging; brain; ischemic-penumbra; magnetic resonance imaging; misery-perfusion; susceptibility-weighted imaging