title: Case report of a young stroke patient showing interim normalization of the MRI diffusion-weighted imaging lesion.
abstract: BACKGROUND
  In acute ischemic stroke, diffusion weighted imaging (DWI) shows hyperintensities and is considered to indicate irreversibly damaged tissue. We present the case of a young stroke patient with unusual variability in the development of signal intensities within the same vessel territory.
  
  
  METHODS
  A 35-year-old patient presented with symptoms of global aphasia and hypesthesia of the left hand. MRI demonstrated a scattered lesion in the MCA territory. After rtPA therapy the patient received further MRI examination, three times on day 1, and once on day 2, 3, 5 and 43. The posterior part of the lesion showed the usual pattern with increasing DWI hyperintensity and decreased ADC, as well as delayed FLAIR positivity. However, the anterior part of the lesion, which was clearly visible in the first examination completely normalized on the first day and only reappeared on day 2. This was accompanied by a normalization of the ADC as well as an even further delayed FLAIR positivity.
  
  
  CONCLUSIONS
  We showed that interim normalization of DWI and ADC in the acute phase can not only be found in rodent models of stroke, but also in humans. We propose that DWI lesion development might be more variable during the first 24 h after stroke than previously assumed.
authors: Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany. aostwaldt@mgh.harvard.edu.
authors: Ann-Christin
authors: AC
authors: Ostwaldt
authors: Department of Neurology, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany. tatiana.usnich@charite.de.
authors: Tatiana
authors: T
authors: Usnich
authors: Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany. christian.nolte@charite.de.|Department of Neurology, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany. christian.nolte@charite.de.
authors: Christian H
authors: CH
authors: Nolte
authors: Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany. kersten.villringer@charite.de.
authors: Kersten
authors: K
authors: Villringer
authors: Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany. jochen.fiebach@charite.de.
authors: Jochen B
authors: JB
authors: Fiebach
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D020521:Stroke / Q000473:pathology*