| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Stroke Service of the Neurology Department (Drs. Ay, Buonanno, Rordorf, Koroshetz, and Schwamm, and O. Wu) and Neuroradiology Division (Drs. Schaefer, Gonzalez, Yamada, and Sorensen), Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Address correspondence and reprint requests to Dr. Walter J. Koroshetz, Dept. of Neurology–Stroke Service, VBK-915, Massachusetts General Hospital, Harvard Medical School, 32 Fruit Street, Boston, MA 02114.
BACKGROUND: Diffusion-weighted MRI (DWI) represents a major advance in the early diagnosis of acute ischemic stroke. When abnormal in patients with stroke-like deficit, DWI usually establishes the presence and location of ischemic brain injury. However, this is not always the case.
OBJECTIVE: To investigate patients with stroke-like deficits occurring without DWI abnormalities in brain regions clinically suspected to be responsible.
METHODS: We identified 27 of 782 consecutive patients scanned when stroke-like neurologic deficits were still present and who had normal DWI in the brain region(s) clinically implicated. Based on all the clinical and radiologic data, we attempted to arrive at a pathophysiologic diagnosis in each.
RESULTS: Best final diagnosis was a stroke mimic in 37% and a cerebral ischemic event in 63%. Stroke mimics (10 patients) included migraine, seizures, functional disorder, transient global amnesia, and brain tumor. The remaining patients were considered to have had cerebral ischemic events: lacunar syndrome (7 patients; 3 with infarcts demonstrated subsequently) and hemispheric cortical syndrome (10 patients; 5 with TIA, 2 with prolonged reversible deficits, 3 with infarction on follow-up imaging). In each of the latter three patients, the regions destined to infarct showed decreased perfusion on the initial hemodynamically weighted MRI (HWI).
CONCLUSIONS: Normal DWI in patients with stroke-like deficits should stimulate a search for nonischemic cause of symptoms. However, more than one-half of such patients have an ischemic cause as the best clinical diagnosis. Small brainstem lacunar infarctions may escape detection. Concomitant HWI can identify some patients with brain ischemia that is symptomatic but not yet to the stage of causing DWI abnormality.
This article has been cited by other articles:
|
|
 |
|
  T.-H. Cho, M. Hermier, J. A. Alawneh, T. Ritzenthaler, V. Desestret, L. Ostergaard, L. Derex, J.-C. Baron, and N. Nighoghossian Total Mismatch: Negative Diffusion-Weighted Imaging but Extensive Perfusion Defect in Acute Stroke Stroke, October 1, 2009; 40(10): 3400 - 3402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. T. Winkler, F. Fluri, P. Fuhr, S. G. Wetzel, P. A. Lyrer, S. Ruegg, and S. T. Engelter Thrombolysis in Stroke Mimics: Frequency, Clinical Characteristics, and Outcome Stroke, April 1, 2009; 40(4): 1522 - 1525. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ay, E. M. Arsava, S. C. Johnston, M. Vangel, L. H. Schwamm, K. L. Furie, W. J. Koroshetz, and A. G. Sorensen Clinical- and Imaging-Based Prediction of Stroke Risk After Transient Ischemic Attack: The CIP Model Stroke, January 1, 2009; 40(1): 181 - 186. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.N. Sylaja, S. B. Coutts, A. Krol, M. D. Hill, A. M. Demchuk, and for the VISION Study Group When to Expect Negative Diffusion-Weighted Images in Stroke and Transient Ischemic Attack Stroke, June 1, 2008; 39(6): 1898 - 1900. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Phillips, D. Dai, A. Mitnitski, G. J. Gubitz, K. C. Johnston, W. J. Koroshetz, K. L. Furie, S. Black, D. E. Heiselman, and on behalf of the GAIN Americas Investigators Clinical Diagnosis of Lacunar Stroke in the First 6 Hours After Symptom Onset: Analysis of Data From the Glycine Antagonist In Neuroprotection (GAIN) Americas Trial Stroke, October 1, 2007; 38(10): 2706 - 2711. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S P Chung, H S Chung, S Rhu, S W Kim, I S Yoo, J Kim, and C J Song Emergency department experience of primary diffusion weighted magnetic resonance imaging for the patient with lacunar syndrome. Emerg. Med. J., September 1, 2006; 23(9): 675 - 678. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Shellhaas, S. E. Smith, E. O'Tool, D. J. Licht, and R. N. Ichord Mimics of Childhood Stroke: Characteristics of a Prospective Cohort Pediatrics, August 1, 2006; 118(2): 704 - 709. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R.G. Gonzalez Imaging-guided acute ischemic stroke therapy: From "time is brain" to "physiology is brain". AJNR Am. J. Neuroradiol., April 1, 2006; 27(4): 728 - 735. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ay, W. J. Koroshetz, M. Vangel, T. Benner, C. Melinosky, M. Zhu, N. Menezes, C. J. Lopez, and A. G. Sorensen Conversion of Ischemic Brain Tissue Into Infarction Increases With Age Stroke, December 1, 2005; 36(12): 2632 - 2636. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Sedlaczek, J. G. Hirsch, E. Grips, C. N.A. Peters, A. Gass, J. Wohrle, and M. Hennerici Detection of delayed focal MR changes in the lateral hippocampus in transient global amnesia Neurology, June 22, 2004; 62(12): 2165 - 2170. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. T. Engelter, S. G. Wetzel, E. W. Radue, M. Rausch, A. J. Steck, and P. A. Lyrer The clinical significance of diffusion-weighted MR imaging in infratentorial strokes Neurology, February 24, 2004; 62(4): 574 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, R. J. Adams, T. Brott, G. J. del Zoppo, A. Furlan, L. B. Goldstein, R. L. Grubb, R. Higashida, C. Kidwell, T. G. Kwiatkowski, et al. Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association Stroke, April 1, 2003; 34(4): 1056 - 1083. [Full Text] [PDF]
|
|
|
|
 |
|
 G. K. Dy and V. S. Swaroop 'Catastrophic' Antiphospholipid Syndrome-Reply-I Mayo Clin. Proc., April 1, 2003; 78(4): 519 - 521. [PDF]
|
|
|
|
|
|
P. W. Schaefer, G. J. Hunter, J. He, L. M. Hamberg, A. G. Sorensen, L. H. Schwamm, W. J. Koroshetz, and R. G. Gonzalez Predicting Cerebral Ischemic Infarct Volume with Diffusion and Perfusion MR Imaging AJNR Am. J. Neuroradiol., November 1, 2002; 23(10): 1785 - 1794. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Kamal, A. Z. Segal, and A. M. Ulug Quantitative Diffusion-Weighted MR Imaging in Transient Ischemic Attacks AJNR Am. J. Neuroradiol., October 1, 2002; 23(9): 1533 - 1538. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Mullins, P. W. Schaefer, A. G. Sorensen, E. F. Halpern, H. Ay, J. He, W. J. Koroshetz, and R. G. Gonzalez CT and Conventional and Diffusion-weighted MR Imaging in Acute Stroke: Study in 691 Patients at Presentation to the Emergency Department Radiology, August 1, 2002; 224(2): 353 - 360. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Yamada, H. Kubota, O. Kizu, H. Nakamura, H. Ito, S. Yuen, O. Tanaka, T. Kubota, M. Makino, M. Van Cauteren, et al. Effect of Intravenous Gadolinium-DTPA on Diffusion-Weighted Images: Evaluation of Normal Brain and Infarcts Stroke, July 1, 2002; 33(7): 1799 - 1802. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Bolay, Y. Gursoy-Ozdemir, Y. Sara, R. Onur, A. Can, and T. Dalkara Persistent Defect in Transmitter Release and Synapsin Phosphorylation in Cerebral Cortex After Transient Moderate Ischemic Injury Stroke, May 1, 2002; 33(5): 1369 - 1375. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Sunshine, N. Bambakidis, R. W. Tarr, C. F. Lanzieri, O. O. Zaidat, J. I. Suarez, D. M.D. Landis, and W. R. Selman Benefits of Perfusion MR Imaging Relative to Diffusion MR Imaging in the Diagnosis and Treatment of Hyperacute Stroke AJNR Am. J. Neuroradiol., May 1, 2001; 22(5): 915 - 921. [Abstract] [Full Text]
|
|
|
|
|
|
P.J. Kelly, E.T. Hedley-Whyte, J. Primavera, J. He, and R.G. Gonzalez Diffusion MRI in ischemic stroke compared to pathologically verified infarction Neurology, April 10, 2001; 56(7): 914 - 920. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Linfante, R. H. Llinas, G. Schlaug, C. Chaves, S. Warach, and L. R. Caplan Diffusion-Weighted Imaging and National Institutes of Health Stroke Scale in the Acute Phase of Posterior-Circulation Stroke Arch Neurol, April 1, 2001; 58(4): 621 - 628. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Schaefer, P. E. Grant, and R. G. Gonzalez Diffusion-weighted MR Imaging of the Brain Radiology, November 1, 2000; 217(2): 331 - 345. [Abstract] [Full Text]
|
|
|
|
|
|
S. L. Keir and J. M. Wardlaw Systematic Review of Diffusion and Perfusion Imaging in Acute Ischemic Stroke Stroke, November 1, 2000; 31(11): 2723 - 2731. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Li, K.-F. Liu, M. D. Silva, T. Omae, C. H. Sotak, J. D. Fenstermacher, M. Fisher, C. Y. Hsu, and W. Lin Transient and Permanent Resolution of Ischemic Lesions on Diffusion-Weighted Imaging After Brief Periods of Focal Ischemia in Rats : Correlation With Histopathology • Editorial Comment: Correlation With Histopathology Stroke, April 1, 2000; 31(4): 946 - 954. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Chalela, D. C. Alsop, J. B. Gonzalez-Atavales, J. A. Maldjian, S. E. Kasner, and J. A. Detre Magnetic Resonance Perfusion Imaging in Acute Ischemic Stroke Using Continuous Arterial Spin Labeling Stroke, March 1, 2000; 31(3): 680 - 687. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W Prichard and J. R Alger The NMR revolution in brain imaging BMJ, November 13, 1999; 319(7220): 1302 - 1302. [Full Text]
|
|
|
|
|
|
D. G. Darby, P. A. Barber, R. P. Gerraty, P. M. Desmond, Q. Yang, M. Parsons, T. Li, B. M. Tress, and S. M. Davis Pathophysiological Topography of Acute Ischemia by Combined Diffusion-Weighted and Perfusion MRI Stroke, October 1, 1999; 30(10): 2043 - 2052. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Diffusion-Weighted MRI to Evaluate Stroke-Like Deficits Journal Watch Psychiatry, August 1, 1999; 1999(801): 19 - 19. [Full Text]
|
|
|
|
 |
|
 Diffusion-Weighted MRI to Evaluate Stroke-Like Deficits Journal Watch (General), July 2, 1999; 1999(702): 4 - 4. [Full Text]
|
|
|
|
|
|
J. W. Prichard and R. I. Grossman New reasons for early use of MRI in stroke Neurology, June 1, 1999; 52(9): 1733 - 1733. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
