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NEUROLOGY 2006;67:E19
© 2006 American Academy of Neurology
Resident and Fellow Page

False-negative diffusion-weighted imaging with lateral medullary infarction

Rakesh Khatri, MD, James Leach, MD and Matthew L. Flaherty, MD

From the Departments of Neurology (R.K., M.L.F.) and Radiology (J.L.), University of Cincinnati College of Medicine, Cincinnati, OH.

Address correspondence and reprint requests to Dr. Matthew L. Flaherty, 231 Albert Sabin Way, MSB Room 5161B, University of Cincinnati Medical Center, Cincinnati, OH 45267-0525; e-mail: matthew.flaherty{at}uc.edu

A 55-year-old man awoke with left ear pain, vertigo, vomiting, left facial numbness, and ataxic gait. MRI including diffusion-weighted imaging (DWI) performed 2 hours later showed no evidence of acute infarction (figure, A). Repeat MRI 2 days later showed DWI and FLAIR changes consistent with a left lateral medullary infarction (figure, B).


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  		Figure. (A) Diffusion-weighted imaging performed on day 1 of symptoms shows no evidence of acute ischemia. (B) Repeat study performed 2 days later reveals a left lateral medullary infarction.

 

False-negative DWI has been reported in 5% of ischemic stroke cases, most commonly brainstem infarcts imaged within 24 hours of onset. Possible explanations include lesions too small for the resolution of the DWI echoplanar sequence, insufficient signal-to-noise ratio in the first hours after onset, and magnetic susceptibility artifacts causing image distortions.1 The clinical history and examination remain fundamental aspects of patient assessment in the era of advanced neuroimaging.

Footnotes

Disclosure: The authors report no conflicts of interest.

Reference

  1. Oppenheim C, Stanescu R, Dormont D, et al. False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol 2000;21:1434–1440.[Abstract/Free Full Text]




This Article
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Right arrow All Cerebrovascular disease/Stroke
Right arrow Infarction

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