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Reversible widespread ischemia after early reperfusion detected by initial diffusion-weighted magnetic resonance imaging

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Abstract

We herein report the time-related dynamic changes according to the diffusion-weighted image (DWI) findings after a cerebral ischemic attack in a 63-year-old woman. At 2 weeks after undergoing a lower limb amputation due to diabetic atherosclerosis, she experienced a sudden loss of consciousness and right hemiparesis. Magnetic resonance image revealed left frontal and parietal areas with an increased signal on the DWI, and magnetic resonance angiography (MRA) showed the left middle cerebral artery to be occluded at the superior M2 branch. However, on the next day the lesion on DWI, except for the gray matter, was observed to have almost completely resolved, and MRA showed complete recanalization of the left superior M2 branch with diminished clinical symptoms. Although a few cases of reversible DWI-identified lesions have been described in the literature, the occurrence of large, reversed DWI lesions in the middle cerebral artery territory with severe apparent diffusion coefficient decreases, as seen in our case, are exceedingly rare.

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References

  1. CS Kidwell JL Saver J Mattiello S Starkman F Vinuela G Duckwiler (2000) ArticleTitleThrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging Ann Neurol 47 462–9 Occurrence Handle10762157 Occurrence Handle10.1002/1531-8249(200004)47:4<462::AID-ANA9>3.0.CO;2-Y Occurrence Handle1:STN:280:DC%2BD3c3it1yisw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  2. BJ Dardzinski CH Sotak M Fisher Y Hasegawa L Li K Minematsu (1993) ArticleTitleApparent diffusion coefficient mapping of experimental focal cerebral ischemia using diffusion-weighted echo-planar imaging Magn Reson Med 30 318–25 Occurrence Handle8412602 Occurrence Handle10.1002/mrm.1910300307 Occurrence Handle1:STN:280:ByuD3MfltlI%3D

    Article  PubMed  CAS  Google Scholar 

  3. C Oppenheim C Grandin Y Samson A Smith T Duprez C Marsault (2001) ArticleTitleIs there an apparent diffusion coefficient threshold in predicting tissue viability in hyperacute stroke? Stroke 32 2486–91 Occurrence Handle11692005 Occurrence Handle10.1161/hs1101.098331 Occurrence Handle1:STN:280:DC%2BD3MnktFehug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  4. J Fiehler K Knudsen T Kucinski CS Kidwell JR Alger G Thomalla (2004) ArticleTitlePredictors of apparent diffusion coefficient normalization in stroke patients Stroke 35 514–9 Occurrence Handle14739409 Occurrence Handle10.1161/01.STR.0000114873.28023.C2

    Article  PubMed  Google Scholar 

  5. PS Loh KS Butcher MW Parsons L MacGregor PM Desmond BM Tress (2005) ArticleTitleApparent diffusion coefficient thresholds do not predict the response to acute stroke thrombolysis Stroke 36 2626–31 Occurrence Handle16269645 Occurrence Handle10.1161/01.STR.0000189688.95557.2b

    Article  PubMed  Google Scholar 

  6. S Arakawa PM Wright M Koga TG Phan DC Reutens I Lim et al. (2006) ArticleTitleIschemic thresholds for gray and white matter: a diffusion and perfusion magnetic resonance study Stroke 37 1211–6 Occurrence Handle16574931 Occurrence Handle10.1161/01.STR.0000217258.63925.6b

    Article  PubMed  Google Scholar 

  7. MS Bristow JE Simon RA Brown M Eliasziw MD Hill SB Coutts et al. (2005) ArticleTitleMR perfusion and diffusion in acute ischemic stroke: human gray and white matter have different thresholds for infarction J Cereb Blood Flow Metab 25 1280–7 Occurrence Handle15889043 Occurrence Handle10.1038/sj.jcbfm.9600135

    Article  PubMed  Google Scholar 

  8. C Dohmen E Kumura G Rosner WD Heiss R Graf (2001) ArticleTitleAdenosine in relation to calcium homeostasis: comparison between gray and white matter ischemia J Cereb Blood Flow Metab 21 503–10 Occurrence Handle11333360 Occurrence Handle10.1097/00004647-200105000-00004 Occurrence Handle1:CAS:528:DC%2BD3MXntFKis7s%3D

    Article  PubMed  CAS  Google Scholar 

  9. PK Stys BR Ransom SG Waxman PK Davis (1990) ArticleTitleRole of extracellular calcium in anoxic injury of mammalian central white matter Proc Natl Acad Sci U S A 87 4212–6 Occurrence Handle2349231 Occurrence Handle10.1073/pnas.87.11.4212 Occurrence Handle1:CAS:528:DyaK3cXktlyns74%3D

    Article  PubMed  CAS  Google Scholar 

  10. T Kuroiwa T Nagaoka M Ueki I Yamada N Miyasaka H Akimoto (1998) ArticleTitleDifferent apparent diffusion coefficient: water content correlations of gray and white matter during early ischemia Stroke 29 859–65 Occurrence Handle9550523 Occurrence Handle1:STN:280:DyaK1c3gvFyqsQ%3D%3D

    PubMed  CAS  Google Scholar 

  11. S Maekawa M Aibiki K Kikuchi S Kikuchi K Umakoshi (2006) ArticleTitleTime related changes in reversible MRI findings after prolonged hypoglycemia Clin Neurol Neurosurg 108 511–3 Occurrence Handle15908105 Occurrence Handle10.1016/j.clineuro.2005.02.004

    Article  PubMed  Google Scholar 

  12. J Böttcher A Kunze C Kurrat P Schmidt G Hagemann OW Witte et al. (2005) ArticleTitleLocalized reversible reduction of apparent diffusion coefficient in transient hypoglycemia-induced hemiparesis Stroke 36 e20–2 Occurrence Handle15692119 Occurrence Handle10.1161/01.STR.0000155733.65215.c2

    Article  PubMed  Google Scholar 

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Correspondence to Yasuyuki Ezaki.

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Ezaki, Y., Nakashima, K., Kamada, K. et al. Reversible widespread ischemia after early reperfusion detected by initial diffusion-weighted magnetic resonance imaging. Radiat Med 25, 553–557 (2007). https://doi.org/10.1007/s11604-007-0180-0

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  • DOI: https://doi.org/10.1007/s11604-007-0180-0

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