Abstract
A 37-year-old migrainous woman was referred several hours after a sudden dysarthria lasting less than 1 min. Brain MRI undertaken a few hours later showed no acute cerebral infarction on the diffusion-weighted imaging (DWI) sequence. However, an intraluminal thrombus within a distal branch of the middle cerebral artery (MCA) was seen on the T2*-weighted gradient echo images as well as hyperintense vessels related to slow flow beyond the occlusion’s site. Control MRI 24 h later confirmed the presence of a small infarct affecting the distal portion of the MCA territory but the thrombus was no longer visible. A comprehensive etiologic workup revealed the presence of a patent foramen ovale, as the underlying cause of the patient’s stroke. Though the sensitivity of DWI sequence for acute ischemia is high, false negative exist particularly in cases of transient ischemic attack, brainstem or lacunar strokes. A careful brain MRI examination or the use of perfusion weighted imaging sequences are useful to avoid misdiagnosis particularly in young patients.
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References
Sylaja PN, Coutts SB, Krol A, Hill MD, Demchuk AM; VISION Study Group (2008) When to expect negative diffusion-weighted images in stroke and transient ischemic attack. Stroke 39:1898–900
Makin SD, Doubal FN, Dennis MS, Wardlaw JM (2015) Clinically confirmed stroke with negative diffusion-weighted imaging magnetic resonance imaging: longitudinal study of clinical outcomes, stroke recurrence, and systematic review. Stroke 46:3142–3148
Kidwell CS, Saver JL, Mattiello J, Starkman S, Vinuela F, Duckwiler G, Gobin YP, Jahan R, Vespa P, Kalafut M, Alger JR (2000) Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Ann Neurol 47:462–469
Lee KY, Latour LL, Luby M, Hsia AW, Merino JG, Warach S (2009) Distal hyperintense vessels on FLAIR: an MRI marker for collateral circulation in acute stroke? Neurology 72(13):1134–1139
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Dr Benjamin Hebant, MD: Study concept and design.
Dr Linda Zourdani, MD: Critical revision of the manuscript for important intellectual content.
Dr Camille Dagba, MD: Critical revision of the manuscript for important intellectual content.
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Hebant, B., Zourdani, L. & Dagba, C. Stroke in a young adult: looking beyond the diffusion-weighted imaging sequence. Neurol Sci 45, 1315–1317 (2024). https://doi.org/10.1007/s10072-023-07237-2
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DOI: https://doi.org/10.1007/s10072-023-07237-2