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ARTICLE

Hyperacute Ischemic Stroke Missed by Diffusion-Weighted Imaging

David Lefkowitz,a, Michael LaBenza, Steven R. Nudoa, Robert E. Stega and John M. Bertonia

a From the Department of Diagnostic Radiology (D.M.L.), University of Maryland Medical System; the Department of Radiology (M.J.L.), Department of Internal Medicine, Creighton University Medical Center (S.R.N.), and the Department of Neurology (J.M.B., R.E.S.), Creighton University Medical Center, Baltimore, MD.

Summary: We present two cases of hyperacute ischemic stroke that were initially missed by diffusion-weighted imaging; abnormalities in locations corresponding to focal neurologic deficits were discovered by MR angiography and perfusion-weighted imaging. Within hours, follow-up diffusion-weighted scans revealed partial conversion of the hypoperfused regions to complete stroke. These cases illustrate the potential for a nonresolving stroke-in-evolution to go undetected by diffusion-weighted imaging at hyperacute timepoints.




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