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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 20:1876-1880 (11 1999)
© 1999 American Society of Neuroradiology

ARTICLE

Diffusion-Negative Stroke: A Report of Two Cases

Paul Y-K. Wang^a, Peter B. Barker^,a, Robert J. Wityk^a, Aziz M. Ulu^a, Peter C. M. van Zijl^a and Norman J. BeauchampJr^a

^a From the Departments of Radiology (P.Y-K.W., P.B.B., A.M.U., P.C.M.v.Z., N.J.B.) and Neurology (R.J.W.), Johns Hopkins University School of Medicine, Baltimore, MD.

Summary: Diffusion-weighted MR imaging is generally thought to be highly sensitive for the diagnosis of acute stroke. We report two cases of hyperacute stroke with absence of changes on diffusion-weighted images within 4 hours of symptom onset. Follow-up studies, performed 4 days later, showed infarction in regions compatible with the clinical presentation and (in one case) with the initial perfusion deficit. These cases indicate that normal findings on diffusion-weighted images in patients with suspected cerebral ischemia do not rule out impending infarction.