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AJNR - American Journal of Neuroradiology

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Do Transient Ischemic Attacks with Diffusion-Weighted Imaging Abnormalities Correspond to Brain Infarctions?

C. Oppenheim^a,d, C. Lamy^b, E. Touzé^b, D. Calvet^b, M. Hamon^c, J.-L. Mas^b and J.-F. Méder^a

^a Departments of Neuroradiology, Université Paris Descartes, Centre Hospitalier Sainte-Anne, Paris, France
^b Departments of Neurology, Université Paris Descartes, Centre Hospitalier Sainte-Anne, Paris, France
^c Department of Neuroradiology, Centre Hospitalo-Universitaire, Caen, France
^d Unité INSERM 562, Unité de Neuro-imagerie Anatomo Fonctionnelle (UNAF) Service Hospitalier Frédéric Joliot, CEA/DRM/DSV, Orsay, France

View larger version (75K): [in a new window]   Fig 1. A 67-year-old man with a left sensory-motor deficit for 30 minutes. Initial MR imaging (3 days after onset) demonstrates a small DWI and FLAIR hyperintensity in the deep right middle cerebral artery (MCA) territory. On follow-up MR imaging (14 months after onset), focal signal intensity changes on all sequences indicate permanent injury in the corresponding area.

View larger version (74K): [in a new window]   Fig 2. A 63-year-old man with a right sensory deficit for 10 hours. Initial MR imaging (63 hours after onset) demonstrates a focal DWI and FLAIR hyperintensity in the left brain stem (arrow). On follow-up MR imaging (6 months after onset), a small permanent injury can be seen as a dark signal intensity on T1-weighted sequence and a bright signal intensity on FLAIR/T2-weighted sequence in the corresponding area.

View larger version (70K): [in a new window]   Fig 3. A 55-year-old man with sensory-motor deficit of the upper right limb for 90 minutes. Initial MR imaging (10 hours after onset) demonstrates a focal DWI hyperintensity with mild FLAIR signal intensity changes in the left primary motor cortex, matching clinical symptoms. On follow-up MR imaging (8 months after onset), no permanent injury can be identified.

View larger version (60K): [in a new window]   Fig 4. A 21-year-old woman with a right sensory-motor deficit and aphasia for 60 minutes. Initial MR imaging (4 days after onset) shows a punctate cortical DWI/FLAIR hyperintensity in the left superficial middle cerebral artery (MCA) territory. On follow-up MR imaging (15 months after onset), a small permanent injury can be seen as a bright cortical dot on T1-weighted sequence with mild atrophy on T2-weighted sequence. Note that no signal intensity change is seen on FLAIR.