We examined the diagnostic use of isotropic diffusion-weighted (DW) MRI in 140 consecutive patients suspected of or diagnosed as having an ischaemic stroke. Isotropic DW imaging could demonstrate the lesion responsible for the clinical deficit in patients with multiple cerebral infarcts at an early stage, even small lesions without a perifocal oedema or mass effect. Accurate diagnosis by DW images may, however, be difficult about 2 weeks after the onset of stroke.