Case Report of False-Negative Diffusion-Weighted Image of Brain Magnetic Resonance Imaging (MRI) in Acute Ischemic Stroke
Unusual clinical course, Challenging differential diagnosis, Management of emergency care, Patient complains / malpractice, Clinical situation which can not be reproduced for ethical reasons
Wei-Lun Chang, Ji-Ching Lai, Rong-Fu Chen, Han-Hwa Hu, Chau-Shiung Pan
Department of Neurology, Chang Hua Show Chwan Memorial Hospital, Changhua, Taiwan
Am J Case Rep 2017; 18:76-79
Acute ischemic stroke is a major cause of mortality and morbidity in Taiwan. Diffusion-weighted image (DWI) is a sensitive and common strategy use for imaging acute ischemic stroke.
CASE REPORT: We present a case of a negative DWI MRI for detecting acute ischemic stroke in a clinical setting. A 75-year-old male had a DWI performed after onset of symptoms suggesting acute ischemic stroke. The initial DWI result was negative within 72 hours of presentation. The neurological symptoms of the patient persisted and DWI was repeated. After 14 days, the DWI data confirmed and demonstrated an acute ischemic stroke. The delay in DWI confirmation, from symptom onset until DWI diagnosis, was 336 hours.
CONCLUSIONS: DWI may not have 100% sensitivity and accuracy in early stages of acute ischemic stroke. The time course to the development of abnormalities detected by DWI may be longer time than anticipated.
Keywords: Diffusion Magnetic Resonance Imaging, Neurologic Examination, Stroke