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Citation:
Baba Y, Sharma R, Knipe H, Diffusion-negative acute ischemic stroke. Reference article, Radiopaedia.org (Accessed on 28 Mar 2024) https://doi.org/10.53347/rID-94549
Diffusion-negative acute ischemic stroke refers to a clinically diagnosed acute ischemic stroke without cerebral restricted diffusion on DWI on brain MRI.
Although DWI is highly sensitive for acute ischemic strokes, it fails in a minority of cases in its detection 1,2.
It is not as rare as previously thought and has a reported prevalence of 6.8% in a meta-analysis of 3,236 ischemic strokes 1.
DWI is reported to fail in the detection of ischemic strokes involving:
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posterior circulation infarction: 5x more likely to be DWI-negative than anterior circulation ischemia, especially within the first 48 hours 3
- small strokes, particularly small brainstem infarcts 4
- hyperacute ischemia: within 3 hours of symptom onset 1,2
The differential is that of a neurological deficit with a normal brain MRI 1:
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1. Edlow B, Hurwitz S, Edlow J. Diagnosis of DWI-Negative Acute Ischemic Stroke: A Meta-Analysis. Neurology. 2017;89(3):256-62. doi:10.1212/WNL.0000000000004120 - Pubmed
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2. Kawano H, Hirano T, Nakajima M, Inatomi Y, Yonehara T. Diffusion-Weighted Magnetic Resonance Imaging May Underestimate Acute Ischemic Lesions: Cautions on Neglecting a Computed Tomography-Diffusion-Weighted Imaging Discrepancy. Stroke. 2013;44(4):1056-61. doi:10.1161/STROKEAHA.111.000254 - Pubmed
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3. Sylaja P, Coutts S, Krol A, Hill M, Demchuk A, Demchuk A. When to Expect Negative Diffusion-Weighted Images in Stroke and Transient Ischemic Attack. Stroke. 2008;39(6):1898-900. doi:10.1161/STROKEAHA.107.497453 - Pubmed
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4. Doubal F, Dennis M, Wardlaw J. Characteristics of Patients with Minor Ischaemic Strokes and Negative MRI: A Cross-Sectional Study. J Neurol Neurosurg Psychiatry. 2011;82(5):540-2. doi:10.1136/jnnp.2009.190298 - Pubmed
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