Diffusion-negative acute ischemic stroke

Last revised by Rohit Sharma on 24 May 2022

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:

  • 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:

ADVERTISEMENT: Supporters see fewer/no ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.