This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Krueger, K. Articles by Lackner, K. Search for Related Content PubMed PubMed Citation Articles by Krueger, K. Articles by Lackner, K. Related Collections Acute Cerebral Infarction Computerized tomography and Magnetic Resonance Imaging PET and SPECT Thrombolysis

(Stroke. 2000;31:2715.)
© 2000 American Heart Association, Inc.

Case Report

Late Resolution of Diffusion-Weighted MRI Changes in a Patient With Prolonged Reversible Ischemic Neurological Deficit After Thrombolytic Therapy

Karsten Krueger, MD; Harald Kugel, PhD; Martin Grond, MD; Alexander Thiel, MD; David Maintz, MD Klaus Lackner, MD

From the Departments of Diagnostic Radiology (K.K., H.K., D.M., K.L.) and Neurology (M.G., A.T.), University of Cologne, Cologne, Germany.

Correspondence to Dr Karsten Krueger, Department of Diagnostic Radiology, Medical School, University of Cologne, Joseph-Stelzmann-Str, Cologne, Germany. E-mail karsten.krueger{at}uni-koeln.de

Background—Reduced apparent diffusion coefficients (ADCs) correlate with cerebral ischemia. The combination of ADC with techniques to measure cerebral perfusion may help to assess the effect of treatment.

Case Description—The authors describe a patient who experienced an acute stroke with hemianopia, consequently treated with intravenous recombinant tissue plasminogen activator. Positron emission tomographic imaging and MRI, including diffusion-weighted MRI, were performed during and shortly after treatment with recombinant tissue plasminogen activator and 34 to 35 hours later. Cerebral perfusion of the left occipital region was reduced to 74%. Diffusion-weighted MRI detected a territory of restricted water movement in the corresponding area. Further magnetic resonance sequences did not show any pathologies. In follow-up, positron emission tomography demonstrated reperfusion. The volume of diffusion and ADC abnormalities detected by MRI decreased markedly. A few hours later, the patient recovered completely. A third MRI examination 10 days later showed normal findings.

Conclusions—In a patient with prolonged reversible ischemic neurological deficit, resolution of early diffusion changes corresponded to cerebral reperfusion and to the recovery of clinical symptoms.

Key Words: magnetic resonance imaging, diffusion-weighted • stroke management • thrombolytic therapy • tomography, emission computed

This article has been cited by other articles:

				E. A.M. Hauth, C. Jansen, R. Drescher, M. Schwartz, M. Forsting, H. J. Jaeger, and K. D. Mathias MR and Clinical Follow-Up of Diffusion-Weighted Cerebral Lesions after Carotid Artery Stenting AJNR Am. J. Neuroradiol., October 1, 2005; 26(9): 2336 - 2341. [Abstract] [Full Text] [PDF]