Stroke, Vol 23, 663-667, Copyright © 1992 by American Heart Association
MJ Alberts, ME Faulstich and L Gray
BACKGROUND AND PURPOSE: Magnetic resonance imaging (MRI) of the brain is
replacing computed tomography in the diagnostic evaluation of acute
ischemic strokes. Past studies have suggested that MRI may not visualize
all acute strokes, but few clinical details were included. To better
understand the clinical characteristics of strokes not detected by MRI, we
collected and reviewed case histories of several patients with acute stroke
who had negative MRI scans. METHODS: Patients with a clinical diagnosis of
stroke and negative brain MRI scans were ascertained from hospital records
dating from 1989 to mid-1991. Patients with transient ischemic attacks,
postictal paralysis, functional examinations, central nervous system
infections, other nonstroke diagnoses, or equivocal findings were excluded.
The MRI scans were performed with a GE Signa 1.5-T magnet in an axial plane
(spin- echo repetition time/echo time: 500 msec/20 msec; 2,500 msec, 30
msec/80 msec). One patient received contrast material. RESULTS: We
identified seven patients with clinically diagnosed ischemic stroke and
negative brain MRI scan. Six of seven patients were scanned within 7 days
of symptom onset and two patients within 24 hours. One patient was scanned
3 months after symptom onset. The strokes not detected by MRI were
clinically localized to the cortex (n = 3), brain stem (n = 3), and
subcortical/lacunar area (n = 1). One patient underwent two MRI scans, one
with gadolinium. CONCLUSIONS: These cases, while selected, illustrate some
potential limitations of MRI for diagnosing stroke.
ARTICLES
Stroke with negative brain magnetic resonance imaging
Division of Neurology, Duke University Medical Center, Durham, N.C. 27710.
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