Stroke with persisting false-negative diffusion-weighted imagings: A case report

Abstract

Rationale: Diffusion-weighted imaging (DWI) is a cardinal tool for detecting acute brain ischemia; however, recent studies have shown that DWI may not show the ischemic lesion during the hyperacute period. Patient concerns: A 76-year old male patient was admitted due to an acute onset of dysarthria and right lower paresis which progressed on the second day of admission. Diagnosis: The preliminary diagnosis was an ischemic stroke and the final diagnosis was left medullary stroke. Interventions: Antiaggregant and anticoagulant therapies were initiated after excluding hemorrhagic stroke by cranial computed tomography. However, DWIs, which were recorded on the 6th hour and 19th hour after the symptom onset, were in normal ranges. Hence, the patient was referred to a senior hospital for further etiological investigations. Outcome: The patient was discharged after treatments with aspirin and atorvastatin, and the neurological examination showed mildmoderate dysarthria and moderate right-sided paralysis (3/5). Lessons: Clinicians should pay more attention to stroke patients with negative DWI and perform DWI several times when the diagnostic is unclear.