Early DWI reversal in ischemic stroke

Dr Daniel J Bell ◉ and Assoc Prof Frank Gaillard ◉ ◈ et al.

Early DWI reversal in ischemic stroke (also referred to as diffusion lesion reversal) is encountered early in the course of ischemic infarction, most frequently in the setting of reperfusion within 3 to 6 hours of onset ¹.

DWI reversal is defined as the interval disappearance of the initially-visible increased DWI signal on repeat MRI scan. In the vast majority of cases it is transient and the abnormal DWI signal returns. That is, it does not represent true reversal (i.e. the region of the brain initially demonstrating reduced ADC values goes on to infarct regardless of whether early DWI reversal is demonstrated) ^1,2 .

It should be noted that in other clinical contexts (e.g. hemiplegic migraine, seizure, transient ischemic attack and transient global amnesia) permanent diffusion lesion reversal, without progression to permanent lesion has been rarely encountered ³.

Note: Early DWI reversal should not be confused with ADC pseudonormalization which occurs later in the evolution of ischemic stroke.

Quiz questions

References

Stroke and intracranial haemorrhage

stroke and intracranial hemorrhage
- code stroke CT (an approach)
- ischemic stroke
  - general discussions
  - scoring and classification systems
  - signs
  - by region
    - hemispheric infarcts
      - frontal lobe infarct
      - parietal lobe infarct
        Gerstmann syndrome
      - temporal lobe infarct
      - occipital lobe infarct
        
        alexia without agraphia syndrome: PCA
        
        cortical blindness syndrome (Anton syndrome): top of basilar or bilateral PCA
        
        Balint syndrome: bilateral PCA
    - lacunar infarct
      - lacunar stroke syndromes
      - lenticulostriate infarct
    - thalamic infarct
      - Déjerine-Roussy syndrome (thalamic pain syndrome): thalamoperforators of PCA
      - top of the basilar syndrome
    - striatocapsular infarct
    - cerebellar infarct
    - brainstem infarct
      - midbrain infarct
        
        Benedikt syndrome: PCA
        
        Claude syndrome: PCA
        
        Nothnagel syndrome: PCA
        
        Weber syndrome: PCA
      - pontine infarct
        
        Brissaud-Sicard syndrome
        
        facial colliculus syndrome
        
        Gasperini syndrome: basilar artery or AICA
        
        inferior medial pontine syndrome (Foville syndrome): basilar artery
        
        lateral pontine syndrome (Marie-Foix syndrome): basilar artery or AICA
        
        locked-in syndrome: basilar artery
        
        Millard-Gubler syndrome: basilar artery
        
        Raymond syndrome: basilar artery
      - medullary infarct
        
        Babinski-Nageotte syndrome
        
        hemimedullary syndrome (Reinhold syndrome)
        
        lateral medullary stroke syndrome (Wallenberg syndrome)
        
        medial medullary syndrome (Déjerine syndrome)
    - acute spinal cord ischemia syndrome
  - by vascular territory
    - anterior circulation infarction
    - posterior circulation infarction
  - treatment options
    - mechanical thrombectomy
  - complications
    - crossed cerebellar diaschisis
    - hemorrhagic transformation of an ischemic infarct
      - cerebral intraparenchymal hyperattenuations post thrombectomy
- intracranial hemorrhage
  - intra-axial hemorrhage
    - signs and formulas
      - ABC/2 (volume estimation)
      - CTA spot sign
      - swirl sign
    - by region or type
  - extra-axial hemorrhage

Article information

rID: 41739

System: Central Nervous System

Tag: cases

Synonyms or Alternate Spellings:

Diffusion lesion reversal
Early diffusion lesion reversal
Early diffusion reversal in ischaemic stroke

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