Absence of an infarct on MRI is not uncommon after clinical diagnosis of ischemic stroke

被引:5
作者
Aben, Hugo P. [1 ,2 ]
Luijten, Linda [1 ]
Jansen, Ben P. W. [1 ]
Visser-Meily, Johanna M. A. [3 ]
Spikman, Jacoba M. [4 ]
Biessels, Geert Jan [2 ]
de Kort, Paul L. M. [1 ]
机构
[1] Elisabeth Tweesteden Hosp, Dept Neurol, POB 90151, NL-5000 LC Tilburg, Netherlands
[2] UMC Utrecht Brain Ctr, Dept Neurol & Neurosurg, Utrecht, Netherlands
[3] UMC Utrecht Brain Ctr, Dept Rehabil Phys Therapy Sci & Sports, Utrecht, Netherlands
[4] Univ Groningen, Dept Clin & Expt Neuropsychol, Groningen, Netherlands
关键词
Ischemic stroke; Magnetic resonance imaging; MRI negative stroke; Occurence; PHYSICIANS;
D O I
10.1016/j.jstrokecerebrovasdis.2020.104979
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
Introduction: An infarct on brain MRI is often seen as gold standard when diagnosing ischemic stroke. Although MRI has high sensitivity in detecting a lesion shortly after ischemic stroke, this rapidly declines when time progresses. We assessed the occurrence of a negative MRI 4-6 weeks after a discharge diagnosis of ischemic stroke, and compared the clinical characteristics of patients with a positive or negative MRI. Patients and methods: The first 125 patients from a prospective longitudinal study of cognitive recovery after ischemic stroke were included in this study. Clinical characteristics were collected during admission. Per protocol, 4-6 weeks after stroke a brain MRI was performed. We operationalized different levels of certainty of the clinical diagnosis of ischemic stroke of a panel of 3 expert vascular neurologists. Results: Thirty patients (24%) were MRI negative. Patients that were MRI negative had lower stroke severity at admission, shorter duration of hospital-stay, and better functional status at discharge. The panel judged that 18/30 (60%) MRI negative patients and 27/30 (90%) MRI positive patients had a likely diagnosis of ischemic stroke. Compared to MRI negative patients with a less likely diagnosis, those with a likely diagnosis had higher admission stroke severity and more often received an acute intervention. Discussion and conclusion: Absence of an infarct on MRI is not uncommon 4-6 weeks after a clinical diagnosis of ischemic stroke. The relatively high proportion of MRI negative strokes with a likely clinical diagnosis of ischemic stroke indicates that neurologists should be cautious ruling out the diagnosis based onMRI beyond the acute stroke stage.
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页数:8
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