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Reversible diffusion-weighted lesion in a TIA patient without arterial recanalization: A case report

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Abstract

A 70-year-old man with right hemiparesis (NIHSS score 15) was admitted to our hospital 1 h after onset. Diffusion-weighted imaging (DWI) revealed a hyperintense lesion in the left corona radiata and magnetic resonance angiography (MRA) revealed occlusion of the left middle cerebral artery (MCA). At 2.5 h after onset, his neurological deficits dramatically improved (with NIHSS score change from 15 to 2). Immediately thereafter, follow-up MRI revealed that the hyperintense lesion on DWI had disappeared, though the left MCA occlusion remained. By the end of follow-up MRI examination, his neurological deficits had completely disappeared. We report here the patient with transient ischemic attack with a reversible ischemic lesion on DWI without early arterial recanalization.

Introduction

Diffusion-weighted magnetic resonance imaging (DWI) abnormalities have been found in the acute phase in several patients with transient ischemic attack (TIA) [1], [2], [3], [4]. In TIA patients, early recanalization should result in disappearance of neurological deficits and abnormalities on DWI. We report here a TIA patient with a reversible ischemic lesion on DWI without early arterial recanalization.

Section snippets

Case

A 70-year-old right-handed man was admitted to our hospital after 1 h of weakness in the right arm and leg. His past medical history was hypertension for 10 years and hyperlipidemia not treated with medication. On physical examination, his height was 168 cm and body weight 65.5 kg. Body temperature was 36.6 °C, blood pressure 170/104 mmHg, and heart rate 68 bpm with regular sinus rhythm. No neck or orbital bruits were present, and peripheral arterial pulsations were palpable bilaterally. The

Discussion

We have reported here a patient with TIA with a reversible ischemic lesion on DWI without early arterial recanalization.

Dramatic neurological improvement immediately after acute hemispheric stroke has been described as spectacular shrinking deficit (SSD) following the rapid migration of an embolus [5]. However, follow-up MRA revealed persistent MCA occlusion despite dramatic neurological recovery. If we had performed follow-up MRI only at 24 h after onset, we would have suspected that the

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