磁共振DWI早期呈阴性的急性缺血性脑卒中的临床特点及原因分析

Clinical Characteristics Analysis of Acute Ischemic Stroke with Early Stage Negative Magnetic Resonance Diffusion-Weighted Imaging

【目的】研究磁共振弥散加权成像（DWI）早期呈阴性的急性缺血性脑卒中的临床特点及原因。【方法】回顾性分析2014年1月至2016年2月于本院神经内科住院的3例磁共振DWI早期呈阴性的急性缺血性脑卒中患者临床特点及原因。【结果】3例患者中1例在起病7h后行磁共振DwI未发现急性梗死灶，起病64h后复查磁共振DWI发现延髓背外侧近期梗死；1例在起病6h后行磁共振DWI未发现急性梗死灶，起病52h、症状加重28h后复查磁共振DwI发现右侧基底节区近期梗死；1例在起病5h后行磁共振DWI未发现急性梗死灶，起病120h后复查磁共振DWI发现延髓右下背侧近期梗死。【结论】磁共振DWI是目前早期临床诊断急性缺血性脑卒中的有力手段，目前普遍公认急性缺血性脑卒中发病几分钟即可出现阳性表现，但急性脑缺血性脑卒中早期DwI呈阴性的患者大量存在，DWI阳性甚至可延迟到起病后120h。当遇到怀疑急性缺血性脑卒中但DwI未见责任灶的患者时，除了尽早治疗外，必要时需再次进行磁共振DwI检查，以早期明确诊断，减少误诊及漏诊。

：【Objective】To study the clinical characteristics and analyze the possible reasons for acute ischemic stroke with early stage negative magnetic resonance diffusion-weighted imaging （DWI） detection.【Methods】Three cases of acute ischemic stroke with early negative magnetic resonance diffusion-weighted imaging were collected from January 2014 to February in our hospital and the clinical characteristics were retrospectively analyzed.【Results】Among the three cases, the magnetic resonance diffusion-weighted imaging of the first case was negative 7 hours after onset of disease, while the diffusion weighted imaging show positive of dorsolateral medulla oblongata recent infarction 64 hours after onset. The diffusion-weighted imaging of the second case was negative 6 hours after onset of disease, while the diffusion-weighted imaging showed positive of recent infarction on the right side of basal ganglia 52 hours after onset, which was 28 hours after the symptoms aggravated. The diffusion-weighted imaging of the third case was negative 5 hours after onset of disease, while the diffusion weighted imaging showed positive of right dorsal medulla oblongata recent infarction 64 hours after onset.【Conclusion】Magnetic resonance diffusion-weighted imaging is an effective tool in diagnosing acute ischemic stroke in the early stage, which shows positive image within a few minutes after onset. However, we noticed that there are the large number of acute ischemic stroke patients with DWI negative in early stage and that some DWI positive image can show up to 120 hours after onset. Therefore, when DWI is negative while the acute ischemic stroke symptoms are present, we should do the proper treatment and re-examine DWI in order to make early diagnosis and reduce misdiagnosis or missed diagnosis.