Five Ischemic Brainstem Infarction Cases Without Any Radiological Evidence in the Short-Term: Case Report

Diffusion-weighted magnetic resonance imaging (DW-MRI) is the most commonly used imaging modality in diagnosing ischemic stroke. However, in some cases, this imaging modality may fail to show acute ischemic strokes early, especially in posterior circulation strokes. We retrospectively documented our five patients’ sex, ages, comorbidities, Modified Rankin Scale (MRS) scores, admission National Institutes of Health Stroke Scale (NIHSS) scores, DWI findings, and delay time of DWI findings applied to our stroke center who had symptoms suggesting brain stem ischemic stroke. All our patients had bulbus ischemic infarctions. Two of them were women, and three of them were men. Their MRS scores were 0 or 1, and most had minor strokes according to their NIHSS scores. The delay times of DWI findings changed from 16 to 101 h; the mean delay time of our seven patients was approximately 46 h. Especially in acute posterior circulation strokes, false negativity can be seen in DW-MRIs within the first 24 h or even longer after their onset. It would be appropriate to perform repeated DW-MRIs in patients with persistent suspicion of stroke based on clinical findings.