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  • Title: Diffusion weighted imaging reversibility in the brainstem following successful recanalization of acute basilar artery occlusion.
    Author: Yoo AJ, Hakimelahi R, Rost NS, Schaefer PW, Hirsch JA, González RG, Rabinov JD.
    Journal: J Neurointerv Surg; 2010 Sep; 2(3):195-7. PubMed ID: 21990621.
    Abstract:
    Acute basilar artery occlusion (ABAO) is a devastating disease that can produce significant brainstem injury. Pretreatment diffusion weighted imaging (DWI) demonstrating extensive brainstem involvement has been shown to predict a poor outcome regardless of reperfusion. This case report describes a patient presenting with coma secondary to ABAO. MRI at presentation demonstrated significant DWI abnormality in the majority of the bilateral pons. The basilar artery was endovascularly recanalized 8 h after stroke onset, and the patient had a marked clinical recovery with no deficit at 3 months. Follow-up imaging revealed significant reversal of the pontine lesion. This finding of brainstem DWI reversibility cautions against the use of DWI to select ABAO patients for intra-arterial stroke therapy. The degree of apparent diffusion coefficient reduction on pretreatment MRI may not adequately identify which DWI abnormal brainstem tissue is potentially reversible.
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