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Emergency department experience of primary diffusion weighted magnetic resonance imaging for the patient with lacunar syndrome

Abstract

Background: The purpose of this study was to evaluate the usefulness of a particular magnetic resonance imaging technique known as primary diffusion weighted imaging (DWI) for patients with lacunar syndrome in the emergency department (ED).

Methods: Patients with one of five classic lacunar syndromes underwent DWI as primary imaging modality. The DWI findings were classified into groups: (a) having a lesion with high signal intensity, (b) having a lesion with mixed signal intensity, and (c) unremarkable. The final clinical diagnoses were extracted from the patients’ medical records, and used as a reference standard.

Results: Of 151 DWI images, 120 (79%) were interpreted as high signal lesions, 21 (14%) as mixed signal lesions, and 10 (7%) as unremarkable. All patients with high signal lesions or unremarkable findings were diagnosed with ischaemic stroke. The patients with mixed signal lesions were diagnosed with haemorrhagic stroke with an exception of one ischaemic stroke.

Conclusion: Primary DWI is a feasible and useful neuroimaging tool for patients with lacunar syndrome in the ED.

  • AH, ataxic hemiparesis
  • CT, computed tomography
  • DCH, dysarthria clumsy hand syndrome
  • DWI, diffusion weighted imaging
  • ED, emergency department
  • MRI, magnetic resonance imaging
  • PMS, pure motor stroke
  • PSS, pure sensory stroke
  • SMS, sensorimotor stroke
  • Diffusion magnetic resonance imaging
  • cerebrovascular accident

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    BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine