Hyperacute Venous Stroke: MR Diffusion

History

Recent neurologic changes, often not focal.

Exam

Head MR- diffusion sequences with DWI and ADC maps

Purpose

1. Assess whether the diffusion maps (DWI & ADC) are positive for recent stroke within the venous egress zone.

2. Assess for hemorrhagic conversion (hematoma formation) using the Bo initial sequence on diffusion MR.

3. Assess for diffusion positivity in nasopharyngeal infection or infiltrative mass (both are typically positive on MR diffusion). These lesions can invade the cavernous sinus.

4. Assess for diffusion positivity in infection or infiltrative mass with the otomastoid and posterior skull base (often positive on MR diffusion). These lesions can invade the transverse sinus and inferior petrosal sinus.

5. Exclude concurrent arterial stroke.

Prior Study

CT Head
CTA/MRA Head and Neck
MR T1-W Sequences

Findings

MR Diffusion

There is evidence of positive diffusion indicating venous parenchymal stroke. [Yes/No]

There is evidence of hemorrhagic conversion. [Yes/No]

There is evidence of a concurrent arterial stroke, as well. [Yes/No]

There is no MR diffusion positive tumor/infection in the skull base (anterior, mid or posterior) possibly causing dural or cavernous sinus thrombosis. [Yes/No]