Brainstem Lesions in Diffusion Sequences of Mri Can Be Reversible After Arterial Recanalization

In acute stroke patients, MRI can provide additional information which can be useful in determining whether thrombolytics should be administered, especially if the time frame for IV treatment has been exceeded. In vertebrobasilar stroke, extensive lesion on diffusion-weighted imaging (DWI) at baseline is considered an exclusion criterion for reperfusion treatment, based on the assumption that it corresponds to irreversible brain damage.1,2 We report a case of basilar artery occlusion with a reversible DWI brainstem lesion and clinical recovery after arterial recanalization. ### Case report. A 64-year-old right-handed woman with a medical history of arterial hypertension arrived at the comprehensive stroke center 55 minutes after experiencing sudden drowsiness, right-side weakness, and anarthria. Blood pressure was 104/46 mm Hg, heart rate was regular, and glycemic levels were 105 mg/dL. NIH Stroke Scale (NIHSS) score upon admission was 16 (drowsiness, ophthalmoparesis, anarthria, right hemiparesis including facial weakness and right anesthesia). A noncontrast CT scan performed 90 minutes after onset demonstrated absence of early signs of cerebral ischemia. A transcranial duplex study showed distal basilar occlusion. Thus, IV thrombolysis with …