ABSTRACT
A 60-year-old man with a history of hypertension presented 4 hours after the onset of speech deficits. Which of the following statements is correct?
a. The negative computed tomogram shown here effectively rules out acute stroke
b. T2-weighted magnetic resonance imaging (MRI) would be expected to be positive at 4 hours if a stroke has occurred
c. Diffusion-weighted MRI may be positive 4 hours after a stroke has occurred
d. If a stroke has occurred, the lesion is likely in the right paramedian thalamic region
e. Diffusion-weighted MRI will show an acute thalamic stroke after T2-weighted MRI
• Computed tomography (CT) is often negative in acute stroke. Use of CT in the setting of acute stroke is to exclude intracranial hemorrhage and mass effect. A negative CT does not rule out acute stroke
• Diffusion-weighted MRI may be positive in acute thalamic stroke as soon as 4 hours after symptoms
• T2-weighted MRI may show hyperintensity at the site of stroke within 24 hours of the event (see images above, obtained 1 day after the CT on previous page)
• Physical manifestations of thalamic stroke depend on the location of the infarct. Language deficits would be expected from left paramedian lesions
