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Images in Neurology |

Reversibility of Brainstem Damage After a Mechanical Thrombectomy

Benjamin Gory, MD, MSc1; Thomas Ritzenthaler, MD, MSc2; Roberto Riva, MD1; Norbert Nighoghossian, MD, PhD2; Francis Turjman, MD, PhD1
[+] Author Affiliations
1Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Bron, France
2Stroke Unit, Department of Neurology, Hôpital Neurologique Pierre Wertheimer, Bron, France
JAMA Neurol. 2014;71(5):646-647. doi:10.1001/jamaneurol.2013.5574.
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Diffusion-weighted imaging (DWI) has revealed the reversal of often sizeable damage due to brainstem lesions in patients treated within 4.5 hours, and this reversibility of damage was strongly associated with early neurological improvement.1 In posterior circulation stroke, the reversibility of damage due to a DWI-detected lesion is poorly documented after intravenous thrombolysis2 or intra-arterial therapy.3,4 We report a case of vertebrobasilar stroke mechanically recanalized 4.5 hours after symptom onset that revealed substantial reversal of early ischemic damage to the brainstem on DWI scans.

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Figure.
Magnetic Resonance Imaging and Angiogram Findings at Baseline and Day 4

A and B, Diffusion-weighted imaging (DWI) at baseline reveals a right lateral pontine infarct and a central pontine lesion. C, The initial angiogram shows a midbasilar artery occlusion. D, An angiogram after a mechanical thrombectomy with the Solitaire Flow Restoration stent reveals complete recanalization. E-H, The DWI and fluid-attenuated inversion recovery sequences on day 4 reveal complete diffusion normalization and a substantial reversal of damage due to a brainstem lesion.

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