Discrepancy between diffusion and perfusion imaging in a patient with transient ischaemic attack

We report paradoxical and ambiguous imaging findings in a patient with tran sient ischaemic attack (TIA). Perfusion-weighted (PW) MRI obtained 2 hours after symptoms onset showed a hypoperfused area in a region compatible with the focal deficit, while diffusion-weighted (DW) MRI was considered negati ve. Despite the, complete resolution of the symptoms which had already begu n at the end of the first MR examination, follow up DW MRI at 3 days showed partial conversion to hyperintensity of the initially hypoperfused area. T his case illustrates that PW and DW MRI have to be used in combination and at different time points to correctly diagnose and manage ischaemic stroke because PW MRI is more sensitive than DW MRI for very early detection of is chaemia and delayed DW MRI provides the final signature of brain damage eve n in case of complete clinical recovering.