Utility of High-b-Value Diffusion-Weighted Magnetic Resonance Imaging in Evaluating Reversible Medial Longitudinal Fasciculus Syndrome Caused by Acute Brainstem Ischemia

J Stroke Cerebrovasc Dis. 2015 Jun;24(6):e157-9. doi: 10.1016/j.jstrokecerebrovasdis.2015.03.002. Epub 2015 Mar 30.

Abstract

Background: Medial longitudinal fasciculus (MLF) syndrome refers to a gaze disorder characterized by impaired adduction on the ipsilateral side to the injured MLF, with dissociated nystagmus of the contralateral abducting eye. The most common cause of the MLF syndrome is ischemic stroke. However, acute ischemic change in the MLF may be undetectable even on diffusion-weighted magnetic resonance imaging (DW-MRI) partly because of its small size and specific brainstem location.

Case report: Herein, we present the first reported case of MLF syndrome in which, compared with the standard-b-value DWI, a higher b-value DWI revealed more clearly a small infarction in the dorsal pons in the acute stage.

Conclusions: We suggest that high-b-value DWI can be a useful diagnostic method for patients with MLF syndrome caused by possible brainstem ischemia and thus supportive for deciding the optimal treatment for such patients.

Keywords: MLF syndrome; MRI; brainstem; high-b-value DWI; stroke.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain Ischemia / complications*
  • Brain Ischemia / pathology
  • Brain Stem / pathology*
  • Diffusion Magnetic Resonance Imaging
  • Humans
  • Male
  • Middle Aged
  • Nystagmus, Pathologic / etiology*
  • Nystagmus, Pathologic / pathology