Open Access Highly Accessed Research article

Clinical presentation and diffusion weighted MRI of acute cerebral infarction. The Bergen Stroke Study

Halvor Naess1*, Jan C Brogger1, Titto Idicula1, Ulrike Waje-Andreassen1, Gunnar Moen2 and Lars Thomassen1

Author Affiliations

1 Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway

2 Department of Radiology, Haukeland University Hospital, 5021 Bergen, Norway

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BMC Neurology 2009, 9:44  doi:10.1186/1471-2377-9-44

Published: 18 August 2009



No large study has compared the yield of diffusion-weighted imaging (DWI) with clinical examination in order to differentiate lacunar stroke from other stroke subtypes. This differentiation is important for guiding further investigations and treatment.


Consecutive patients admitted with cerebral infarction were classified according to the Oxfordshire Community Stroke Project scale. Based on DWI and CT stroke was classified as lacunar (LI) and non-lacunar (NLI). Acute ischemic lesion <1.5 cm and located in subcortex or in brainstem were classified as LI. All other infarctions were classified as NLI.


DWI was performed in 419 (69%) patients. Among patients with lacunar syndrome (LACS) 45 (40.5%) had NLI on DWI. All patients with total anterior syndrome (TACS) and 144 (88.3%) with partial anterior syndrome (PACS) had NLI on DWI.


DWI is important among patients presenting with clinical symptoms suggestive of lacunar syndrome to differentiate between LI and NLI. On the other hand, there is good correspondence between TACS or PACS and NLI on DWI.