Presentation
Acute onset right sided paraparesis with a right sided homonymous hemianopia.
Patient Data
Hyperdense MCA sign (thrombus within the MCA) and peripheral low attenuation of the supplied MCA territory with loss of grey-white differentiation. Features of an MCA territory infarct.
Case Discussion
Typical appearances of an a relatively large and established MCA (middle cerebral artery) infarct with thrombus visualized in the proximal MCA (hyperdense MCA sign).
A subsequent CT (not uploaded) confirmed marked deterioration within 24 hours and a craniotomy was performed to facilitate decompression.
Large vessel occlusion from thrombus is atypical in this age group (45 year old female) and an underlying coagulopathy was suspected, but not found.