Acute ischemic stroke: dense MCA sign

Case contributed by Gaurav Som Prakash Gupta
Diagnosis certain


Sudden onset right-sided weakness and aphasia.

Patient Data

Age: 80 years
Gender: Female

Image clearly demonstrates:

  • dense MCA sign on the left
  • insular ribbon sign

CT also show hypodensity with loss grey-white matter differentiation in the left MCA territory.

Follow up CT showed sell established left MCA infarct.

Case Discussion

This case illustrates early signs of infarction. Although in this case the parenchymal hypodensity is well seen, however, in patients with an earlier presentation, the dense MCA sign and insular ribbon sign may be the only evidence of infarction and prompt either CT perfusion or MRI to determine the feasibility of thrombolytic therapy. 

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