Acute right MCA stroke

Case contributed by Dr Abdallah Mohamed


The patient presented to the emergency department with 4 hours history of left-sided weakness.

Patient Data

Age: 65 years
Gender: Male

Non-enhanced CT scan of the brain demonstrates early signs of right MCA territory infarction noted as loss of right insular ribbon sign due to cortical edema and loss of grey-white matter differentiation with obliteration of the Sylvian fissure secondary to edema.

A dense MCA sign is noted involving the M2 segment at the Sylvian fissure consistent with thromboembolic/atherothrombotic insult. 

Diffuse brain involution changes with periventricular arteriosclerotic ischemic white matter changes are also noted.

Annotated image

The first image shows the dense MCA sign (blue arrow)

The second image shows loss of insular ribbon sign (red ellipse)

Case Discussion

Dense vessel sign is one of the earliest signs in acute ischemic stroke usually seen at MCA. It can also be seen in other locations such as the basilar tip.

Loss of the insular ribbon is very specific for hyperacute ischemic stroke. It is believed to take place within few hours of the insult. Cortical edema and loss of grey-white matter differentiation with attenuation of the Sylvian fissure lead to the appearance.

Other features such as obscuration of the lentiform nucleus and caudate head can be seen in hyperacute ischemic stroke, but not demonstrated in this case. 


How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.