Hyperdense MCA sign

Case contributed by Naim Qaqish
Diagnosis certain


Dysarthria and right sided weakness.

Patient Data

Age: 75 years
Gender: Female



There is evidence of hyperdense left MCA indicating occlusion of the left MCA which needs further evaluation by MRI.



There is evidence of a large fresh infarct involving the left middle cerebral artery territory but not containing hemorrhagic components.

Unfortunately, ADC map images are not included.

There is no evidence of any mass effect or midline shift.

Case Discussion

This lady presenting through ER with dysarthria and right-sided weakness, she has multiple risk factors for stroke formation. Initially, an unenhanced brain CT was requested which shows a left hyperdense MCA sign, and further evaluation by MRI was requested to show a recent large ischemic infarct involving the left MCA territory. The importance of unenhanced brain CT in the acute setting of infarction relies on an appreciation of the cytotoxic edema effect which is accentuated on utilizing the ( W 8 HU, C 32 HU) window which depicts the loss of GWM differentiation, obscured lentiform nucleus, and loss of insular ribbon sign.

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