Presentation
History of hypertension, COPD, CVA presenting via EMS for altered mental status
Patient Data
Large territorial infarct involving the entire territory of the right MCA with associated Dense MCA sign on the right. Chronic infarct in the left MCA territory.
Large volume brain edema bilaterally involving the majority of the supratentorial brain with left to right midline shift of approximately 4.4 mm. New bilateral dense MCA sign.
Case Discussion
Hyperdense MCA sign refers to the increased density in non-contrast head CTs seen in ischemic strokes involving the middle cerebral artery. The increased density is due to the thromboembolic material, which can have associated calcification or hemorrhage, which bring about high attenuation. The prognosis is usually is poor as the sign is very specific (above 90%) for MCA infarct. It is thought to be the earliest visible sign of infarction and can be seen within 90 minutes of the event. It is a key and classic sign of ischemic stroke in a non-contrast head CT.