Left MCA infarct

Case contributed by Jeremy Jones
Diagnosis almost certain


Acute onset right sided paraparesis with a right sided homonymous hemianopia.

Patient Data

Age: 45 years
Gender: Female

CT brain


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.

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