Left middle cerebral artery territory stroke - dense MCA sign
Right arm weakness and aphasia. History of Takayasu vasculitis.
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Hyperdense left MCA. No acute intracranial hemorrhage. There is loss of grey-white matter differentiation in the region of the left lentiform and caudate nuclei. Mild left cerebral convexity sulcal effacement and subtle subcortical loss of grey-white differentiation. The ventricular pattern is normal. No midline shift.
Acute left MCA stroke.
This case shows how subtle the loss of normal grey-white matter differentiation can be in early acute stroke. Without the dense MCA hitting you in the face, one might easily fly past the subtle parenchymal changes.