Presentation
Left sided facial droop and inattention since few hours. Provisional diagnosis: stroke?
Patient Data
There is mild brain atrophy with consequent sulcal and ventricular widening. Mild chronic small vessel ischemic change noted in the supratentorial white matter.
Hyperdense appearance of the right MCA bifurcation may raise suspicion of acute thrombus, clinical correlation is essential.
There is no evidence of an established infarct, intracranial hemorrhage, space-occupying lesion or extra-axial fluid collection.
Sudden deterioration of clinical status
Wedge-shaped loss of the grey-white matter differentiation noted in the right frontoparietal temporal region, there is associated intraparenchymal and subarachnoid hyperdensity in keeping with hemorrhagic transformation of right-sided acute infarction.
The ventricular system is normal. Basal cisterns are patent. No midline shift. Posterior fossa structures are normal. No sinister bone lesion.
Case Discussion
MCA dot sign/ Sylvian fissure sign represents thromboembolism within a branch of the MCA located within the Sylvian fissure (M2 segment). It is a highly specific sign.
This patient developed hemorrhagic transformation in the right MCA territory infarct, a known complication of thrombolysis.
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