Resolution of "hyperdense" middle cerebral artery post tPA thrombolysis

Case contributed by Chris O'Donnell
Diagnosis certain

Presentation

Acute right hemiplegia, presented within 1 hour ro ED. Treated with tPA thrombolysis leading to complete resolution of symptoms.

Patient Data

Age: 85
Gender: Male

CT at time of initial presentaion & at 24 hours as per protocol

Dense left MCA (distal M1) on the inital scan that resolves on the subsequent ie post tPA (60 HU to 36 HU) consistent with lysed blood clot. No signs of infarction including no loss of the "insular ribbon". No features of infarction on the subsequent scan nor hemorrhage.

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