Right middle cerebral artery territory stroke

Case contributed by Dr Andrew Van


Two hour history of dysphasia, right facial droop, left hemianopia and left upper and lower limb weakness

Patient Data

Age: 60 years
Gender: Male

Initial non-contrast CT

Early chronic small vessel changes but otherwise no acute abnormality. Grey-white matter differentiation is normal. No evidence of acute or established cortical infarct, no hyperdense MCA sign.


20 hours post thrombolysis CT

Infarction in the right middle cerebral artery territory involving the internal capsule, extending superiorly into the corona radiata.

In the left occipital lobe is also a 1.3cm diameter acute parenchymal bleed with surrounding edema.  

Case Discussion

The patient presented within thrombolysis cut off time. The decision to not do CT Perfusion was made due to known pre-existing impaired renal function.

This case demonstrates ischemic strokes may not show any signs of ischemia on the non-contrast CT scan in the hyperacute phase as well as an acute parenchymal bleed measuring 70 Hounsfield units in the left occipital lobe likely secondary to thrombolysis.

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Case information

rID: 45118
Published: 16th May 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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