Stroke progression on CT

Case contributed by Ian Bickle


2 hours of onset with a dense right hemiparesis.

Patient Data

Age: 65 years
Gender: Male

Hyperdense artery sign in the M1 segment of the left middle cerebral artery.

Loss of the insula ribbon.

24 hours after the original scan.


Within 24 hours of the original CT a huge left MCA territory infarction has evolved.

No hemorrhage.

Case Discussion

These sequential CTs demonstrate a number of important aspects in stroke imaging.

  1. Initially the signs may be subtle or entirely absent on CT. 
  2. The hyperdense MCA and insula ribbon are two early signs of stroke.
  3. CT is still the first imaging modality in most scenarios in stroke.

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