Presentation
2 hours of onset with a dense right hemiparesis.
Patient Data
Age: 65 years
Gender: Male
From the case:
Stroke progression on CT
Axial non-contrast
Hyperdense artery sign in the M1 segment of the left middle cerebral artery.
Loss of the insula ribbon.
Axial non-contrast
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.
- Initially the signs may be subtle or entirely absent on CT.
- The hyperdense MCA and insula ribbon are two early signs of stroke.
- CT is still the first imaging modality in most scenarios in stroke.
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