Case 16
History:
55 year old male with right sided weakness
Findings:
Day one CT scan revealed a hyperdense middle cerebral artery. Day two shows large left MCA infarct.
Diagnosis:
Hyperdense middle cerebral artery
Discussion:
The hyperdense middle cerebral artery is an indirect sign of cerebral ischemia corresponding to the clot itself. Can be encountered on NCCT images before other changes are seen. Although its significance is somewhat controversial, the HMCA sign has been associated with poor prognostic, as was also seen in our case. HDMCA is not a contraindication for thrombolysis.
References:
- T Tomsick, T Brott, W Barsan, J Broderick, EC Haley, J Spilker and J Khoury. Prognostic value of the hyperdense middle cerebral artery sign and stroke scale score before ultraearly thrombolytic therapy. American Journal of Neuroradiology, Vol 17, Issue 1 79-85, 1996
