MyPACS.net: Radiology Teaching Files > Case 5170324

Never visited HYPERDENSE MCA
Contributed by: Radiology Residency Program Faculty & Staff, Northeastern Ohio Universities College of Medicine-Canton Affiliated Hospitals, Ohio, USA.
Patient: 65 year old female
History: 65 year old female with altered level of consciousness. Found unresponsive.
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Fig. 1: Routine brain windows demonstrate increased attenuation in the left middle cerebral artery relative to the right side compatible with a "dense middle cerebral artery sign." There is also slight effacement of the temporal horn of the left lateral ventricle.

Fig. 2: Routine brain windows demonstrate increased attenuation in the left middle cerebral artery relative to the right side compatible with a "dense middle cerebral artery sign." There is also slight effacement of the temporal horn of the left lateral ventricle.

Fig. 3: Routine brain windows demonstrate increased attenuation in the left middle cerebral artery relative to the right side compatible with a "dense middle cerebral artery sign." There is also slight effacement of the temporal horn of the left lateral ventricle.

Fig. 4: Other findings include remote lacunes in the bilateral basal ganglia and left thalamus and chronic small vessel ischemic disease in the frontal periventricular white matter.

Fig. 5

Fig. 6: Narrow windows highlighting gray-white differentiation show a slight diminished attenuation in the left temporal and fronto-parietal lobes with slight effacement of sulci and loss of gray-white differentiation.

Fig. 7: Narrow windows highlighting gray-white differentiation show a slight diminished attenuation in the left temporal and fronto-parietal lobes with slight effacement of sulci and loss of gray-white differentiation.

Fig. 8: Narrow windows highlighting gray-white differentiation show a slight diminished attenuation in the left temporal and fronto-parietal lobes with slight effacement of sulci and loss of gray-white differentiation.

Fig. 9: Narrow windows highlighting gray-white differentiation show a slight diminished attenuation in the left temporal and fronto-parietal lobes with slight effacement of sulci and loss of gray-white differentiation.

Fig. 10: Narrow windows highlighting gray-white differentiation show a slight diminished attenuation in the left temporal and fronto-parietal lobes with slight effacement of sulci and loss of gray-white differentiation.

Fig. 11: Follow up scan 22 hours later.

Fig. 12: Follow up scan 22 hours later.

Fig. 13: Follow up scan 22 hours later.

Fig. 14: Follow up scan 22 hours later.

Fig. 15: Follow up scan 22 hours later.
Findings:

Routine brain windows demonstrate increased attenuation in the left middle cerebral artery relative to the right side compatible with a "dense middle cerebral artery sign", a finding seen with acute thrombotic or embolic infarct. There is also slight effacement of the temporal horn of the left lateral ventricle.  Other findings include remote lacunes in the bilateral basal ganglia and left thalamus and chronic small vessel ischemic disease in the frontal periventricular white matter. 

Narrow windows highlighting gray-white differentiation show a slight diminished attenuation in the left temporal and fronto-parietal lobes with slight effacement of sulci and loss of gray-white differentiation.

Follow up CT the next day demonstrates significant interval change with large areas of nonhemorraghic infarction involving the territories of at least the left middle cerebral artery and anterior cerebral artery with midline shift, mass effect, and cerebral edema.

Diagnosis: Dense left MCA with a large acute anterior circulation territory infarct.
Discussion:

Early CT signs of cerebral infarction include:

Loss of gray-white interfaces
Sulcal effacement
Hyperdense clot in artery on noncontrast CT ("dense MCA sign")

References:

Weissleder, R., Wittenberg, J., and Harisinghani, M. G.  Primer of Diagnostic Imaging. 2003. p. 506.

Submitted by Aakash D. Singh, MD, PGY-IV Radiology Resident

Comments:
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Additional Details:

Case Number: 5170324Last Updated: 2011-08-02
Anatomy: Cranium and Contents   Pathology: Hematological
Modality: CTAccess Level: Readable by all users
Keywords: hyperdense mca, acute strokeACR: 1742.771

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