72 year old female with left sided

weakness since waking

Michael Levin
MS4
With help from Carolyn Hanna, MD
 H&P
• Onset at waking, UE > LE, dysarthria, left sided
facial drooping
• For a presentation of unilateral hemiparesis,
CTA head and neck perfusion with an without
contrast
• Looking for MCA more than ACA stroke
Imaging: CT head w/o IV contrast
Imaging: CT head w/o IV contrast
Imaging: CTA w/ bone subtraction
Imaging: CT perfusion
 Imaging findings
• Hyperdense MCA sign
• Sulcal effacement and edema in cortex =>
cytotoxic (not vasogenic) => infarct
• Impaired filling of R M1 and M2
• Perfusion to R MCA territory delayed; still gets
some slower blood flow from collaterals
 R MCA Stroke
• 1st: check for midline shift/herniation
• Arterial hyper-density specific but not
sensitive (50%)
• MCA hyper-density can be seen immediately
• Calcification => angioplasty c/i
Mair G, Boyd EV, Chappell FM, et al. Sensitivity and specificity of the Hyperdense Artery Sign for
arterial obstruction in acute ischemic stroke. Stroke; a journal of cerebral circulation.
2015;46(1):102-107. doi:10.1161/STROKEAHA.114.007036.

https://radiopaedia.org/articles/middle-cerebral-artery-mca-infarct