Presentation
Melanesian. Presents with left hemiplegia for about 12 hours. Blood pressures normal. No aphasia. GCS = 15/15.
Patient Data
This plain CT brain study demonstrates a hyperdense right middle cerebral artery (MCA). The right MCA has a density of 69 Hounsfield Units (HU). There are also brain parenchymal changes seen, most notably there is loss of grey-white matter differentiation in the right insular ribbon and the right frontotemporal region.
Case Discussion
This patient presented to the emergency department with the above symptoms and was clinically diagnosed with a stroke. Upon completion of the CT scan, which revealed an acute ischemic stroke, the patient was promptly admitted to the medical ward. There, they commenced antithrombotic therapy (acetylsalicylic acid and clopidogrel) and also started physiotherapy.
No additional imaging, such as angiography, was performed, and no thrombectomy was conducted.
The presence of a hyperdense middle cerebral artery (MCA) indicates an acute ischemic cerebrovascular accident (CVA). The 'hyperdense MCA sign' is considered one of the earliest and most sensitive indicators for detecting an ischemic stroke.
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