Hyperacute MCA infarction


  • A 55 years old man
  • Underlying hypertension and DM
  • Presented with acute onset of altered consciousness
Urgent plain CT brain soft tissue window

CT findings:

  • There is no intracranial haemorrhage
  • Hyperdense MCA sign seen on the left side (yellow arrow)
  • Insular ribbon sign with effacement of left sylvian fissure
  • No definite area of hypodensity is seen
Axial MRI in T1, T2, FLAIR and DWI sequence

MRI findings:

  • Abnormal signal intensity at left MCA territory
  • Hypointense on T1, hyperintense on T2 and not well seen on FLAIR
  • The region showed restricted diffusion on DWI/ADC images

Diagnosis: Hyperacute left MCA infarction


  • The middle cerebral artery territory is the commonest affected territory in cerebral infarction
  • The earliest finding in MCA infarction is hyperdense MCA sign that represent direct visualisation of thromboembolism
  • Early parenchymal sign include decreased attenuation involving the lentiform nucleus, caudate nucleus and at insular ribbon region

Progress of patient:

  • Decompression craniectomy done
  • Patient was discharged, able to ambulating but had expressive dysphasia and unable to work
Plain CT brain performed after operation
Author: radhianahassan