Case contribution: Dr. Raja Rizal Azman
Clinical:
- An 82-year old man presented with sudden onset of right sided body weakness and reduced consciousness following a fall at home.
- Physical examination revealed a dense right sided hemiparesis with upper and lower limb power of 0/5.
- His GCS was 11/15.
- He was haemodynamically stable with no evidence of external injury on physical examination.
CT scan findings:
- Diffuse hypodensity of the left temporal lobe involving both grey and white matter with effacement of the overlying sulci.
- The M1 segment of the left Middle Cerebral Artery (MCA) appeared hyperdense (white arrow).
Diagnosis: Acute left MCA infarct with dense MCA sign
Discussion (dense MCA sign):
- The dense MCA sign is the earliest sign of acute ischaemic stroke.
- This sign was first reported by Gάcs et al in 1983.
- The hyperdense appearance of the MCA is due to formation of thrombus within.
- Similar signs of occluded hyperdense vessels have been described of the carotid artery, anterior cerebral artery and the basilar artery.
- Causes of dense MCA not related to ischaemic stroke include an elevated haematocrit or calcified atheromatous plaque, these causes however are commonly bilateral.
- The presence of the dense MCA sign in acute ischaemic stroke is associated with a poorer outcome, larger volume strokes and more severe neurological deficits.
