Dense MCA sign

Case contribution: Dr. Raja Rizal Azman


  • 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.
Non-contrast CT scan of brain, axial plane soft tissue window

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.
Author: radhianahassan