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Hyperdense middle cerebral artery CT sign

Comparison with angiography in the acute phase of ischemic supratentorial infarction

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The early CT finding of an hyperdensity of a portion of the middle cerebral artery Hyperdense Middle Cerebral Artery Sign (HMCAS), in patients with supratentorial stroke, is often indicative of an embolic occlusion. Aim of this study was to verify the incidence and reliability of the HMCAS and its possible correlation with early CT findings and with the extent of late brain damage. We studied 36 patients presenting with symptoms of stroke in the MCA territory, by means of CT and angiography performed respectively within 4 and 6 hours. Follow-up CT scans were then obtained after one week and three months from the ischemic event. The HMCAS was present in 50% of our patients and in this group it always correlated positively with the angiographic finding of occlusion. The same group presented a high incidence of erly CT hypodensity (88%). Finally the presence of HMCAS might be considered a negative prognostic sign for the development of extensive brain damage.

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Bastianello, S., Pierallini, A., Colonnese, C. et al. Hyperdense middle cerebral artery CT sign. Neuroradiology 33, 207–211 (1991). https://doi.org/10.1007/BF00588219

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Key words

  • CT
  • Cerebral infarction
  • MCA
  • Embolism
  • Angiography