Discussion Author(s): Medical Student: Holly Neglio, Resident: Jason Chu, Radiologist: Michael Winkler, Neurologist: Antonio Liu
Recognized as a focus of increased attenuation in a cerebral vessel on computed tomography, the hyperdense MCA sign is an early diagnostic findings found in an occasional patient with ischemic stroke. The HDMCA sign is seen when there is clot in the horizontal portion of the middle cerebral artery and is commonly reported to be associated with thromboembolism, and it may serve as a early sign of a impending enlarging infarction. With prompt intraarterial thrombolytic therapy there are hopes of improving prognosis.
A hyper-density is defined qualitatively to have absolute density of >43 Hounsfield Units (HU) or a ratio >1.2 when comparing dense MCA vs. normal MCA. In many cases the increased density may be due to a combination of clot and calcium.
Identification of the sign is most effectively accomplished by computed tomography with thin slice imaging. Magnetic resonance imaging with T2 weighting has also demonstrated the clot in the middle cerebral artery.
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