Hyperdense middle cerebral artery sign.

A 57-year old man presented with sudden onset hemiplegia. On examination he had global aphasia, a dense right hemiplegia and a right extensor plantar response. He had a history of diabetes mellitus, hypertension and a myocardial infarction one year ago. A non contrast CT scan of the brain done on the same day did not show a cerebral infarction, but showed a loss of visualisation of the insular ribbon, loss of outline of the lentiform nucleus, effacement of the overlying cortical sulci and a hyperdense middle cerebral artery on the left side (Figure 1), all of which are early signs of a middle cerebral artery territory infarction in the CT. A repeat CT scan done a week later showed a large infarction in the territory of the left middle cerebral artery (Figure 2) and the disappearance of the hyperdense artery sign. Hyperdense middle cerebral artery sign