Middle cerebral artery infarction
case study by Dr.Eman ragab
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DeyeCOM sign = conjugate eye deviation
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MCA dot sign = dense M2 within the sylvain fissure
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Hyper dense MCA sign
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TERMINOLOGY
• Interrupted blood flow to brain resulting in cerebral ischemia/infarction with variable neurologic deficit
IMAGING
• Major artery (territorial) infarct
○ Generally wedge-shaped; both gray matter (GM), white matter (WM) involved
• Embolic infarcts
○ Often focal/small, at GM-WM interface
• NECT
○ Hyperdense vessel = clot ("dense MCA" sign)
○ Loss of GM-WM distinction in first 3 hours (50-70%)
– "Insular ribbon" sign: GM-WM interface lost
– "Disappearing basal ganglia" sign
○ Calcified embolus
– Don't miss this (high risk of recurrent stroke)
• CTA
Excellent for major vessel occlusions
• MR
○ Parenchymal ± intraarterial FLAIR hyperintensity
○ ↑ intensity on DWI with corresponding ↓ on ADC
○ ↓ CBF, CBV on perfusion MR