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A note on the hyperdense middle cerebral artery sign
  1. Josef Georg Heckmann
  1. Correspondence to Professor Dr Josef Georg Heckmann MME, Department of Neurology, Municipal Hospital Landshut, Robert-Koch Str. 1, 84034 Landshut, Germany; josef.heckmann{at}

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Stroke is an acute emergency needing a well-conceived diagnostic and therapeutic approach with broad differential diagnosis.1 ,2 After physical and neurological examination cranial CT (CCT) is the most used imaging procedure searching for early signs of stroke or other structural pathologies. We wish to present a patient with pronounced hyperdense middle cerebral artery sign (HMCAS) and to annotate this finding.

A 93-year-old woman developed progressive aphasia, right-sided hemiparesis, and hemianopia to the right side and gaze paresis to the right. The axial and reconstructed coronal CT of the brain showed a hypodensity of the left temporal lobe and a marked HMCAS (HMCAS; figure 1 A,B). The middle cerebral artery (MCA) …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.