Hyperdense Middle Cerebral Artery Sign in the Setting of Acute Cerebral Ischemia: A Case Report

Hyperdense Middle Cerebral Artery Sign: A Case Report


  • Kaylee Mach
  • Blake Snow
  • Sean Hayes
  • Jamison Williams
  • Samuel Jellison
  • Donald Von Bortsel


Non-contrast computed tomography (CT) is the initial imaging modality of choice for acute stroke symptoms.5 Other imaging modalities, such as CT angiogram (CTA) and CT perfusion studies, can help confirm ischemic stroke, identify viable tissue, and determine therapeutic intervention.1 One of the earliest signs of ischemia on non-contrast CT in stroke patients is the hyperdense middle cerebral artery sign (HMCAS).2 The HMCAS is suggestive of acute occlusion within the branches of the middle cerebral artery (MCA).3 In this case, a patient presented with delayed-onset neurological symptoms in the presence of the HMCAS. Imaging proved to guide the therapeutic approach and gave insight necessary to reveal arterial involvement and tissue injury. Identification of this HMCAS in patients is valuable as its presence has been directly correlated to poor clinical outcomes when treatment is delayed.4