A case of large right MCA stroke with hyperdense MCA sign in CT imaging

Description

A 76-year-old woman with no significant medical history was brought to the emergency department with complaints of sudden onset of left-sided weakness and facial drooping 1 hour prior to the arrival. On physical examination, patient had profound left-sided neglect and conjugate deviation of the eyes to the right side. Motor examination showed grade 0 power on left upper and lower extremities, and she had 3+ reflexes on the left and 2+ reflexes on the right. Babinski was positive on the left side. She was sent for a CT scan which showed increased density of M1 segment of middle cerebral artery (MCA) with loss of grey white differentiation of MCA territory (figure 1). Alberta Stroke Programme Early CT Score was 8. Patient's initial National Institutes of Health Stroke Scale score was 17 and was immediately given tissue plasminogen activator (TPA) as the family adamantly refused endovascular procedure; however, her post-TPA score was also 17 as...

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