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Age: 26

Sex: Male

Indication: Unresponsive

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Case #1


Findings

  • Diffuse, confluent low attenuation with loss of gray-white differentiation in the left cerebral hemisphere involving the ACA and MCA territories
  • Dense left MCA and ACA
  • Left hemispheric sulcal effacement with slight left to right midline shift and slight effacement of the left lateral ventricle


Diagnosis

  • Acute left ACA and MCA territory infarct

Sample Report

Diffuse, confluent low attenuation with loss of gray-white differentiation in the left cerebral hemisphere involving the ACA and MCA territories concerning for acute/early subacute ischemia. Asymmetrically dense appearance of the left MCA and ACA concerning for thrombosis. Recommend head CTA and brain MRI for further evaluation.

No evidence of hemorrhagic transformation. Associated cytotoxic edema with resultant left hemispheric sulcal effacement, 3 mm left to right midline shift, and slight effacement of the left lateral ventricle. Basal cisterns are patent without evidence of herniation.


Discussion

  • Remember to always look at the brain on narrow (“stroke”) windows
  • Dense vessel signs are immediate findings in strokes and are apparent hours before cytotoxic edema develops. While dense vessel signs are seen in a minority of cases, it is important to look for them because they may be the only clue that the patient is having an acute stroke


Images

Asymmetrically dense appearance of the proximal left ACA (red arrow) and MCA (yellow arrow) concerning for thrombosis Representative diffusion-weighted MR image from this patient Cross-sectional arterial territories of the brain.

Video Reviews

Ischemia on Head CT Video



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