A 77-year-old right-handed woman presented to the emergency department after being found on the floor at home. She had a history of diabetes mellitus, coronary artery disease, and hypertension. Her family found her noncommunicative and unable to walk. When last seen 12 hours previously, she had been doing well. New findings on examination were global aphasia, left gaze preference, flaccid right hemiplegia, and a right extensor plantar response. Results of a noncontrast computed tomographic (CT) scan performed on presentation revealed a hyperdense tubular region in the proximal segment of the left middle cerebral artery (MCA), consistent with acute thrombosis (Figure 1). Also noted were subtle left cerebral sulcal effacement and hypodensity of the left basal ganglia and frontal, anterior parietal, and superior temporal lobes. Taken together, these findings are consistent with an acute MCA infarction.
Bakshi R, Mazziotta JC. Acute Middle Cerebral Artery Thrombosis Demonstrated by Cranial Computed TomographyThe "Dense MCA" Sign. Arch Neurol. 1998;55(12):1577. doi:10.1001/archneur.55.12.1577