Presenter: Sri Patel, DO
Topic: Hyperdense MCA Stroke
60 yo M presents as a stroke in the field PMHx afib, recent valve repair on Coumadin. Patient had L face droop, L arm, L leg weakness 50min PTA with a fall from chair.
VS 140 110/90 99% 16 98.6
Patient improving upon arrival, no focal deficits. STAT CTH performed, patient decompensated with worsening deficits on the L. CTH showed dense thrombus in the R MCA, patient taken to cath lab for endovascular retrieval.
Patient improved post-op to 5/5 strength bilaterally.
- hyperdense MCA sign reported in 17%-50% of patients with an MCA distribution ischemic stroke; approx. 100% sensitive, 30% specific
- 70-84% of patients with hyperdense MCA sign treated with IV tPA have poor outcome; IA tPA showed better outcome in a 2008 prospective study (53% improved vs 23% (IV)
- know the absolute contraindications to tPA
Mattle HP, Arnold M, Georgiadis D, et al. Comparison of intraarterial and intravenous thrombolysis for ischemic stroke with hyperdense middle cerebral artery sign. Stroke. 2008;39(2):379–383.
Berkhemer et al. “A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke.” The New England Journal of Medicine. (2015). 372:1. 11-20.