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Hyperdense Middle Cerebral Artery Sign After Trauma

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Veröffentlicht/Copyright: 1. November 2014
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Journal of Osteopathic Medicine
Aus der Zeitschrift Journal of Osteopathic Medicine Band 114 Heft 11

A 56-year-old man presented to the emergency department after a highway-speed, single-vehicle motor vehicle accident. Physical examination revealed no evidence of head trauma but was notable for a Glasgow Coma Scale score of 6, with the patient exhibiting a withdrawal response to pain on his left side. Computed tomography findings included a hyperdense middle cerebral artery sign (HMCAS) on the left side (image A). A magnetic resonance (MR) angiogram showed occlusion of the left middle cerebral artery, and an MR image revealed an infarct (image B). Although the patient's mental status improved, he was discharged to inpatient rehabilitation 9 days later because of hemiplegia on his left side.

The present case highlights the interrelationship of vascular structure and central nervous system function in a complex presentation. As seen in the present case, HMCAS is associated with large infarcts and functional impairment.1 Early identification of HMCAS is particularly important in stroke patients, as data suggest improved outcomes among patients treated with intra-arterial as opposed to intravenous thrombolysis.2,3 Physician awareness of HMCAS is essential for optimal detection, prognostication, and management. (doi: 10.7556/jaoa.2014.175)

*Address correspondence to Ronald F. Sing, DO, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232-2861. Email:

References

1. Paciaroni M ,AgnelliG,FloridiP, et al. Hyperdense middle cerebral and/or internal carotid arteries in acute ischemic stroke: rate, predictive factors, and influence on clinical outcome [published online August 23, 2011].Cerebrovasc Dis.2011;32(3):239-245. doi:10.1159/000329375.10.1159/000329375Suche in Google Scholar PubMed

2. Mattle HP ,ArnoldM,GeorgiadisD, et al. Comparison of intraarterial and intravenous thrombolysis for ischemic stroke with hyperdense middle cerebral artery sign [published online December 20, 2007].Stroke.2008;39(2):379-383.10.1161/STROKEAHA.107.492348Suche in Google Scholar PubMed

3. Agarwal P ,KumarS,HariharanS, et al. Hyperdense middle cerebral artery sign: can it be used to select intra-arterial versus intravenous thrombolysis in acute ischemic stroke [published online December 29, 2003]? Cerebrovasc Dis. 2004;17(2-3):182-190.10.1159/000075789Suche in Google Scholar PubMed

Received: 2014-06-10
Accepted: 2014-06-11
Published Online: 2014-11-01
Published in Print: 2014-11-01

© 2014 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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  1. LETTERS TO THE EDITOR
  2. Observational Study Fails to Demonstrate the Effectiveness of OMT in Decreasing Low Back Pain
  3. Impact of the Single Accreditation Agreement on GME Governance and the Physician Workforce
  4. EDITORIAL
  5. Emerging Infections: The Cauldron of Medicine, Mobility, and Media
  6. Reversing the Paradox: Evidence-Based Medicine and Osteopathic Medicine
  7. ORIGINAL CONTRIBUTION
  8. Relationship Between Hypothermia and Blood Loss in Adult Patients Undergoing Open Lumbar Spine Surgery
  9. CLINICAL PRACTICE
  10. Management of Ionizing Radiation Injuries and Illnesses, Part 5: Local Radiation Injury
  11. MEDICAL EDUCATION
  12. Professionalism Score and Academic Performance in Osteopathic Medical Students
  13. SPECIAL COMMUNICATION
  14. Use of Beat-to-Beat Cardiovascular Variability Data to Determine the Validity of Sham Therapy as the Placebo Control in Osteopathic Manipulative Medicine Research
  15. BRIEF REPORT
  16. Intermittent Left Bundle Branch Block: An Overlooked Cause of Electrocardiographic Changes That Mimic High-Grade Stenosis of the Left Anterior Descending Coronary Artery
  17. CASE REPORT
  18. Osteopathic Manipulative Treatment for Postural Orthostatic Tachycardia Syndrome
  19. CLINICAL IMAGES
  20. Hyperdense Middle Cerebral Artery Sign After Trauma
https://doi.org/10.7556/jaoa.2014.175
Creative Commons
BY-NC-ND 4.0

Artikel in diesem Heft

  1. LETTERS TO THE EDITOR
  2. Observational Study Fails to Demonstrate the Effectiveness of OMT in Decreasing Low Back Pain
  3. Impact of the Single Accreditation Agreement on GME Governance and the Physician Workforce
  4. EDITORIAL
  5. Emerging Infections: The Cauldron of Medicine, Mobility, and Media
  6. Reversing the Paradox: Evidence-Based Medicine and Osteopathic Medicine
  7. ORIGINAL CONTRIBUTION
  8. Relationship Between Hypothermia and Blood Loss in Adult Patients Undergoing Open Lumbar Spine Surgery
  9. CLINICAL PRACTICE
  10. Management of Ionizing Radiation Injuries and Illnesses, Part 5: Local Radiation Injury
  11. MEDICAL EDUCATION
  12. Professionalism Score and Academic Performance in Osteopathic Medical Students
  13. SPECIAL COMMUNICATION
  14. Use of Beat-to-Beat Cardiovascular Variability Data to Determine the Validity of Sham Therapy as the Placebo Control in Osteopathic Manipulative Medicine Research
  15. BRIEF REPORT
  16. Intermittent Left Bundle Branch Block: An Overlooked Cause of Electrocardiographic Changes That Mimic High-Grade Stenosis of the Left Anterior Descending Coronary Artery
  17. CASE REPORT
  18. Osteopathic Manipulative Treatment for Postural Orthostatic Tachycardia Syndrome
  19. CLINICAL IMAGES
  20. Hyperdense Middle Cerebral Artery Sign After Trauma
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