A 64-year-old man presented with left-sided weakness with an initial NIH Stroke Scale score of 11. Brain CT imaging showed a hyperdense artery sign of right middle cerebral artery (MCA) occlusion (figure 1, A and B). Brain MRI showed the susceptibility vessel sign (SVS) on gradient recalled echo and hyperintense vessels (HV) on fluid-attenuated inversion recovery images (figure 1, C and D). Angiography demonstrated right MCA occlusion with well-developed pial collateral flow (figure 2). HV is not identical to hyperdense artery sign and SVS, which indicate intraluminal thrombus.1 HV may indicate slow collateral flow, not thrombus itself.2
Figure 1 Brain CT and MR imaging
(A) Noncontrast CT shows hyperdense artery sign (arrow). (B) Contrast CT shows middle cerebral artery occlusion (arrow). (C) Gradient recalled echo MRI shows susceptibility vessel sign (arrow head). (D) Fluid-attenuated inversion recovery images show hyperintense vessels (arrow head).
Figure 2 Cerebral angiography
Angiography demonstrates occlusion of right middle cerebral artery and well-developed retrograde pial collateral flow.
Footnotes
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