CTB quiz 1


A 79 year old man is found on the floor with an altered conscious state, unable to get up. He is non communicative. There is a suggestion of a facial droop.

A CT of his brain is performed. Is the scan normal?


The key finding on this CT is the presence of a hyperdense Middle Cerebral Artery sign.  The MCA appears bright and dense, which in the clinical context is strongly suggestive of thrombus, causing acute ischaemic stroke.

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This finding is supported by some early signs of cerebral ischaemia.  There is the suggestion of hypodensity in the left basal ganglia region (it looks darker than the opposite side).  This is likely to represent early oedema around the area of infarction.  In addition, on the coronal slices, the insular cortex has a bulging appearance due to the oedema.

These are just some of the many subtle early signs of MCA territory strokes[1,2]


  1. Early signs of brain infarction at CT: observer reliability and outcome after thrombolytic treatment--systematic review.  Wardlaw JM, Mielke O. Radiology. 2005;235(2):444. 
  2. Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk.  von Kummer R, Meyding-LamadéU, Forsting M, Rosin L, Rieke K, Hacke W, Sartor K. AJNR Am J Neuroradiol. 1994;15(1):9. 

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Past QUizzes

Chest Xrays

Quiz 1 - Chest trauma

Quiz 2 - Fall from a bike

Quiz 3 - Hypoxia after intubation

Abdominal Xrays

Quiz 1 - Fever and distension


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