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Hyperdense middle cerebral artery sign
  1. Cynthia Kenmuir,
  2. R Victoria Totoraitis,
  3. Tudor Jovin,
  4. Ashutosh Jadhav
  1. Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Cynthia Kenmuir, Department of Neurology, University of Pittsburgh Medical Center, UPMC Presbyterian, Kauffman Building, Suite 811, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA; kenmuircl{at}

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What is the most likely diagnosis?

A 30-year-old woman, previously well, presented to an outside hospital after being found lying on her bedroom floor, with a history of confusion, headache, déjà vu and fever. She had been discharged the day before having had normal investigations for headache, including a CT and MR scans, both read as normal. Laboratory studies showed a urinary tract infection with leucocytosis, but she was afebrile. She was discharged home with medications to treat her urinary tract infection and headache.

During a second presentation to the outside hospital, her cerebrospinal fluid (CSF) showed a pleocytosis and she was started on acyclovir, empirically to treat viral encephalitis. EEG showed right-sided sharp waves. Her neurological condition further deteriorated and she was intubated for airway protection and transferred to the Presbyterian Hospital. On examination, she was …

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  • Contributors CK, RVT, TJ and AJ were involved in the care of the patient, analysis and interpretation of data for this case report. CK and AJ were responsible for drafting text and figures. All authors were involved in the editorial process.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed. This article was reviewed by Tom Hughes, Cardiff, UK.

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