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A 61-year-old woman presented with acute symptoms of right middle cerebral artery ischaemia, with left face/arm/leg weakness, right gaze preference and homonymous hemianopia. A non-contrast CT scan of the head showed a calcified Y-shaped hyperdensity at the right middle cerebral artery bifurcation (figure 1A). We did not identify any contraindications for thrombolytic therapy, and the patient was treated with intravenous tissue plasminogen activator.
We used a multi-phase CT angiogram to assess her cerebrovascular status. We expected a role for endovascular intervention given the clinical deficits and corresponding right middle cerebral artery bifurcation hyperdensity, which we assumed to be thrombus. However, the initial phase of the CT angiogram did not show the expected occlusion …
Contributors VY and GS were responsible for drafting the manuscript and subsequent revisions. SP and DD provided critical revision for intellectual content. DI is guarantor of the paper.
Competing interests None declared.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Provenance and peer review Not commissioned; externally peer reviewed. Reviewed by William Whiteley, Edinburgh, UK and Joshua Klein, Boston, USA.