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(Stroke. 2003;34:e100.)
© 2003 American Heart Association, Inc.

Letters to the Editor

The "Dot CT Sign" Indicates MCA Branch Occlusion

Department of Neurology, Mayo Clinic, Rochester, Minnesota

To the Editor:

The hyperdense sylvian fissure MCA "dot" sign¹ has been described as a CT marker of acute ischemia seen in 16% of a series of patients presenting with acute ischemic stroke. It is thought to represent thromboembolic occlusion of the distal MCA branches within the sylvian fissure; however, the authors of the original study¹ acknowledged they had no vascular imaging to confirm this. To our knowledge, such a study has not been reported.

We cared for a 48-year-old woman who presented with the sudden onset of right arm dysesthesias and expressive dysphasia, fluctuating over the course of 3 hours before fully resolving. Treatment was with antiplatelet agents. The "dot sign" was noted on CT, and another "dot" was noted on DWI indicating infarction (Figure). The MRA indicated an occlusion in a distal MCA branch, supporting the original hypothesis.¹

View larger version (80K): [in this window] [in a new window]   Left, axial CT shows the MCA "dot" sign within the left sylvian fissure (arrow). Middle, diffusion-weighted MRI shows a small area of restricted diffusion within the left insular cortex (arrow). Right, MRA shows a "cut-off" within a distal branch of the left middle cerebral artery (arrow).

References

1. Barber P, Demchuk A, Hudon M, Pexman J, Hill M, Buchan A. Hyperdense sylvian fissure MCA "dot" sign: a CT marker of acute ischemia. Stroke. 2001; 32: 84–88.[Abstract/Free Full Text]

This Article Extract Full Text (PDF) All Versions of this Article: 34/8/e100    most recent 01.STR.0000080944.04893.48v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Blacker, D. J. Articles by Wijdicks, E. F.M. Search for Related Content PubMed PubMed Citation Articles by Blacker, D. J. Articles by Wijdicks, E. F.M.