Table of Contents
ISRN Stroke
Volume 2013 (2013), Article ID 954825, 6 pages
Clinical Study

Prevalence, Comorbid Associations and Prognostic Value of the Hyperdense Middle Cerebral Artery Sign

1Department of Neurology, The Canberra Hospital, Canberra, ACT 2605, Australia
2Australian National University, Canberra, ACT 0200, Australia
3Department of Radiology, The Canberra Hospital, Canberra, ACT 2605, Australia

Received 6 March 2013; Accepted 4 April 2013

Academic Editors: H. C. Emsley, H. McNaughton, and J. Wambaugh

Copyright © 2013 Patrick Aouad et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. The significance of the Hyperdense Middle Cerebral Artery Sign (HMCAS) is uncertain. Aims. This prospective study investigated the sensitivity, specificity, prevalence, prognosis, interobserver variability, and associated clinical features of HMCAS in acute ischemic stroke. Methods. Initial CT scans of 117 patients with acute ischemic stroke or transient ischemic attack (TIA) and 65 age-matched controls were reported independently by two neuroradiologists blinded to diagnosis. Details of initial stroke severity and comorbidities were collected, and outcome on the modified Rankin scale (mRS) was assessed at 3–6 months. Results. HMCAS was seen in 15% of all ischemic strokes and 25% of all middle cerebral artery (MCA) strokes; specificity was 100%. HMCAS was associated with more severe initial deficit and atrial fibrillation. Only 21% of patients with a first-ever MCA stroke and HMCAS had a good outcome ( ) compared to 55% of those without the sign ( ). Interobserver agreement was only 0.747 (Kappa statistic). Conclusion. The prevalence, specificity, sensitivity, and clinical associations of HMCAS were similar to previous reports. This study confirmed prospectively that HMCAS was associated with a poorer outcome at 3 to 6 months and demonstrated interobserver variability in detection of the sign.