Abstract Details

Title Pseudo-Hyperdense Middle Cerebral Artery in HSV Encephalitis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P02 - (-)

Poster/Presentation
Number 025

Objective

Background BACKGROUND: A 30 year old woman presented with headache, confusion and fevers followed by a right gaze preference and left face and arm twitching.

Design/Methods DESIGN/METHODS: The differential diagnosis was wide including infectious, metabolic, and inflammatory causes of seizure and stroke.

Results RESULTS: A CT head was concerning for hyperdensity in the right MCA. However, CTA revealed a patent right MCA. An MRI head showed T2 hyperintensity in the right temporal lobe consistent with edema. CSF analysis revealed lymphocytic pleocytosis and positive HSV serology.

Conclusions CONCLUSIONS: A hyperdense middle cerebral artery 'sign' can be associated with acute thrombus1, but several conditions (including encephalitis related cerebral edema) can give the appearance of a 'pseudo'-hyperdense MCA 'sign'.2 REFERENCES 1. Barber PA, Demchuk AM, Hudon ME, Pexman JH, Hill MD, Buchan AM. Hyperdense sylvian fissure MCA "dot" sign: A CT marker of acute ischemia. Stroke. 2001 Jan;32(1):84-8. 2. Jha B, Kothari M. Pearls & oy-sters: hyperdense or pseudohyperdense MCA sign: a Damocles sword? Neurology. 2009 Jun 9;72(23):e116-7.

Authors/Disclosures
Cynthia L. Kenmuir, MD, PhD (University of Pittsburgh Medical Center) PRESENTER	The institution of Dr. Kenmuir has received research support from NIH NINDS CREST2.
Ruta V. Totoraitis, MD	No disclosure on file
Tudor G. Jovin, MD (Cooper University Healthcare)	Dr. Jovin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Jovin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Contego Medical. Dr. Jovin has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Several law firms. Dr. Jovin has stock in Corindus. Dr. Jovin has stock in Methinks. Dr. Jovin has stock in Viz.ai. Dr. Jovin has stock in Route92. Dr. Jovin has stock in FreeOx Biotech. Dr. Jovin has stock in Galaxy. Dr. Jovin has stock in Kandu. The institution of Dr. Jovin has received research support from Stryker. The institution of Dr. Jovin has received research support from Medtronic.
Ashutosh P. Jadhav, MD, FAAN (Barrow Neurological Institute)	Dr. Jadhav has nothing to disclose.
Tanja Schmitz-Huebsch	No disclosure on file

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