Neuro Osce

25 30 Physical examination : HR 90 / min, totally irregular : Stupor : Pupil 2 mm equal and reactive : decrease Rt. Nasolabial fold : flaccid Rt. Hemiplegia : Generalized hyporeflexia : Rt. extensor plantar response non contrast CT brain 3 hr

1.
2. 3.

1.
1. Normal bony structure and paranasal sinus 2. Tubular shape hyperdensity area along the course of left middle cerebral artery 3. Pressure effect at left basal ganglia area upon frontal horn of the left lateral ventricle or ill defined hypodensity area at left basal ganglia 4. Effacement of cerebral sulci / or loss of gray white difference /or loss of cerebral sulci at left fronto-temporal area

2.
Left middle cerebral clot Early brain edema of left fronto temporo parietal area

3.
Acute cerebral embolism of left middle cerebral artery

Imaging in acute stroke

CT early signs of ischemia

Hypo attenuating brain tissue obscuration of the lentiform nucleus Insular Ribbon sign Dense MCA sign Hemorrhagic infarcts

Penumbra: Occlusion of the MCA with irreversibly affected or dead tissue in black and tissue at risk or penumbra in red

CT early signs
Hypoattenuating brain tissue Obscuration of lentiform nucleus

Dense MCA sign

Insular ribbon sign Loss of sulci effacement

MCA infarction: on CT an area of hypoattenuation appearing within six hours is highly specific for irreversible ischemic brain damage

Obscuration of the lentiform nucleus or blurred basal ganglia

 Obscuration of the lentiform nucleus, also called blurred basal ganglia

Insular Ribbon sign : This refers to hypodensity and swelling of the insular cortex

Dense MCA sign

This is a result of thrombus or embolus in the MCA

Hemorrhagic infarction

Case 1
57 year old woman presented to the ER with sudden onset left hemiparesis 2 hours before arriving at the ER

Answer

Description
CT brain without contrast Soft tissue, bony structure, sinus, orbit, mastoid- normal Hypodensity lesion in the right frontoparietal region Loss of gray white differentiation/ loss of sulci in the right frontoparietal region Edema in the right frontoparietal region with pressure effect on right lateral ventricle No midline shift

Left hyperdensed MCA sign