44 year old male with acute onset speech difficulty. LastSeenNormal (LSN) 2 hours. NIHSS<5 

Baseline imaging: NCCT – 09:02 am

ASPECTS: 10

mCTA: No proximal artery occlusion on single phase CTA.

 

Collaterals: Good

Multiphase CTA: shows a patchy area of contrast hold-up involving the left frontal lobe (middle and inferior frontal gyri posteriorly). Retrospectively an M4 branch occlusion is identified.

 

Arch anatomy: Type 2 arch

CT perfusion: Small area of potential infarct- on TMax map in left inferior frontal gyrus

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3] Decision making: IV tPA- Yes 

4] 24 hr MRI- Small infract in the left MCA territory, no hemorrhage