44 year old male with acute onset speech difficulty. LSN 2 hours. NIHSS5

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

Baseline imaging: NCCT – 09:02 am

 

 

ASPECTS: 10

 


mCTA: No proximal artery occlusion on single phase CTA.

 

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.

Collaterals: Good

Arch anatomy: Type 2 arch

 


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

 


3] Decision making: IV tPA- Yes

 


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