Hyperdense M2 - Imaging Sign

The course of the MCA through the Sylvian Fissue, so-called M2 Branches after the triforcation of the M1 segment, can appear hyperdense indicative of cloth within the vessel. 

The Insular Ribbon Sign

PCA Territory loss of Grey White - Look out For

PCA territory infarct can be subtle on non-contrast CT of the head. Make sure you look in this vascular territory and strutinize the grey white differentiation in all vascular territories, including the PCA and the ACA. 

Calcified Emboli - Imaging Sign

Look for small calcific emboli with the vessels. These could be acute or chronic but are suggestive of proximal embolic source, such as a ruptured calcified plaque. 

Hemorrhagic Transformation in an Infarcted Region

Susceptability sequences SWI show diffuse hemmohragic change in an area of infarction correspoiding to DWI restriction.

Calcified Carotid Plaque - Source of Emboli

Calcified carotid plaques can serve as an embolic source in acute stroke. Although considered more stable than atheromateous plaque, their rupture could lead to vascular occlusion. Given their calcified nature, they are refractory to IV thrombolysis and their retrieval using interventional techniques is more challenging. Given their solid nature, it would not incorporate as a traditional cloth would within the stent retriever and can get be pushed against the intimal wall as the stent opens. 

Insular Ribbon - Imaging Sign

Loss of the grey-white diffrentiation in the external capsule/insula is called the insular ribbon sign that can be lost in acute stroke. 

Gaze Deviation

The Hyperdense MCA Sign - Essential Finding

The increased density of the MCA or any other intracranial vessel should be treated with suspicion for presence of thrombus. Comparison with other vessels, dural venous sinuses, history of previous contrast from another radiologic study, or delayed contrast excretion post previous administration could be consideration. Unilateral and asymmetric hyperdensity in any vessel of any size can be suggestive of presence of acute cloth and should be further investigated with a CT Angiogram CTA. 

ICA Occlusion - Look at the skull base for

Stroke Mimics - This was a Tumor!

Stroke Mimic - Not every hypoattenuation on CT is indicative of acute stroke. Given the preservation of cortical gray white in the insula, and in fact cortical expansion, this was a tumor with underlying vasogenic edema producing this appearance.