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

Gaze deviation is ipsilateral (ie. same side) as the ischemic brain hemisphere. Eyes point towards the affected side. 

Left PCA Occlusion

There is a left PCA occlusion. When assessing the cerebral vasculuture, make sure you focus on the posterior circulation. The cerebral veins (basal vein of rosenthal) travel close to the PCA, so ensure that you don't accidentally follow a venous structure instead of the PCA.

Importance of Windowing and Levelling

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The often quoted ideal stroke windows are 35 35 , or 40 40. But it is suggested to always window and level yourself based on your visual preferences. Many factors such as monitor grey scale values can affect the final output, so better to rely on a window and level that is comfortable for you in detecting the subtle grey-white differentiation. 

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. 

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