The ASPECTS score in noncontrast brain CT is routinely used assess prognosis and the potential of endovascular intervention in ischemic MCA stroke. However it is much more prone to interobserver variability, and - as demonstrated by this case - far more likely to underestimate the extent of damage than CTA-SI ASPECTS, which is essentially the same scoring system applied to brain window and kernel reconstructions generated from the source images of multiphase CT angiography. It is therefore recommended to generate and evaluate brain window CTA source images whenever an angiography is performed in suspected acute stroke.