Dense vessel sign is one of the earliest signs in acute ischemic stroke usually seen at MCA. It can also be seen in other locations such as the basilar tip.

Loss of the insular ribbon is very specific for hyperacute ischemic stroke. It is believed to take place within few hours of the insult. Cortical edema and loss of grey-white matter differentiation with attenuation of the Sylvian fissure lead to the appearance.

Other features such as obscuration of the lentiform nucleus and caudate head can be seen in hyperacute ischemic stroke, but not demonstrated in this case.