This patient presented with a high NIHSS, some lateralizing signs and general confusion with speech disturbance and neglect.

Unenhanced CT and CTA were performed (the patient was considered too agitated for multiphase CTA / perfusion). A right M1 occlusion was confirmed, with early insular / lenticuostriate infarct.

The clot was evacuated on first pass, with good clinical and radiographic outcomes.

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Case courtesy of Dr Alberto Nania, INR consultant