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Noncontrast images were obtained. Despite this patient's sub 3 hour presentation following symptom onset, known renal failure precluded CTP/CTA.
Loss of right insular cortical grey-white matter differentiation (insular ribbon) in keeping with acute ischemia within the territory of the right middle cerebral artery. No hyperdense MCA or sub-branch thereof is identified. Basal ganglia delimitation is preserved. No intracranial haemorrhage. No hydrocephalus or midline shift.
Elsewhere, extensive periventricular and deep white matter hypoattenuation is consistent with advanced chronic small vessel ischaemic change.
Incidental note made of bilateral cavernous ICA calcification. Dense calvarium, without evidence of fracture or focal suspicious abnormality.
Loss of right insular cortical grey-white matter differentiation (insular ribbon) in keeping with acute right MCA territory infarct.
Findings discussed with Stroke team at time of scanning.