On the initial CT Brain (3 hours from onset of symptom), the dense vein sign was subtle and was not appreciated (due to the location). The loss of right insular ribbon sign was misleading. Furthermore, power of left-sided body weakness was not documented in the request form.
Hence, the case was mistakenly reported as a hyperacute infarct, possibly right MCA vascular territory. The degree of swelling so early would be unusual in an ischemic stroke and could have been a clue to the diagnosis.

12 hours later, the patient developed a generalized tonic-clonic seizure. The dense vein sign was more conspicuous in subsequent plain CT Brain allowing a final diagnosis of superior sagittal sinus thrombosis with involvement of adjacent right cortical veins to be made.