44 year old male with acute onset speech difficulty CT

Distal occlusion, use of mCTA

1] Presenting complaints: (June, 2017)

44 year old male with acute onset speech difficulty. LSN 

2 hours. NIHSS<5

2] Baseline imaging:
NCCT – 09:02 am
ASPECTS: 10
mCTA: No proximal artery occlusion on single phase CTA.
Multiphase CTA: shows a patchy area of contrast hold-up involving the left frontal lobe (middle and inferior frontal gyri posteriorly). Retrospectively an M4 branch occlusion is identified.
Collaterals: Good
Arch anatomy: Type 2 arch
CT perfusion: Small area of potential infarct- on TMax map in left inferior frontal gyrus

3] Decision making: IV tPA- Yes

4] 24 hr MRI- Small infract in the left MCA territory, no hemorrhage