A focused look at the basal ganglia is absolutely essential on early CT scans in a patient with acute neurological deficit. The subtle signs of early MCA infarction are demonstrated in this case, and their careful detection can aid immensely in induction of thrombolytic therapy for it to be of timely benefit within the window period.

This case clearly delineates the early signs of MCA infarction: namely, loss of the insular ribbon sign, obscured lentiform nucleus sign, and disappearing basal ganglia sign. A hyperdense MCA can be seen at times when thrombosed, but in the event of an embolic phenomenon this may not be demonstrated.

This patient had complete recovery and reversal of neurological deficit post-thrombolysis.