CT brain scan showing a right hemisphere total anterior circulation infarct (A) at four hours, and (B) at five days after symptom onset. CT brain scan.

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CT brain scan showing a right hemisphere total anterior circulation infarct (A) at four hours, and (B) at five days after symptom onset. CT brain scan showing a right hemisphere total anterior circulation infarct (A) at four hours, and (B) at five days after symptom onset. Note on (A) the subtle signs of early infarction: loss of the basal ganglia on the right (white arrow—compare with the left where the caudate and lentiform nuclei are clearly visible), loss of the grey/white matter cortical differentiation (black arrowheads), a little swelling with sulcal effacement (black arrow and compare left side). On day 5 there is obvious hypodensity and massive infarct swelling with midline shift and obstruction of the left lateral ventricle. J M Wardlaw J Neurol Neurosurg Psychiatry 2001;70:i7-i11 ©2001 by BMJ Publishing Group Ltd