Hey,

Last week’s PDF gives you the 10 obvious findings on call. This one is about what happens when the finding tries to hide.

A 64-year-old comes in for “left arm weakness for 2 hours.” The CT head reads normal at first glance — no bleed, no obvious mass effect, no midline shift.

Then you find it: the right insular ribbon is blurred. The gray-white differentiation that should be sharp at the lateral edge of the insular cortex is gone. The basal ganglia look slightly hypoattenuated on that side. Sulci look subtly effaced.

That’s hyperacute stroke. MCA territory. The thrombectomy window opened the second the symptoms started.

The search pattern that catches it:

Every CT head — compare insular ribbons side by side. Compare basal ganglia density side by side. If anything looks off, look harder at the proximal MCA for a hyperdense vessel.

The pitfall:

You scroll past it because it looks subtle. But on CT, “subtle” doesn’t mean “uncertain” — it means “early.” Early is the only window where you can do something about it.

The 12-page Call Guide covers the subtle version of every can’t-miss finding — the one that fools junior residents, how to catch it, how to call it without panicking the team.

→ Get the Call Guide ($18.99): https://radiologyguide.gumroad.com/l/khyiv

What’s the one finding on call that scares you most? Hit reply — that’s what next Sunday gets built around.

Stay sharp,

— Radiology Roadmap

P.S. If this is your first Sunday, the free PDF you signed up for is your starting point — print it, tape it next to the monitor, run every overnight through it.