For today’s TR pearl, I’d like to take you back to January 2020, when covid was just a foreign virus and I was a fresh-faced intern, shadowing one of our recent grads, Dr. Sengupta in the cardiac room, along with Dr. Meyers. EMS called in a prenotification for a 63-year-old who was found by her family that morning, unresponsive and with a R-sided facial droop. The last known well was the night prior (approximately 12 hours prior to arrival). She was awake, protecting her airway, but not responding to commands. I was sent with the patient to the scanner, along with the neurology team. CT head and CTA were performed.
Here is the non-con CT, which seemed unremarkable (based on the patient’s clinical status, everyone was expecting a large bleed). Take a look, and then we’ll move on to the rest of the imaging in the PowerPoint below.
![](http://sinaiem.org/wp-content/uploads/2022/03/CT-head-dense-basilar.png)
Now, see below for the big reveal for this case, the answer to the CT head above, and the dope teaching points: