Fig. 1

a–f 60-year-old female with right MCA territory infarct. The 10 MCA zones designated by the ASPECTS scoring system are C caudate, L lentiform nucleus, IC internal capsule, I insular ribbon, M1–6 cortical regions (M1–3 at the level of basal ganglia, M4–6 at the level cranial to the basal ganglia). Initial DW images and their corresponding ADC maps at the basal ganglia level (a, a') and the supraganglionic level (b, b') reveal the presence of acute infarction in I, M1, M2, and M5 regions with a resultant ASPECTS score of 6. SW images at the basal ganglia level (c) and the supraganglionic level (d) reveal the presence of APVs, in terms of either density and/or caliber and/or hypointensity, in I (blue arrow) and in M1–6 regions (red, purple, gray, green, orange, and black arrows respectively) with a resultant ASPECTS score of 3 (similar colored arrows point to the corresponding areas in the contralateral normal hemisphere for comparison). DWI/SWI mismatch score is 3. Follow up FLAIR images, obtained 10 days later, at the basal ganglia level (e) and the supraganglionic level (f) reveal in addition to the originally infarcted zones, infarction growth in L, IC, and M4, giving an overall ASPECTS score of 3 and an IGS of 3. The faint hyperintensities noted at M3 and M6 zones were considered to be ischemic foci and not newly infarcted areas as they were evident in the FLAIR images of the initial MRI with no corresponding diffusion restriction