Evolution of early ischemic changes on head CT scan

Evolution of early ischemic changes over time in a 35-year-old woman who presented with acute aphasia.
(A) NCCT at one hour after symptom onset shows loss of gray white matter differentiation in the left frontal and temporal operculum and insular cortex and hypodensity in the lentiform nucleus (ASPECTS was 4 points for involvement of insula, lentiform, M1-3, M5).
(B and C) NCCT and CTA-SI at two hours after symptoms onset and IV rtPA administration show more conspicuous hypodensity and mild effacement of cortical sulci compared with NCCT at one hour after symptoms onset.
(D) NCCT at eight hours after symptoms onset shows frank hypodensity in the infarcted areas. The extent of the hypodense areas remains the same but is more conspicuous than prior NCCT studies.