The case of the wandering woman
A young female was found behaving erratically, having left her vehicle after a crash. A head CT and a CT scan of the chest, abdomen and pelvis obtained for trauma.
Surprisingly, the head CT showed a left middle cerebral artery stroke, with a dense MCA sign and loss of cortico-medullary differentiation. The trauma CT showed subtle bilateral pulmonary emboli. No other acute finding.
Further workup showed a patent foramen ovale. The working hypothesis is she had pulmonary emboli, and then the stroke secondary to right to left shunt through the PFO. Interetestingly there is no clear contralateral weakness on exam.
This case shows the amazing ways in which disease processes can manifest, and quite often, all is not as simple as it seems.
Of course, you can also appreciate the power of spectral CT in diagnosing subtle pulmonary emboli: vastly improving detection and the diagnostic confidence of the radiologist.