CT - Herniation, subfalcial, middle cerebral artery distribution infarction: This 88-year-old woman presented with the acute onset of left-sided weakness after a fall. She had a past medical history significant for coronary artery disease, hypertension and transient ischemic attacks. Examination revealed a right carotid bruit, left-sided homonymous hemianopia, right gaze palsy and a flaccid left hemiplegia. The axial CT image on the left was obtained two hours after the onset of symptoms and is unremarkable. The patient deteriorated clinically over the next 24 hours and the CT scan of the brain on the right was obtained. This follow-up scan shows marked interval development of swelling involving the right anterior and middle cerebral artery distribution with associated midline shift and ventricular effacement. There is also high-density signal within the mass indicating hemorrhage.