I have 15+ years of experience working in an academic, urban emergency department setting where stroke presentations are common. I see multiple patients with stroke symptoms per shift and I diagnose and treat patients with all varieties of hemorrhagic and ischemic strokes, including those like the patient in this current case whose primary cause is likely dissection. I have lectured on the subject of stroke management to our medical students and emergency medicine residents. My initial thought is that the delay in diagnosis based on radiology had a significant impact on the patient’s treatment. Depending on the exact timing of the presentation and other factors, the delay in diagnosis may have significantly impacted the patient’s outcome. For the emergency physician caring for a stroke patient, correct imaging study reads are critical. When a stroke code is called, the CT scanner is cleared so that an initial head CT can be done. The purpose of this is to look for contraindications (such as bleeding) to giving medicine that will break up blood clots or doing an endovascular procedure to remove the clot. Time is of the essence with these treatments and every minute can lead to a worse outcome. Without the correct radiologic diagnosis, the correct acute and subacute treatments cannot be made. If the scans had been correctly read, depending on the timing and other factors, many different possible treatments may have occurred including: transfer to a stroke center if the patient was not already at one, giving medicines to break up clots, using endovascular techniques to remove clot, and/or starting anti-platelet or anti-coagulation drugs. Each of these may well have altered the patient’s outcome.