An 82 year old man with aphasia and right side weakness performed NCCT and sCTA from 2.5 h from onset that show a large parenchymal hypodensity with ASPECT score of 6 (Insula, M2, M3, M6 segments) due to distal M1 cerebral artery occlusion. 3.5 hours later repeated neuroimaging study protocol with NCCT, mCTA and CTP in hub center. A spontaneous partial vascular recanalization with leptomeningeal vasodilatation occurred and CTP showed a little ischemic core and large penumbra. 3 days after NCCT uphold the ischemic core size. This case shows a typical Perfusion Scotoma with underestimation of ischemic core >6 hours from symptom onset due to early reperfusion from partial recanalization as well as luxury perfusion [1,2].