COVID-19 associated neurological syndromes, including acute ischemic stroke, pose a challenge to treating physicians. The role of MRI in aiding diagnosis and further management is indispensable. The advent of new MRI sequences such as vessel wall imaging (VWI) allows an avenue in which these patients could be better investigated and treated. We describe our experience in managing a patient with COVID-19 associated atherothrombosis and stroke, focusing on the VWI imaging findings.

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The article briefly discusses the basis of why the intracranial stent was deployed during mechanical thrombectomy.

The article briefly discusses the association of middle cerebral artery fenestration and stroke.

Background: In many institutions, computed tomography is the preferred neuroimaging modality for acute stroke (CT). MRI, on the other hand, is more sensitive in detecting infarct core. We present our early experience adopting MRI-first policy, using Putra Acute Stroke Protocol with 8-minute first 3 sequences, for hyperacute stroke. Methods: We retrospectively reviewed our early 6 months experience between June until Dec 2020. All hyperacute stroke cases who had MRI first and the door to needle (DTN) were evaluated. Results: There were total of 124 cases with 11 haemorrhagic stroke (8.9%) and 6 cases stroke mimics (4%). There were total of 105 cases of acute stroke, who had MRI first, where, 18 were thrombolysed (17.1%) while 8 cases had thrombectomy (7.6%). Fourteen were thrombolysed within 60 minutes (77.8%). DTN time range between 6 to 78 minutes with total accumulated time of 716 minutes, giving an average DTN of 42 minutes. Conclusion: Our experience shows there is no significant overall delay in DTN with higher percentage of thrombolysis rate. MRI-first policy, adopting Putra Acute Stroke Protocol, helps to achieve early and confident decision after the 8-minute scan. The stroke mimics and haemorrhagic stroke were excluded effectively. A more comprehensive study over a longer period to include other parameters might benefit the treatment decision for hyperacute stroke.