Context: Recently, with the advance of neuroimaging modalities, the windows of reperfusion therapy in patients with acute stroke have been reviewed and extended, especially for mechanical thrombectomy. Case report: 81 year old patient, previously hypertensive and dyslipidemic, fully functional (modified Rankin scale = 0), admitted to the emergency room of a tertiary hospital with global aphasia, right hemiparesis, right homonymous hemianopsia and severe hypoesthesia of the right upper limb, scoring 26 on the NIHSS, with report of having contacted family members for the last time 15 hours before admission. She was treated according to the institution’s acute stroke protocol, and underwent non-contrast brain computed tomography (CT), perfusion CT with Rapid CT protocol and cerebral artery + neck angio-CT, which ruled out bleeding and showed an ASPECTS of 8, an estimated ischemic core volume of 17 mL, and an area with hypoperfusion of 118 mL (perfusional mismatch of 101 mL), besides occlusion of the M1 segment of the left middle cerebral artery. Thus, she was submitted to chemical thrombolysis, with a decrease in NIHSS score to 15 and evolving without complications upon hospitalization. Conclusions: In patients with uncertain ictus, the use of advanced neuroimaging modalities, such as perfusion tomography with Rapid CT protocol, may assist in the indication of reperfusion therapies safely.

Context: Moyamoya disease or chronic occlusive cerebrovascular disease is characterized by proximal occlusion of the internal carotid artery and its branches bilaterally, generating an angiographic “smoke” pattern (moyamoya, from Japanese “something hazy”) and by diverse ischemic manifestations. Case report: The sample consists of three female patients, aged between 13 and 46 years, followed in our service due to the diagnosis of Moyamoya Disease. Among the clinical manifestations presented, ischemic cerebrovascular events with neurological deficit predominated, and one of the patients presented two episodes compatible with stroke and one episode compatible with transient ischemic accident. The youngest patient presented with a choreic picture initially interpreted as Sydenham’s chorea. Although the gold standard for the diagnosis of chronic occlusive cerebrovascular disease is cerebral arterial angiography, it was possible to observe a pattern compatible with the disease in other modalities of examination, such as cerebral arterial angiotomography and cerebral arterial angioresonance. From the therapeutic point of view, one of the patients underwent surgical intervention (encephaloduromyosinangiosis), with improvement of symptoms after treatment. Conclusions: In this paper, we emphasize the importance of complementary imaging tests in the evaluation of patients with cerebrovascular syndromes and the diversity of clinical presentation of Moyamoya disease.

The new coronavirus (COVID-19) pandemic has resulted in the unprecedented production of vaccines. In this context, the possible adverse effects remain to be identified and reported. In this article, we report the case of a young female patient who developed anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMG-CoA) immune-mediated necrotizing myositis (IMNM) after receiving the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine. The diagnosis of probable post-vaccination IMNM was made due to the absence of other factors that may have led to the development of autoantibodies (medicines; e.g., statins, drugs) and the temporal relationship between exposure and event. This case report is the first to suggest that a COVID-19 vaccine may trigger anti-HMG-CoA reductase necrotizing myopathy.