Diagnostic challenges of focal neurological deficits during an acute take-Is this vascular?: Clinical hints, pearls and pitfalls.

Stroke and TIAs are amongst the common neurological presentations encountered by specialists and non-specialist health care providers. Despite the advances of neuroimaging techniques, clinicians are frequently faced with diagnostic challenges on evaluation of patients with suspected stroke. In this review, we discuss the characteristic features of cerebrovascular diseases and how to identify them. We also aim to provide a resource for non-stroke specialist clinicians to help them to correctly identify the symptoms and signs of disorders that may masquerade as stroke such as migraine, seizure, and functional disorder, and at the same time we explore how we can identify strokes that present atypically.

A retrospective audit of out-of-hours mechanical thrombectomy of anterior circulation large vessel occlusion in a UK tertiary centre.

Mechanical thrombectomy (MT) is indicated for patients with acute ischemic stroke resulting from large vessel occlusion (LVO). At Hull Royal Infirmary (HRI), the MT service is available from 08:00 h to 16:00 h, Monday to Friday. Consequently, many patients who present outside of those times are denied a chance of having this treatment. The objective of this audit was to detect the percentage of patients who had presented out of hours and managed to have MT and to identify why the remaining proportion of patients did not receive this treatment. A total of 35 patients with anterior circulation LVO who presented out of hours and on weekends were included in this audit. Of these, only six patients (17%) received MT. Selection of those patients was favoured by their early-morning presentation shortly before the opening of the MT service at 08:00 h. Thus, a substantial number of patients presenting with LVO out of hours were not considered for MT. This could be attributed to inadequate communication between staff. Initiation of an in-hospital protocol could facilitate communication between stroke physicians and neuroradiologists and provide a pathway for consideration of such patients for late-window MT.

Stylocarotid syndrome causing middle cerebral artery infarction.

Stylocarotid syndrome is a variant of Eagle's syndrome that depicts elongation of styloid process or calcification of stylohyoid ligament causing compression of external or internal carotid arteries. Because of this compression, several neurological presentations could occur ranging from transient ischaemic attacks to carotid dissection and devastating ischaemic stroke. It is a rare cause of stroke that many physicians are not familiar with, yet it can be readily diagnosed by computed tomography angiography (CTA). Styloidectomy remains the definitive treatment for stylocarotid syndrome, however conservative treatment can be attempted in certain patients.

An interesting case of small vessel pathology following coronavirus infection.

Vasculitis is a descriptive term for a wide variety of conditions characterised by inflammation of the blood vessels that may occur as a primary process or secondary to an underlying disease. Occlusive vasculopathy is a different clinical entity characterised by skin changes and ulceration of the lower extremities because of thrombosis of the small vessels of the dermis and is usually associated with pre-thrombotic conditions. Both conditions can be confirmed or excluded by skin biopsy. We report the case of a 63-year-old woman presenting with upper and lower respiratory tract symptoms followed by a vasculitic rash on both legs. The patient underwent extensive radiological and laboratory investigations that were negative apart from positive coronavirus OC43. A biopsy of the skin was performed. Considering the clinical presentation and the investigations performed, the diagnosis of small vessel vasculopathy following coronavirus OC43 has been suggested by the authors.