When thrombolysing a patient of acute stroke we should pay most attention to exact time of onset rather than FLAIR changes in MRI , which may take sometimes 7 hours to appear . Here is a patient of 5 hours left pontine infarct seen on DWI but still not visualised on FLAIR .
On the other extreme , FLAIR changes can appear as early as 3 hours after onset of Stroke. So we should make our decision by exact onset of time rather than solely depending on FLAIR .
This is the first case of Dabigatran rash I have seen in my 10 years of using it . The frequency of dermatologic reactions to dabigatran etexilate is estimated in the product labeling to be less than 0.1%. To date, five cases of dabigatran etexilate-associated rash have reported.
This 87 year man had acute Infarct in left frontal lobe. SW imaging showed blooming in infarct but CT brain was inconclusive. I did not thrombolyse him considering his age and blooming . I am not sure if I should have still thrombolysed him considering the Blooming CT mismatch.
This 30 year woman had 10 recurrent TIAs of left hemiplegia due to right supraclinoid ICA dissection despite being on Clopidogrel and Aspirin . Clopidogrel was replaced by Ticagrelor and Aspirin. The TIAs dramatically stopped.
This patient of right pontine infarct developed acute ipsilateral dystonia and tremor of right hand . Could not find a similar case in literature . All cases are reported on the contralateral side of infarct .