Mohamad Syafeeq Faeez Md Noh

Intracranial atherosclerotic stenosis (ICAS) is an important cause of acute ischemic stroke, particularly in the Asian population. The mainstay of treatment is largely medical, however, despite aggressive medical management, the recurrence rate remains high. Recently, balloon angioplasty in addition to aggressive medical management has emerged as a viable interventional treatment to manage this neurovascular disease entity, effectively. The utilization of drug eluting balloons (DEB) compared to conventional balloons has shown promise, with some early studies demonstrating superiority. Larger scale studies are underway to prove this theory. We attempt to discuss this topic, with an illustrated case in our center. The rationale of this interventional approach, as well as related issues will also be highlighted.

Background: Trigeminal neuralgia (TN) in elderly or medically complex patients poses significant management challenges due to medication side effects, comorbidities, and limited tolerance for invasive surgery. Cases: This case series described two elderly patients with multiple comorbidities and medically refractory TN who underwent CT-guided Gasserian ganglion injection after declining or being unsuitable for microvascular decompression or radiofrequency ablation. Both procedures were performed under CT guidance using 2% lignocaine and 8 mg dexamethasone, with no procedural complications. Patient 1 reported reduced pain intensity and medication reliance, while Patient 2 experienced complete pain relief lasting eight months, requiring a repeat injection with similar benefit. This minimally invasive approach provided meaningful symptom control, improved quality of life, and preserved independence, with a low side effect profile. Although analgesia is often temporary, repeat injections are feasible. Conclusion: CT-guided Gasserian ganglion injection appears to be a feasible and potentially effective therapeutic option for elderly patients with TN who are unable to tolerate pharmacological treatment. Nevertheless, the current evidence base remains limited, and well-designed controlled studies are required to more clearly establish its safety and efficacy.

Since the start of the pandemic, there have been extensive studies from all over the world reporting on coronavirus disease 2019 (COVID-19)-associated neurological syndromes. Although initially thought of as primarily a respiratory pathogen, it became increasingly clear that the virus does have other systemic manifestations, including on the neurological system. Since then, the discovery of the many neuroimaging features of COVID-19-associated neurological syndromes have puzzled researchers and physicians in terms of interpretation, and how best to manage these findings to benefit patients. We sought to review the neuroimaging findings of COVID-19-associated neurological syndromes, particularly the vessel wall imaging (VWI) features, in the hope of finding a common feature that would better guide physicians in terms of further management of this group of patients. We will also look into the potential pitfalls of interpreting the VWI findings in these patients.

Recent advances in technology, particularly in the field of magnetic resonance imaging, have brought forth new sequences, including vessel wall imaging (VWI). Traditionally, the workup for intracranial vascular pathology has always turned to luminal imaging using computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography. Since its introduction, VWI has enabled researchers and practicing clinicians to better understand disease processes and manage patients to the best standard of care possible. Spontaneous recanalization in acute ischemic stroke (AIS) is a known but understudied phenomenon. Available literature has looked at this phenomenon and postulated the occurrence based on conventional cross-sectional imaging and angiography; however, objective evidence pointing to the occurrence of this phenomenon is scarce. We would like to share our experience using VWI in a patient who was clinically suspected to have a middle cerebral artery syndrome at onset, with resolution of the symptoms 3 hours after initial presentation. VWI showed vessel wall enhancement at the suspected vessel involved, with evidence of acute infarcts at the vascular territory supplied. A presumptive diagnosis of AIS with spontaneous recanalization was made. Our experience could potentially aid in the understanding of spontaneous recanalization in patients with AIS, particularly in the postulation of the pathophysiology.

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.

The middle cerebral artery (MCA) dot sign is an important radiological sign in patients presenting with acute ischemic stroke (AIS). If identified and intervened early, a good clinical outcome may be achieved

A 22-year-old male with underlying end-stage renal failure was referred to our center for a malpositioned dialysis catheter. Imaging showed the tip of the catheter to be placed in the brachiocephalic trunk; the patient was, however, asymptomatic. Surgical removal of the malpositioned catheter followed, with no postoperative complications. Received: 09 April 2019 Accepted: 20 June 2020 Publication Date: 23 December 2020 (online) © 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA