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Patients with ischaemic stroke due to large vessel occlusion (LVO) are treated with thrombolysis before thrombectomy, if eligible, as recommended in current guidelines. However, new randomised controlled trials (RCTs) suggest, that pretreatment with thrombolysis may not be necessary in patients with LVO presenting directly at a thrombectomy-capable centre. In this review, we both gather the current knowledge on the treatment of ischaemic stroke due to LVO and evaluate on, whether this should be revised in the view of new RCTs.

We report a case of severe acute ischaemic stroke in a patient who could not receive treatment with thrombolysis due to concomitant treatment with dabigatran (new anticoagulant drug). Endovascular treatment was the only treatment of choice. Due to well-organized prehospital logistics, including helicopter transport, the patient arrived at hospital shortly after onset of symptoms and was treated successfully with thrombectomy.

Superficial siderosis (SS) of the central nervous system is a rare disorder in which the most common clinical manifestations are gait ataxia, sensorineural deafness and affection of the corticospinal tracts. Knowledge of this disorder is important since early diagnosis and treatment is crucial for the prognosis. Furthermore, new treatment strategies are emerging. The effect of corticosteroids on SS without an identifiable bleeding source has been debated. We present a case with a good clinical effect of steroids.

MR is increasingly used as a diagnostic tool in stroke management, especially since new and acute treatments are now available. This article describes the new MR sequences used in the scanning of stroke patients. A scanning protocol is suggested and our preliminary experiences with acute MR scanning of stroke patients are presented. Pros and cons are discussed.