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Cardiac CT studies to detect embolic sources can be a useful supplement to the imaging armamentarium of acute stroke patients and we explore its possibilities in 2 distinct populations in this technical note. Prior literature has looked at the yield of covering the heart during CT angiography (CTA) in addition to echocardiography and found that it can increase the detection rate of occult embolic sources such as mural thrombus, tumors, and infarcts. The advent of multiphasic CTA for acute stroke patients as part of vascular imaging prior to EVT selection has increased the likelihood of extending coverage or specifically screening the heart in such patients. Additionally, patterns of infarcts and imaging signs can help focus selective patients for dedicated cardiac screening, especially after initial negative echocardiography. We describe the technical aspects of cardiac CT screening in acute stroke patients in this brief report. Future studies in these specific cohorts can confirm the increased yield for early anticoagulation and address modifications for optimal balance with regard to additional radiation exposure.

Recent studies have shown that diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) MRI (DWI-FLAIR) mismatch is useful for thrombolytic treatment decisions in acute ischemic stroke. However, the role of partial mismatch in strategic locations among patients with evolving stroke has not been described before. Partial imaging mismatch involving strategic locations might indicate reversible ischemia, enabling thrombolysis even in those patients presenting in the extended time windows. In this report, we describe the partial strategic concept of DWI-FLAIR mismatch with case examples.

•The incidence and causes of pre-hospital delay in 505 patients who presented with acute ischemic stroke to a tertiary care hospital in South India were looked into.•Pre-hospital delay was seen in 70% of patients with a median delay of 9.5 h.•Modifiable factors pertaining to stroke recognition (knowledge about stroke symptoms) and stroke response behavior (perception of urgency at stroke onset, use of ambulance services, and visit to family doctor) were found to be the major determinants of pre-hospital delay.•The need of the hour therefore is a strong patient education campaign to help recognize stroke and respond quickly and appropriately.