Sequential strokes in a hyperacute stroke unit.

Vasculitis is a rare, but treatable condition that can present to hyperacute stroke units. Thrombolysis does not treat the underlying pathology, and a rapidly evolving clinical picture drives clinical decision often before all the investigation results are available.

Rehabilitation following intracerebral haemorrhage secondary to extracorporeal membrane oxygenation (ECMO).

Extracorporeal membrane oxygenation (ECMO) was first used in adults with severe respiratory failure in the 1970s. Its use has been steadily increasing since the 1990s after a trial demonstrated improved survival. There are currently seven centres in the UK offering ECMO to adults.

Diagnostic confusion resolved by being upbeat.

The classical stroke presentation - captured by the public health campaign mnemonic FAST (face, arm, speech, time) - does not apply in a large number of stroke cases; yet establishing a prompt diagnosis is imperative for optimal management. Here, we describe a patient with acute bulbar weakness, numbness in all extremities and an apparently normal magnetic resonance imaging (MRI) of the brain upon admission for whom even the fundamental question of whether this reflected a central or peripheral nervous system process was unclear. The critical localizing sign was upbeat nystagmus that denotes a brainstem cause.