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. 2020 Sep 17;11:1004. doi: 10.3389/fneur.2020.01004

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Copyright © 2020 Tiwari, Berekashvili, Vulkanov, Agarwal, Khaneja, Turkel-Parella, Liff, Farkas, Nandakumar, Zhou, Frontera, Kahn, Kim, Humbert, Sanger, Yaghi, Lord, Arcot and Dmytriw.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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A patient with no significant past medical history presented to the ER after 8 days of viral illness and was on Azithromycin therapy after testing positive on day 3. NIHSS was 18 on presentation secondary to a left MCA syndrome. (A) CT/CTA confirmed a left M1 thrombus. As presentation was within 4.5 h of symptoms onset, IV tPA was administered. (B) The patient was taken for mechanical thrombectomy and on initial cerebral angiography showed partial recanalization post-TPA and migration of the clot to distal MCA branches. (C) The patient was thus given intra-arterial tPA in these branches. (D) Post procedurally, infarcts in the left putamen as well as temporal and parietal regions were seen. On last follow-up patient's mRS was 3.