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Background: To evaluate the stand-alone efficacy and improvements in diagnostic accuracy of early-career physicians of the artificial intelligence (AI) software to detect large vessel occlusion (LVO) in CT angiography (CTA)., Methods: This multicenter study included 595 ischemic stroke patients from January 2021 to September 2023. Standard references and LVO locations were determined by consensus among three experts. The efficacy of the AI software was benchmarked against standard references, and its impact on the diagnostic accuracy of four residents involved in stroke care was assessed. The area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity of the software and readers with versus without AI assistance were calculated., Results: Among the 595 patients (mean age 68.5±13.4 years, 56% male), 275 (46.2%) had LVO. The median time interval from the last known well time to the CTA was 46.0 hours (IQR 11.8-64.4). For LVO detection, the software demonstrated a sensitivity of 0.858 (95% CI 0.811 to 0.897) and a specificity of 0.969 (95% CI 0.943 to 0.985). In subjects whose symptom onset to imaging was within 24 hours (n=195), the software exhibited an AUROC of 0.973 (95% CI 0.939 to 0.991), a sensitivity of 0.890 (95% CI 0.817 to 0.936), and a specificity of 0.965 (95% CI 0.902 to 0.991). Reading with AI assistance improved sensitivity by 4.0% (2.17 to 5.84%) and AUROC by 0.024 (0.015 to 0.033) (all P<0.001) compared with readings without AI assistance., Conclusions: The AI software demonstrated a high detection rate for LVO. In addition, the software improved diagnostic accuracy of early-career physicians in detecting LVO, streamlining stroke workflow in the emergency room., Competing Interests: Competing interests: SYH, HH, DK, ML and W-SR are employees of JLK Inc, Seoul, Republic of Korea., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To analyze the clinical phenotype of hereditary spastic paraplegia (HSP) caused by SPG11 mutations (SPG11-HSP)., Methods: Among the 17 patients with sporadic HSP who performed whole exome sequencing analysis, six were diagnosed with SPG11-HSP. The clinical and radiologic findings and the results of the electrodiagnostic and neuropsychologic tests were reviewed retrospectively., Results: The median age at onset was 16.5 years (range, 13-38 years). Progressive spastic paraparesis was a core feature, and the median spastic paraplegia rating scale score was 24/52 (range, 16-31 points). Additional major symptoms were pseudobulbar dysarthria, intellectual disability, bladder dysfunction, and being overweight. Minor symptoms included upper limbs rigidity and sensory axonopathy. The median body mass index was 26.2 kg/m 2 (range, 25.2-32.3 kg/m 2 ). The thin corpus callosum (TCC) was predominant at the rostral body or anterior midbody, and the ears of the lynx sign was seen in all. The follow-up MRI showed the worsening of periventricular white matter (PVWM) signal abnormalities with ventricular widening or the extension of the TCC. Motor evoked potentials (MEP) to the lower limbs showed an absent central motor conduction time (CMCT) in all subjects. The upper limb CMCT was initially absent in three subjects, although it became abnormal in all at the follow-up. The mini-mental state examination median score was 27/30 (range, 26-28) with selective impairment of the attention/calculation domain. The median score of the full-scale intelligence quotient was 48 (range, 42-72) on the Wechsler Adult Intelligence Scale test., Conclusion: Attention/calculation deficits and being overweight as well as pseudobulbar dysarthria were common additional symptoms in patients with SPG11-HSP. The rostral body and anterior midbody of the corpus callosum were preferentially thinned, especially in the early stage of the disease. The TCC, PVWM signal changes, and MEP abnormality worsened as the disease progressed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Kang, Nam, Kim, Kang, Choi, Lee, Kim and Kim.)