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As recommended by the working group of vascular and interventional neurology of the Colombian Association of Neurology (ACN), stroke is defined as a neurological emergency characterized by a sudden neurological deficit potentially of arterial origin. Upon confirmation via neuroimaging, the diagnosis is rendered as cerebral infarction (CI) or hemorrhage, either intracerebral (ICH) or subarachnoid (SAH). Additionally, it can be of venous origin, such as cerebral venous thrombosis (CVT). The stroke code is currently widely recognized as a time-is-brain strategy that seeks to meet strict time goals for treating ischemic stroke (iS), which have substantially improved the outcomes of stroke patients. However, this has not been the case for hemorrhagic stroke (hS), which, given the conditions, is also admitted through the emergency department and clearly benefits from having a standardized protocol of care and time goals, like iS, to improve patient outcomes. The strategy recommended by the ACN for the early identification of a stroke is CORRE+. This acronym was created by neurologist Luis Roa and is designed to facilitate the identification of both ischemic and hemorrhagic strokes of anterior or posterior circulation. It comprises the following criteria: C: twisted face and/or worst headache, O: eye sudden alteration of vision, R: rapid weakness of an arm and/or leg, R: rare when speaking, E: altered balance + emergencies attend. The acronym is intended to be used by the general community and in different extra- and intra-hospital scenarios for immediate consultation.

Background Intracranial aneurysms (IAs) are more common in women than in men; however, there is still limited knowledge on sex‐dependent differences regarding aneurysm location, multiplicity, rupture risk, risk factors, and histopathology. Methods This cross‐sectional, consecutive cohort study examined whether IAs differ in multiplicity, location, geometry, rupture risk, risk factors, and histology between sexes. Results We included 982 patients (714 women, 268 men) totaling 1484 IAs (1056 unruptured, 397 ruptured). A total of 363 patients (36.97%) had multiple IAs, the proportion of which was significantly higher in women. In women, the internal carotid artery (40.79%) was the most frequent location for IAs, whereas in men most were found along the anterior carotid artery territory (32.86%). Men were significantly more often diagnosed with ruptured aneurysms. Aneurysm geometry did not differ between sexes; however, ruptured aneurysms in men presented with a significantly larger neck diameter than unruptured ones. Regarding risk factors for aneurysm rupture, blood pressure control was more effective in women, whereas the effect of smoking status did not show clear sex‐dependent differences. Histologically, wall‐type classification analysis showed significantly more severe aneurysm wall types in men. Conclusion IA prevalence in women is significantly higher than in men. Women more often present with multiple IAs, whereas men were more often diagnosed with ruptured IAs. Sex‐specific differences in IA location were identified, whereas geometry of IAs did not differ between sexes. IAs in men showed a more severe histological wall type. Further research is needed to unravel the molecular mechanisms underlying these important sex‐dependent manifestations in IAs.

Objectives: Due to the limitations of the Coronavirus disease pandemic, medical applicants have relied on remote means of information, such as a program's website, to decide where to apply. However, studies have shown that many residency and fellowship websites lack information. Vascular neurology fellowship websites have not yet been studied. This study evaluates the availability and accessibility of information on vascular neurology fellowship websites. Methods: From 2021 to 2022, a total of 109 U.S. vascular neurology fellowship programs from the Fellowship and Residency Electronic Interactive Database were investigated to determine whether they had websites. Each website was evaluated on the immediate availability of 34 different criteria, which were deemed important by past studies. These criteria were reviewed under four categories: program overview, application information, fellow life, and curriculum. The comprehensiveness of the information among these different categories were analyzed. Programs were grouped by geographic region and electronic residency application service (ERAS)-participation status and comparisons were made within these groups. Results: There were 107 programs with websites (98%). ERAS-participating programs fulfilled more criteria on average than non-participating programs (P = 0.004). All websites provided information on general descriptions of their programs, but information on board exam pass rates, fellow testimonials, history of the fellowship program, responsibility progression, family and social events, parking availability, and application deadline were provided by less than 25% of websites. Conclusion: This study found that there was a large lack of information on vascular neurology fellowship websites, which could be improved to attract more applicants. [ABSTRACT FROM AUTHOR]

The field of vascular neurology has made tremendous advances over the last several decades, with major shifts in diagnosis, treatment, prevention, and rehabilitation of patients with stroke. Furthermore, the individuals who are providing the care represent a different cohort than those who were caring for stroke patients 30 years ago, with the increasing need for rapid decision-making for acute interventions and a larger workforce being needed to provide the many complicated aspects of care of stroke patients. Understanding the history of the field is critical before one can speculate about its future directions. In summarizing some of the past massive shifts in the past few decades, this review will discuss future opportunities and future challenges and will introduce the rest of this special issue focusing on vascular neurology in a post-thrombectomy era. Although thrombolysis and thrombectomy remain a major part of ischemic stroke management and care, in the coming years, there will likely be further modifications in how we provide the care, who provides it, how we train those individuals who provide it, where it is provided, and what data inform early management decisions. [ABSTRACT FROM AUTHOR]

Background White matter hyperintensity (WMH) on magnetic resonance imaging (MRI) of the brain is associated with vascular cognitive impairment, cardiovascular disease, and stroke. We hypothesized that portable magnetic resonance imaging (pMRI) could successfully identify WMHs and facilitate doing so in an unconventional setting. Methods and Results In a retrospective cohort of patients with both a conventional 1.5 Tesla MRI and pMRI, we report Cohen's kappa (κ) to measure agreement for detection of moderate to severe WMH (Fazekas ≥2). In a subsequent prospective observational study, we enrolled adult patients with a vascular risk factor being evaluated in the emergency department for a nonstroke complaint and measured WMH using pMRI. In the retrospective cohort, we included 33 patients, identifying 16 (49.5%) with WMH on conventional MRI. Between 2 raters evaluating pMRI, the interrater agreement on WMH was strong (κ=0.81), and between 1 rater for conventional MRI and the 2 raters for pMRI, intermodality agreement was moderate (κ=0.66, 0.60). In the prospective cohort we enrolled 91 individuals (mean age, 62.6 years; 53.9% men; 73.6% with hypertension), of which 58.2% had WMHs on pMRI. Among 37 Black and Hispanic individuals, the Area Deprivation Index was higher (versus White, 51.8±12.9 versus 37.9±11.9; P

Lesion studies are crucial in establishing brain-behavior relationships, and accurately segmenting the lesion represents the first step in achieving this. Manual lesion segmentation is the gold standard for chronic strokes. However, it is labor-intensive, subject to bias, and limits sample size. Therefore, our objective is to develop an automatic segmentation algorithm for chronic stroke lesions on T1-weighted MR images. Methods: To train our model, we utilized an open-source dataset: ATLAS v2.0 (Anatomical Tracings of Lesions After Stroke). We partitioned the dataset of 655 T1 images with manual segmentation labels into five subsets and performed a 5-fold cross-validation to avoid overfitting of the model. We used a deep neural network (DNN) architecture for model training. Results: To evaluate the model performance, we used three metrics that pertain to diverse aspects of volumetric segmentation, including shape, location, and size. The Dice similarity coefficient (DSC) compares the spatial overlap between manual and machine segmentation. The average DSC was 0.65 (0.61–0.67; 95% bootstrapped CI). Average symmetric surface distance (ASSD) measures contour distances between the two segmentations. ASSD between manual and automatic segmentation was 12 mm. Finally, we compared the total lesion volumes and the Pearson correlation coefficient (ρ) between the manual and automatically segmented lesion volumes, which was 0.97 (p-value < 0.001). Conclusions: We present the first automated segmentation model trained on a large multicentric dataset. This model will enable automated on-demand processing of MRI scans and quantitative chronic stroke lesion assessment. [ABSTRACT FROM AUTHOR]

• We presented an accurate and first-ever published predictive score designed explicitly for posterior circulation stroke patients not submitted to reperfusion therapies; • Male gender, NIH Stroke Scale, Blood glucose and cardioembolism can predict hemorrhagic transformation (HT) in these patients; • A score like ours may be useful for evaluating secondary prevention and stratifying patients; • These findings highlight the importance of designed tool specifically for these patients. Posterior Circulation (PC) stroke represents one-fifth of all ischemic strokes, with peculiar physiological characteristics. Hemorrhagic Transformation (HT) is a dreaded complication among stroke patients. Many predictive scores of this complication have been proposed, but none is designed specifically for PC stroke patients – therefore, patients who are not eligible for reperfusion therapies (RT) represent about 80% of hospitalized cases. We propose a scoring system to assess the HT risk in PC stroke patients not submitted to RT. We retrospectively evaluated data of patients diagnosed with PC stroke not treated with RT from 5 Comprehensive Stroke Centers (four in Brazil, 1 in the US) from 2015 to 2018. All patients underwent CT scan or MRI at admission and a follow-up neuroimaging within seven days. Independent variables identified in a logistic regression analysis were used to produce a predictive grading score. We included 952 patients in the final analysis. The overall incidence of HT was 8.7%. Male gender (1 point), NIH Stroke Scale at admission ≥ 5 points (1), blood glucose at admission ≥ 160 mg/dL (1), and cardioembolism (2) were independently associated with HT. The AUC of the grading score (0 to 5 points) was 0.713 (95% CI 0.65–0.78). Subjects with a score ≥ 3 points had an OR of 4.8 (95% CI 2.9–7.9, p < 0.001) for HT. Our score has good accuracy in identifying patients at higher risk of HT. This score may be useful for evaluating secondary prevention and stratifying patients in the context of even clinical trials. [ABSTRACT FROM AUTHOR]

Abstract Background Routing of patients with intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) to the most appropriate hospital is challenging for emergency medical services particularly when specific treatment options are only provided by specialized hospitals and determination of the exact diagnosis is difficult. We aimed to develop a prehospital score – called prehospital-intracerebral hemorrhage score (ph-ICH score) – to assist in discriminating between both conditions. Methods The ph-ICH score was developed with data from patients treated aboard a mobile stroke unit in Berlin, Germany, between 2011 and 2013 (derivation cohort) and in 2018 (validation cohort). Diagnosis of ICH or AIS was established using clinical data and neuroradiological cerebral imaging. Diagnostic accuracy was measured with significance testing, Cohen’s d and receiver-operating-characteristics. Results We analyzed 416 patients (32 ICH, 224 AIS, 41 transient ischemic attack, 119 stroke mimic) in the derivation cohort and 285 patients (33 ICH and 252 AIS) in the validation cohort. Systolic blood pressure, level of consciousness and severity of neurological deficits (i. e. certain items of the National Institutes of Health Stroke Scale) were used to calculate the ph-ICH score that showed higher values in the ICH compared to the AIS group (derivation cohort: 1.8 ± 1.2 vs. 1.0 ± 0.9 points; validation cohort: 1.8 ± 0.9 vs. 0.8 ± 0.7 points; d = 0.9 and 1.4, both p

Background: The presence of an intraluminal thrombus in acutely symptomatic carotid stenosis is thought to represent a high-risk lesion for short-term stroke reccurrence though evidence on natural history and treatment is lacking, leading to equipoise and much variation in practice. The objective of this study was to map these variations in practice (medical management and timing of revascularization), determine the considerations that influence clinician decision-making in this condition and gather opinions that inform the development and design of future trials in the area., Methods: This was a mixed-methods study using both quantitative survey methods and qualitative interview-based methods. International perspectives were gathered by distributing a case-based survey via the "Practice Current" section of Neurology: Clinical Practice and interviewing international experts using established qualitative research methods., Results: The presence of an intraluminal thrombus significantly increased the likelihood of using a regimen containing anticoagulation agents ( p < 0.001) in acutely symptomatic carotid stenosis in the case-based survey. Themes that emerged from qualitative interview analysis were therapeutic uncertainty regarding anticoagulation, decision to reimage, revascularization choices and future trial design and anticipated challenges., Conclusion: Results of this study demonstrate a preference for anticoagulation and delayed revascularization after reimaging to examine for clot resolution, though much equipoise remains. While there is interest from international experts in future trials, further study is needed to understand the natural history of this condition in order to inform trial design.

Essential thrombocythemia (ET) is a rare, chronic myeloproliferative neoplasm characterized by the overproduction of platelets. ET is of significant clinical importance due to thrombotic and hemorrhagic cerebrovascular disease. The JAK2 V617F mutation has been identified in approximately 50-60% of ET cases. Our case report: a 41-year-old male presented to the hospital with a one-day history of vertigo, ataxic gait, and vomiting. The patient was diagnosed with ET at an external center two years ago. The JAK2 V617F mutation was detected. He regularly uses acetylsalicylic acid 100 mg per day. Magnetic resonance imaging (MRI) showed an acute infarction involving the bilateral cerebellar hemisphere, thalamic area, and right occipital area. Computed Tomography Angiography showed that no significant stenosis was detected in major branches. The patient was diagnosed with ischemic cerebrovascular disease for ET. Antiplatelet therapy was started with acetylsalicylic acid 100 mg and clopidogrel 75 mg once a day. With the recommendation of hematology, cytoreductive treatment, hydroxyurea 1000 mg twice a day, was started. The patient's complaints were resolved at the end of the second day, and the patient with minimal ataxia was discharged with recommendations. Patients with ET should be aware of ischemic cerebrovascular disease and consider antiplatelet and cytoreductive treatment options., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Korucu et al.)

Background: Health systems are striving to improve delivery of mechanical thrombectomy (MT) for ischaemic stroke. With the move to 24/7 provision, we aimed to assess (1) the change in referral and procedural frequency and timing, (2) reasons referrals did not proceed to MT, and (3) nocturnal procedural efficacy and safety., Methods: This was an observational study comparing 12-month data for an extended daytime service (2021/2022, hours, 0800-2000) to that for a 12-month period delivering 24/7 cover (2023-2024). Nocturnal and daytime outcomes (rate of recanalisation using modified TICI scoring), extent of postprocedural infarction (using ASPECTS grading), rate of early neurological improvement (using 24-h NIHSS change), 90-day mortality, and complicating symptomatic intracranial haemorrhage (SICH) in the latter period were compared., Results: Both referrals (432 to 851) and procedural caseload (191 to 403) approximately doubled with the move to 24/7 cover; 36% of procedures occurred overnight (n = 145). The dominant reasons for referrals not proceeding to MT were a large core infarct (n = 144) or absence of a large vessel occlusion on baseline imaging (n = 140). There were no significant differences in successful recanalisation (TICI 2B/3: 85.5% vs 87.1%, P = .233), rates of postprocedural ASPECTS≥7 (74.9% vs 75.8%, P = .987), early neurological improvement (NIHSS reduction ≥30%: 43.4% vs 42.4%, P = .917), 90-day mortality (19.6% vs 18.6%, P = .896), or SICH (1.9% vs 4.1%, P = .214) obtained for daytime vs nighttime hours., Conclusion: 24/7 MT provision has resulted in a rapid rise in the number of patients who may benefit from MT. This service can be provided with an acceptable safety profile during nighttime hours in a high-volume comprehensive UK centre., (© The Author(s) 2024. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The impact of remote limb ischemic conditioning on poststroke cognitive impairment was evaluated with 104 first-time patients of noncardiac ischemic stroke. During the acute phase the patients were randomized into control and remote limb ischemic conditioning groups. Both groups received standard treatment, while the remote limb ischemic conditioning group received additional remote limb ischemic conditioning treatment for 6 months. All participants underwent neuropsychological evaluation, transcranial Doppler detection, P300 event-related potential and brachial-ankle pulse wave velocity measurements, and determination of serum intercellular adhesion molecule-1 and endothelin-1 levels both at admission and 6 months poststroke. The number of cases with poststroke cognitive impairment in each group was evaluated 6 months poststroke. No statistically significant difference was found in demographic data or baseline detection indices at admission between the two groups. However, at 6 months poststroke, the remote limb ischemic conditioning group had significantly higher total Montreal Cognitive Assessment score and its domains of visuospatial and executive functioning and attention scores, significantly lower activity of daily living scale score, shorter P300 latency, and higher amplitude compared with the control group. Moreover, the middle cerebral artery, average blood flow velocity was significantly higher, while the middle cerebral artery-pulsation index, basilar artery pulsation index, and the levels of brachial-ankle pulse wave velocity, intercellular adhesion molecule-1, and endothelin-1 were significantly lower in the remote limb ischemic conditioning group compared with the control group. These results demonstrate that remote limb ischemic conditioning causes a significant improvement in cognitive domains, such as visuospatial and executive functioning and attention, and is therefore linked with reduced incidence of poststroke cognitive impairment.

目的 了解血管神经病学专业护士的焦虑状况并分析影响因素。 方法 对临床注册护士进行调查，收集受试者的一般资料，进行性格测试，通过焦虑心理自评量表 （self-rating anxiety scale，SAS）判断受试者是否存在焦虑，分析护士焦虑水平现状及其影响因素。 结果 共纳入血管神经病学专业护士292例，其中93例（31.85%）存在焦虑。多因素Logistic回归分析结 果显示，相对于＜30岁者，30～40岁和＞40岁对焦虑影响的OR 值分别为3.20（1.46～7.01，P =0.0036）和 3.64（1.47～9.05，P =0.0054）；相对于活泼型人格，完美型人格的OR 值为3.33（1.14～9.68，P =0.0273）。 结论 神经病学专业护士焦虑的发生率较高，年龄增加和完美型人格是焦虑的危险因素。 Abstract: Objective To survey the anxiety status of vascular neurology specialist nurses, and analyze the influencing factors for anxiety. Methods The general information of clinical registered nurses in Department of Vascular Neurology, Beijing Tian Tan Hospital were collected. The personality test and the self-rating anxiety scale (SAS) were conducted to assess anxiety in all the subjects. The nurses' anxiety condition and its influencing factors were analyzed. Results Of all enrolled 292 nurses, 93 (31.85%) had anxiety. Multivariate logistic regression analysis showed that compared with nurses aged 40 years were 3.20 (1.46-7.01, P =0.0036) and 3.64 (1.47- 9.05, P =0.0054), respectively, and compared with nurses with active personality, the OR value of personality affecting the anxiety in nurses with perfect personality was 3.33 (1.14-9.68, P =0.0273). Conclusions The incidence of anxiety among nurses in vascular neurology specialty was high. An increasing age and perfect personality were risk factors for anxiety.

Occlusion of the artery of Percheron (AOP) is a rare yet potentially disabling form of ischemic stroke resulting in infarction of the bilateral paramedian thalami and mesencephalon with variable and often atypical presentation. Given the various patterns of thalamic blood supply, recognizing the presence of AOP infarction is crucial for the diagnosis and management of ischemic strokes involving these regions. Here, we report a case of acute hemorrhagic infarction involving the bilateral thalami and the rostral mesencephalon caused by a cardioembolic occlusion of the AOP., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board, Jose R. Reyes Memorial Medical Center issued approval 2024-022. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Llapitan et al.)

We provide an updated estimate of adult stroke event rates by age group, sex, and stroke type using Canadian administrative data. In the 2017-2018 fiscal year, there were an estimated 81,781 hospital or emergency department visits for stroke events in Canada, excluding Quebec. Our findings show that overall, the event rate of stroke is similar between women and men. There were slight differences in stroke event rate at various ages by sex and stroke type and emerging patterns warrant attention in future studies. Our findings emphasize the importance of continuous surveillance to monitor the epidemiology of stroke in Canada.

The article summarizes the training pathways and vocational opportunities within the field of vascular neurology. It highlights the groundbreaking clinical trials that transformed acute stroke care and the resultant increased demand for readily available vascular neurology expertise. The article emphasizes the need to train a larger number of diverse physicians in the subspecialty and the role of vascular neurologists in improving outcomes across demographic and geographic lines., Competing Interests: Disclosure Dr. H.J. Roeder has no financial disclosures. Dr. E.C. Leira receives salary support from the NIH, United States-NINDS and is the vice chair of the Vascular Neurology Examination Writing Committee of the American Board of Psychiatry and Neurology., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Artificial intelligence (AI) is currently being used as a routine tool for day-to-day activity. Medicine is not an exception to the growing usage of AI in various scientific fields. Vascular and interventional neurology deal with diseases that require early diagnosis and appropriate intervention, which are crucial to saving patients' lives. In these settings, AI can be an extra pair of hands for physicians or in conditions where there is a shortage of clinical experts. In this article, the authors have reviewed the common metrics used in interpreting the performance of models and common algorithms used in this field., Competing Interests: Disclosure A. Mowla: Speakers Bureau/Consultant to Cerenovus, Stryker, Wallaby Medical, RapidAI, BALT USA, LLC. D.S. Liebeskind: Consultant as imaging core lab to Cerenovus, Genentech, Medtronic, Stryker, Rapid Medical. Others have no disclosure., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Neurodevelopmental and neurodegenerative diseases (NDDs) with severe neurological/psychiatric symptoms, such as cerebrovascular pathology in AD, CAA, and chronic stroke, have brought greater attention with their incidence and prevalence having markedly increased over the past few years. Causes of the significant neuropathologies, especially those observed in neurological diseases in the CNS, are commonly believed to involve multiple factors such as an age, a total environment, genetics, and an immunity contributing to their progression, neuronal, and vascular injuries. We primarily focused on the studies of glial involvement/dysfunction in part with the blood-brain barrier (BBB) and the neurovascular unit (NVU) changes, and the vascular mechanisms, which have been both suggested as critical roles in chronic stroke and many other NDDs. It has been noted that glial cells including astrocytes (which outnumber other cell types in the CNS) essentially contribute more to the BBB integrity, extracellular homeostasis, neurotransmitter release, regulation of neurogenic niches in response to neuroinflammatory stimulus, and synaptic plasticity. In a recent study for NDDs utilizing cellular and molecular biology and genetic and pharmacological tools, the role of reactive astrocytes (RACs) and gliosis was demonstrated, able to trigger pathophysiological/psychopathological detrimental changes during the disease progression. We speculate, in particular, the BBB, the NVU, and changes of the astrocytes (potentially different populations from the RACs) not only interfere with neuronal development and synaptogenesis, but also generate oxidative damages, contribute to beta-amyloid clearances and disrupted vasculature, as well as lead to neuroinflammatory disorders. During the past several decades, stem cell therapy has been investigated with a research focus to target related neuro-/vascular pathologies (cell replacement and repair) and neurological/psychiatric symptoms (paracrine protection and homeostasis). Evidence shows that transplantation of neurogenic or vasculogenic cells could be achieved to pursue differentiation and maturation within the diseased brains as expected. It would be hoped that, via regulating functions of astrocytes, astrocytic involvement, and modulation of the BBB, the NVU and astrocytes should be among major targets for therapeutics against NDDs pathogenesis by drug and cell-based therapies. The non-invasive strategies in combination with stem cell transplantation such as the well-tested intranasal deliveries for drug and stem cells by our and many other groups show great translational potentials in NDDs. Neuroimaging and clinically relevant analyzing tools need to be evaluated in various NDDs brains.

Neurodevelopmental and neurodegenerative diseases (NDDs) with severe neurological/psychiatric symptoms, such as cerebrovascular pathology in AD, CAA, and chronic stroke, have brought greater attention with their incidence and prevalence having markedly increased over the past few years. Causes of the significant neuropathologies, especially those observed in neurological diseases in the CNS, are commonly believed to involve multiple factors such as an age, a total environment, genetics, and an immunity contributing to their progression, neuronal, and vascular injuries. We primarily focused on the studies of glial involvement/dysfunction in part with the blood-brain barrier (BBB) and the neurovascular unit (NVU) changes, and the vascular mechanisms, which have been both suggested as critical roles in chronic stroke and many other NDDs. It has been noted that glial cells including astrocytes (which outnumber other cell types in the CNS) essentially contribute more to the BBB integrity, extracellular homeostasis, neurotransmitter release, regulation of neurogenic niches in response to neuroinflammatory stimulus, and synaptic plasticity. In a recent study for NDDs utilizing cellular and molecular biology and genetic and pharmacological tools, the role of reactive astrocytes (RACs) and gliosis was demonstrated, able to trigger pathophysiological/psychopathological detrimental changes during the disease progression. We speculate, in particular, the BBB, the NVU, and changes of the astrocytes (potentially different populations from the RACs) not only interfere with neuronal development and synaptogenesis, but also generate oxidative damages, contribute to beta-amyloid clearances and disrupted vasculature, as well as lead to neuroinflammatory disorders. During the past several decades, stem cell therapy has been investigated with a research focus to target related neuro-/vascular pathologies (cell replacement and repair) and neurological/psychiatric symptoms (paracrine protection and homeostasis). Evidence shows that transplantation of neurogenic or vasculogenic cells could be achieved to pursue differentiation and maturation within the diseased brains as expected. It would be hoped that, via regulating functions of astrocytes, astrocytic involvement, and modulation of the BBB, the NVU and astrocytes should be among major targets for therapeutics against NDDs pathogenesis by drug and cell-based therapies. The non-invasive strategies in combination with stem cell transplantation such as the well-tested intranasal deliveries for drug and stem cells by our and many other groups show great translational potentials in NDDs. Neuroimaging and clinically relevant analyzing tools need to be evaluated in various NDDs brains. [ABSTRACT FROM AUTHOR]

目的 探讨定期文献报告会在血管神经病学研究生临床教学中的效果。 方法 选取首都医科大学附属北京天坛医院神经病学中心血管神经病学科2病区的临床实习轮转研 究生，开展定期文献报告会，最终评价教学效果。 结果 研究生的文献阅读量明显增加，查阅文献、归纳整理文献的能力、临床专业知识及制作幻灯、 表达交流能力均有了很大提高，能够更好地发现和解决临床问题，临床教学效果良好。 结论 定期文献报告会对提高学生临床能力、科研能力及表达能力有重要意义，值得推广。 Abstract: Objective To investigate the effect of regular literature review seminar in teaching of vascular neurology for postgraduates. Methods Postgraduate students in vascular neurology center of Beijing Tiantan Hospital, Capital Medical University participated in this study, who attended regular literature review seminar. Teaching effect was evaluated after one semester. Results Regular literature review seminar promoted an improvement of postgraduates’ various ability: the quantity and quality of literature reading, literature content extraction, and the ability of expression and communication; moreover, it also solidified students’ professional knowledge, and enhanced their ability of discovering and solving clinical problems. Conclusions Regular literature review seminar can help postgraduate students understand professional knowledge more deeply and comprehensively, broaden their horizon in professional field. This method is worthy of popularization in postgraduates teaching.

Background: Professor Fisher's legacy, defined by meticulous observation, curiosity, and profound knowledge, has established a foundational cornerstone in medical practice. However, the advent of automated algorithms and artificial intelligence (AI) in medicine raises questions about the applicability of Fisher's principles in this era. Our objective was to propose adaptations to these enduring rules, addressing the challenges and leveraging the opportunities presented by digital health., Summary: The adapted rules we propose advocate for the harmonious integration of traditional bedside manners with contemporary technological advancements. The judicious use of advanced devices for patient examination, recording, and sharing, while upholding patient confidentiality, is pivotal in modern practice and academic research. Additionally, the strategic employment of AI tools at the bedside, to aid in diagnosis and hypothesis generation, underscores their role as valued complements to clinical reasoning. These adapted rules emphasize the importance of continual learning from experience, literature, and colleagues, and stress the necessity for a critical approach toward AI-derived information, which further consolidates clinical skills. These aspects underscore the perpetual relevance of Professor Fisher's rules, advocating not for their replacement but for their evolution. Thus, a balanced methodology that adeptly utilizes the strengths of AI and digital tools, while steadfastly maintaining the core humanistic values, arises as essential in the modern practice of medicine., Key Messages: A commitment between traditional medical wisdom and modern technological capabilities may enhance medical practice and patient care. This represents the future of medicine - a resolute commitment to progress and technology, while preserving the essence of medical humanities., (© 2024 S. Karger AG, Basel.)

Alexia without agraphia is a striking vascular syndrome of the acquired inability to read words just written down. This syndrome occurs after lesions in the splenium of the corpus callosum that disconnect the angular gyrus from the visual pathway. Most of the time, a lesion in the left occipital lobe is also present, and patients present with a visual field deficit. It is a classic neurological syndrome that is rarely seen. We present two cases of alexia without agraphia seen in our hospital the same week., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Carranza-Rentería et al.)

Cardiac arrhythmias are one of the most common disorders with high morbidity and mortality. The effect of cardiac arrhythmias on the brain is very pronounced due to the high sensitivity of the brain to oxygen and blood supply. This mortality is preventable by early diagnosis and treatment which improves the patient's quality of life. Intervening at the right time, post arrhythmia is significant in preventing deaths and improving patient outcomes. Multiple pathophysiological mechanisms are studied for the brain-axis implications, that have the potential to be targeted by novel therapies. In this review, we describe the pathophysiological mechanisms and recent advances in detail to understand the functional aspects of the brain-heart axis and neurological implications post-stroke, caused by cardiac disorders.  This paper aims to discuss the current literature on the neurological consequences of cardiac arrhythmias and delve into a deeper understanding of the brain-heart axis, imbalances, and decline, with the aim of summarizing everything and all about the neurological consequences of cardiac arrhythmias., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Srinivas et al.)

Stroke is often viewed as a diagnosis found In the elderly with or without comorbidities, but it is vital to not rule it out in a pediatric patient presenting with signs and symptoms of stroke. Here, we present a case of an 18-month-old boy who arrived at the emergency department with left arm weakness and left-sided seizures a few minutes after a right-sided trivial neck bite that was initially overlooked by the parents until symptoms occurred. Urgent imaging further with a computed tomography scan of the brain revealed a hypodense lesion in the area covering the lateral part of the frontal lobe, insula, and parietal cortex of the right hemisphere. Subsequent CT cervical-cerebral angiogram revealed normal aortic arch, carotid, and vertebral arteries with no dissection, stenosis, or occlusion. However, there was a 4 mm-long occlusion of the M2 segment of the right middle cerebral artery (MCA) suggestive of emboli and subsequent low attenuation of the brain parenchyma in the anterior aspect of the right MCA vascular territory corresponding with the infarction. The objective of this case report is to educate and inform both parents and medical professionals regarding the risk of neurological damage that can occur with minor head and neck trauma that is often overlooked and therefore the importance of ruling it out with necessary imaging modalities., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Duvuru et al.)

A male in his 60s with stroke risk factors presented with confusion and word-finding difficulties. He was diagnosed with acute ischemic stroke in the right basal ganglia. He was started on secondary stroke prevention measures including dual antiplatelet therapy and a high-dose statin. A highly reactive rapid plasma reagin (RPR) was performed as part of the workup and found to be positive. Follow-up fluorescent treponemal antibody absorption (TPA) test was also positive, confirming a diagnosis of syphilis. He was discharged home with a scheduled course of antibiotic treatment for tertiary syphilis but returned due to a new episode of transient facial paralysis. Further workup and physical exam findings revealed the patient had neurosyphilis. He was started on the appropriate antibiotic therapy, which significantly improved his confusion and prevented new episodes of stroke., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Carranza et al.)

Introduction: Vascular pathology in the extracranial vertebral arteries remains among the possible causes in cryptogenic stroke. However, the diagnosis is challenged by the great variety in the anatomy of the vertebral arteries, clinical symptoms and difficulties in the radiological assessments. The aim of this study was to assess the prevalence of CT angiography (CTA)-detected pathological findings in the extracranial vertebral arteries in an acute stroke population and secondly to determine the frequency of posterior pathology as probable cause in patients with otherwise cryptogenic stroke. Method: The analysis was based on 657 consecutive patients with symptoms of acute stroke and a final diagnosis of ischemic stroke or transient ischemic attack. On admission, a noncontrast CT cerebrum and CTA were performed. A senior consultant neuroradiologist, blinded to clinical data, reviewed all CTA scans systematically, assessing the four segments of the extracranial vertebral arteries. First, the frequency of pathological findings including stenosis, plaques, dissection, kinked artery and coiling was assessed. Subsequently, we explored the extent of the pathological findings that were the most plausible causes of stroke, namely either a possible dissection or a kinked artery. Results: Findings in the extracranial vertebral arteries included significant stenosis (0.8%), atherosclerotic plaque types (3.8%), possible dissections (2.6%), kinked arteries (2.6%) and coiling (32.0%). Eighteen patients (2.8%) with pathological findings had an unknown cause of stroke, likely posterior symptoms and no clinical stroke symptoms from the anterior circuit. Of these, 3 cases were kinked arteries (0.5%) and 15 cases (2.3%) were possible dissections. Conclusion: We found that in approximately 3% of the study population, the most plausible cause of the cryptogenic strokes was due to a pathological finding in the posterior extracranial vertebral arteries, being either a possible dissection or a kinked artery. In general, posterior vascular pathology is not uncommon, and CTA is a useful modality in the detection of changes based on characteristics and locations of findings in the extracranial vertebral arteries. Ultrasound examination can be a useful supplementary tool in deciding the consequence of vascular findings on CTA.

This case highlights a patient presenting with a stroke code in the emergency department with decreased consciousness. The patient was later found to have bilateral thalamic strokes due to ischemia of the artery of Percheron. Initial head computed tomography (CT) and CT angiogram (CTA) of the head and neck showed no abnormalities. CT perfusion (CTP) showed a perfusion deficit of 169 mL with a T-max greater than 4 s and 4 mL with a T-max greater than 6 s in the posterior circulation. The patient received IV alteplase. This case report emphasizes the importance of perfusion neuroimaging in the evaluation of acute ischemic stroke., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Qaiser et al.)

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare neurological condition that classically presents with recurrent, thunderclap headaches and radiographic findings of multifocal narrowing of cerebral vasculature. Complications of RCVS may include ischemic or hemorrhagic strokes. Sympathomimetic agents including cannabinoids have been associated as precipitants in many cases. RCVS is classically considered to be reversible, although cases of recurrent RCVS have been described in the literature. In this report, we describe two cases of recurrent RCVS, which were precipitated by recurrent exposures to inciting agents. The first patient was found to have a history of repeated exposure to tetrahydrocannabinol (THC) and suffered from recurrent multifocal ischemic strokes with evidence of persistent multifocal narrowing of cerebral vasculature by cerebral arteriography. The second case describes a patient with a history of use of ashwagandha, medical marijuana, and serotonin-norepinephrine reuptake inhibitors (SNRIs) who experienced multiple intracranial hemorrhages with radiographic evidence of multifocal narrowing of cerebral vessels as well., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Patel et al.)

Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by non-atherosclerotic and non-inflammatory progressive narrowing of the intracranial part of the carotid artery and its proximal branches. The disease process is commonly associated with the development of weak, dilated collateral blood vessels at the base of the brain. This gives it a classic smoky appearance on cerebral angiograms and hence the name "Moyamoya" which means "puff of smoke" in Japanese. When a patient has similar vasculopathy in the setting of another disease then it is known as Moyamoya syndrome (MMS). The associated diseases are sickle cell anemia, neurofibromatosis, long-standing diabetes, uncontrolled hypertension, or chemotherapy. Despite being known as a disease of the East Asian population, the disease is no longer exclusive to Asians, as evidenced by the rising incidence among non-Asian groups such as Caucasians, Hispanics, and African Americans. Patients can remain asymptomatic or present with ischemic or hemorrhagic stroke, headache, seizures, or recurrent transient ischemic attacks. Conventional cerebral angiography is considered the gold standard for diagnosing MMD. Treatment may be supportive, medical, or surgical. We present the case of a 42-year-old African American woman with several comorbidities who presented with sudden onset of ischemic stroke and upon further workup was found to have MMD. Equally important is to identify the most effective therapeutic approaches based on individual patients to achieve better clinical outcomes. Our case report highlights the importance of surgery in symptomatic MMD with a lack of supporting evidence indicating the benefits of dual antiplatelet therapy (DAPT)., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Yadav et al.)

The authors explore the importance of neurology training program accreditation. Topics discussed include vascular neurology, which was certified by the American Board of Psychiatry and Neurology (ABPN) in 2005, and neurocritical care, which was certified by the United Council for Neurologic Specialties (UCNS) in 2007. Also mentioned are the impact of accreditation on patient care, reimbursements, and neurology workforce.

We present the case of a 72-year-old female with multifocal strokes found to have multiple, mobile intracardiac masses. We discuss the differential diagnosis and evaluation of intracardiac masses, and the challenges in management of the ultimately diagnosed etiology of stroke in this patient., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Acute ischemic stroke (AIS) is a significant source of morbidity and mortality and is one of the top causes of death in the United States. Of these patients, most are elderly individuals, compared to a limited proportion of cases seen in pediatrics. AIS is classically associated with age-dependent atherosclerotic disease processes secondary to comorbidities such as diabetes and hypertension. When considering the pediatric population, stroke is far less common and often requires workup of other underlying etiologies that create a hypercoagulable state. Here we present a case of an eight-year-old male with a left middle cerebral artery (MCA) ischemic stroke in the setting of increased factor VIII activity and SARS-CoV-2 antibodies., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Deskins et al.)