Impact of an automated large vessel occlusion detection tool on clinical workflow and patient outcomes.

Purpose: Automated large vessel occlusion (LVO) tools allow for prompt identification of positive LVO cases, but little is known about their role in acute stroke triage when implemented in a real-world setting. The purpose of this study was to evaluate the automated LVO detection tool's impact on acute stroke workflow and clinical outcomes. Materials and methods: Consecutive patients with a computed tomography angiography (CTA) presenting with suspected acute ischemic stroke were compared before and after the implementation of an AI tool, RAPID LVO (RAPID 4.9, iSchemaView, Menlo Park, CA). Radiology CTA report turnaround times (TAT), door-to-treatment times, and the NIH stroke scale (NIHSS) after treatment were evaluated. Results: A total of 439 cases in the pre-AI group and 321 cases in the post-AI group were included, with 62 (14.12%) and 43 (13.40%) cases, respectively, receiving acute therapies. The AI tool demonstrated a sensitivity of 0.96, a specificity of 0.85, a negative predictive value of 0.99, and a positive predictive value of 0.53. Radiology CTA report TAT significantly improved post-AI (mean 30.58 min for pre-AI vs. 22 min for post-AI, p < 0.0005), notably at the resident level (p < 0.0003) but not at higher levels of expertise. There were no differences in door-to-treatment times, but the NIHSS at discharge was improved for the pre-AI group adjusted for confounders (parameter estimate = 3.97, p < 0.01). Conclusion: Implementation of an automated LVO detection tool improved radiology TAT but did not translate to improved stroke metrics and outcomes in a real-world setting.

Long-Term Sequela of Intrathecal Gadolinium Extravasation: Symptoms Mimicking Post-concussive Syndrome.

Gadolinium contrast administration, usually with magnetic resonance imaging, is an important diagnostic modality in the investigation of neurological pathologies. There is little evidence in the literature suggesting repeated exposure to intrathecal gadolinium results in symptoms mimicking post-concussive syndrome (PCS). We studied one patient who received intrathecal gadolinium to investigate a pain pump malfunction and presented with encephalopathic symptoms of confusion and aphasia with imaging consistent with intracranial gadolinium extravasation. The patient was followed up regularly with repeat imaging, reassessment of persistent symptoms, and specialist evaluations; however, symptoms remained refractory and resembled PCS. Our findings indicate a need to further investigate potential associations between intrathecal gadolinium exposure and a clinical presentation consistent with PCS, irrespective of histopathological changes.