Identification of successful cerebral reperfusions (mTICI ≥2b) using an artificial intelligence strategy.

BACKGROUND: The modified thrombolysis in cerebral infarction (mTICI) scale is a widely used and validated qualitative tool to evaluate angiographic intracerebral inflow following endovascular thrombectomy (EVT). We validated a machine-learning (ML) algorithm to grade digital subtraction angiograms (DSA) using the mTICI scale. MATERIALS AND METHODS: We included angiograms of identified middle cerebral artery (MCA) occlusions who underwent EVT. The complete DSA sequences were preprocessed and normalized. We created three convolutional neural networks to classify DSA into two outcomes, low- (mTICI 0,1,2a) and high-grade (mTICI 2b,2c,3). RESULTS: We included a total of 234 angiograms in this study. The area under the receiver operating characteristic was 0.863 (95% CI 0.816-0.909), 0.914 (95% CI 0.876-0.951), and 0.890 (95% CI 0.848-0.932) for the anteroposterior (AP), lateral (L), and combined models, respectively, when dichotomizing outcomes into low and high grade. The models' area under the precision-recall curve was 0.879 (95% CI 0.829-0.930), 0.906 (95% CI 0.844-0.968), and 0.887 (95% CI 0.834-0.941) for the AP, L, and combined models. CONCLUSION: In complete cerebral DSA, our angiography-based ML strategy was able to predict mTICI scores following EVT rapidly and reliably for MCA occlusions.

Bilateral medial medullary stroke: "The heart sign".

Bilateral medial medullary stroke is a very rare condition. It is usually associated with severe motor deficits, dysarthria, sensory symptoms, nystagmus, and respiratory disturbances. The most common etiology is atherosclerotic disease of the vertebral and anterior spinal artery or its branches. We present the case and brain imaging of a 48-year-old man with a bilateral medial medullary stroke and its classic "Heart Sign" in the magnetic resonance imaging. This case highlights the anatomy of the rostral medulla, clinical presentation, etiology, and characteristic radiologic findings of this uncommon type of stroke.

Bilateral carotid dissection due to Eagle syndrome in a young female.

Eagle syndrome (ES) is a rare clinical syndrome characterized by the elongation of the temporal bone's styloid process, or calcification of stylohyoid ligament, compressing surrounding structures causing pharyngalgia. One of its variants, the styloid-carotid artery syndrome, produces symptoms by compression of the external or internal carotid arteries (ICA). Here, we present a case of a 43-year-old woman with ES and bilateral ICA dissections. The patient underwent staged bilateral angioplasty and covered stent placement, followed by styloidectomy. A computerized tomography angiogram revealed patency of both stents at a two-year follow-up.

Rapidly progressive dementia-associated N-type voltage-gated calcium channel antibody encephalopathy.

Autoimmune encephalopathy is one of the treatable causes of rapidly progressive dementia; however, it is often underdiagnosed. Autoantibodies against voltage-gated calcium channel (VGCC) have been linked to several neurological disorders, including Lambert-Eaton syndrome, but VGCC antibody-associated encephalopathy is uncommon. Herein, we present a case of a 74-year-old woman with prominent neuropsychiatric symptoms followed by rapid cognitive decline. Extensive initial studies were nondiagnostic. Subsequently, serum N-type VGCC antibody was positive. After treatment with intravenous immunoglobulin, the patient's cognition and neuropsychiatric symptoms significantly improved.

Adult Langerhans cell histiocytosis of the central nervous system.

Langerhans cell histiocytosis (LCH), a disorder characterized by aberrant function and proliferation of mononuclear phagocytic cells called Langerhans cells, usually occurs in those <15 years of age. Adult-onset LCH is extremely rare. We present a case of a 35-year-old woman who presented with multiple episodes of confusion, rapidly progressive cognitive decline, and multiple endocrinopathies, including diabetes insipidus. Brain imaging showed a hypothalamic lesion, and biopsy results confirmed the diagnosis of LCH. Given the wide variety of presentations and the multiple differential diagnoses of hypothalamic lesions, it is essential to be aware of this uncommon condition, especially in adults, where it may be underdiagnosed.

Self-inflicted transorbital pontine stab injury with a retained pen.

Self-inflicted transorbital stab injuries are not commonly seen in clinical practice. These lesions usually lead to major disability depending on the intracranial structures transected. We present a case of a 34-year-old man with a self-inflicted stab injury in his right orbit from a pen. Computed tomography revealed that the pen crossed intracranially from the orbit to the posterior fossa and pierced the pons. Such injuries are usually seen in the context of major psychiatric or drug abuse disorders. A multidisciplinary approach between ophthalmology and neurosurgery is essential in the management of these patients.