The hyperdense sinus sign (HDSS) is a readily identifiable non-contrast CT marker of acute thrombus in cerebral venous sinus thrombosis (CVST). We aimed to characterize HDSS associated features and prognostic significance. Data from prospective multicenter CVST registries was analysed. HDSS was defined as attenuation > 70 Hounsfield units within a thrombosed venous structure. Baseline characteristics and outcomes were compared between patients with and without HDSS on admission CT. Multivariable logistic regression identified independent predictors of Excellent-Functional-Outcome (mRS 0–1) and remote seizures. Among 465 patients (mean age 41.9 ± 18.4 years; 64.3

BACKGROUND AND PURPOSE:Hematoma expansion (HE) is a major cause of early neurological deterioration and poor outcome in spontaneous intracerebral hemorrhage (ICH). The perihematomal region (PHR), a potential site of secondary vascular injury, remains poorly characterized. We evaluated whether quantitative PHR features provide predictive information for HE beyond hematoma features and insight into HE dynamics. MATERIALS AND METHODS:In this retrospective two-center study, 149 patients with acute ICH underwent baseline CT within 24 hours of symptom onset and follow-up CT within 72 hours. HE was defined as >6 mL or >33% hematoma growth on follow-up CT. Hematoma and perihematomal regions were segmented using relative (half- and full-radius) and absolute (2, 5, and 10 mm) definitions. Radiomic features were extracted and modeled using multivariable logistic regression. Clinical predictors were added to create combined clinical-radiomic models, and performance was evaluated on an independent test set. RESULTS:HE occurred in 29% (44/149) of patients. The hematoma-only radiomic model showed modest discrimination (AUC=0.71, 95% CI 0.62-0.80). Incorporating PHR features improved performance, with the absolute 5-mm PHR model achieving the highest discrimination (AUC=0.91, 95% CI 0.86-0.95). Adding clinical predictors further enhanced performance (AUC=0.94, 95% CI 0.90-0.97). Key PHR features associated with HE included reduced sphericity, increased texture coarseness, and clustered heterogeneity. CONCLUSIONS:Quantitative PHR characterization was strongly associated with HE and provided incremental value beyond hematoma-derived radiomics, with further improvement when combined with clinical predictors. This contrast-free approach may support objective risk stratification, guide targeted interventions and reduce expansion related morbidity.

Abstract Background and aims Acute incidental cerebral microinfarcts (CMIs) are small cortical/subcortical ischemic lesions that appear as diffusion-restricted-foci on MRI-DWI and are detectable only briefly after onset. While uncommon in the general population, CMIs are more frequent in patients with cerebrovascular disease and cancer. The temporal evolution of apparent diffusion coefficient(ADC) values in CMIs remains incompletely understood Methods We performed a retrospective cohort study. Patients with lung, breast, pancreatic, or colorectal cancer underwent brain MRI with DWI before and/or after cancer diagnosis were included. CMIs were manually segmented as regions of interest(ROIs) and coregistered across baseline,acute,and follow-up scans. Homologous contralateral ROIs served as controls. ADC values were analyzed using mixed-effects linear models with timepoint and ROI as factors, followed by post-hoc paired t-tests Results Twenty-eight CMIs from 17 patients (mean-age 64 years) were analyzed, most with lung cancer. A significant interaction between timepoint and ROI was observed(p<0.001). No ADC difference was detected at baseline. At the acute CMI timepoint, ADC values were significantly reduced in lesions compared with controls, whereas at follow-up ADC values were significantly increased. This biphasic pattern was consistent across cancer types and tissue classes. Conclusions CMIs show a biphasic ADC trajectory with acute reduction followed by subsequent elevation, paralleling the diffusion behavior of larger ischemic infarcts. This likely reflects cytotoxic edema followed by tissue disintegration or gliosis. ADC dynamics appear to be a robust marker of microinfarct evolution and may have potential value for cerebrovascular risk stratification in oncology populations. Conflict of interest nothing to disclose"

Background and objectives Non-functional transverse sinus (NFTS) represents a markedly narrowed but non-thrombosed transverse sinus that may impair cerebral venous outflow. Its influence on the clinical course and outcomes of cerebral venous sinus thrombosis (CVST) remains unclear. This study aimed to evaluate the prevalence and prognostic significance of NFTS among patients with CVST. Methods Data from consecutively enrolled patients with confirmed CVST in multicentre databases were retrospectively analysed. NFTS was defined as a transverse sinus showing severe luminal reduction compared with the contralateral side in the absence of thrombosis. Patients with and without NFTS were compared for clinical and radiological features and 90-day excellent functional outcome, defined as a modified Rankin Scale score of 0–1. A preplanned secondary analysis included only patients with unilateral transverse sinus thrombosis sparing the NFTS to isolate its haemodynamic impact. Results Among 443 CVST patients (mean age 41.4±18.2 years; 64.3% female), 49 (11%) had NFTS. Compared with those without NFTS, affected patients had higher rates of papilledema (50% vs 23%, p<0.001) and multiple cerebral vein involvement (43% vs 22%, p=0.002), with a trend towards lower rates of excellent 90-day outcome (78% vs 87%, p=0.067). In the secondary analysis of 299 patients with unilateral transverse sinus thrombosis not involving NFTS, NFTS (n=29) was associated with more papilledema (51.3% vs 24.3%, p<0.001), multiple vein involvement (51.3% vs 31.9%, p=0.017) and superior sagittal sinus thrombosis (48.7% vs 28.9%, p=0.013). NFTS patients with contralateral transverse sinus thrombosis had poorer outcomes (excellent outcome 74.4% vs 89.7%, p=0.006). NFTS independently predicted non-excellent outcome (OR 4.37; 95% CI 1.5 to 13; p=0.008). Conclusions NFTS identifies a subset of CVST patients with impaired venous drainage, greater thrombotic extent, increased papilledema and poorer functional recovery. Recognition of NFTS on baseline imaging may assist in risk stratification and tailored monitoring in CVST.

Abstract Background and aims Cerebral small vessel disease (CSVD) is a major contributor to stroke, cognitive decline, and intracerebral hemorrhage (ICH). While MRI markers of CSVD are well described, their role in predicting first-ever ICH remains unclear. Methods We conducted a retrospective case–control study at tertiary stroke center, including patients with first-ever spontaneous ICH between 2012–2024 who had a prior brain MRI, with age and sex-matched controls without ICH. MRI markers of CSVD were rated according to STRIVE-2, including white matter hyperintensities (WMH), lacunes, perivascular spaces (PVS), cerebral microbleeds (CMB), cortical infarcts, superficial siderosis (SS), and acute cortical microinfarcts (CMI). Associations between MRI markers and ICH risk were evaluated using Cox proportional hazards regression (HR) models. Results Altogether, of 2,734 ICH cases, 63 met inclusion criteria and were matched with 63 controls. The mean interval between MRI and ICH was 19 ± 15 months. In univariable analyses, WMH (HR=2.10, 95% CI 1.27–3.45, p<0.01), lacunar infarcts (HR=2.11, 95% CI 1.26–3.52, p<0.01), severe PVS (HR=3.05, 95% CI 1.71–5.43, p<0.01), acute CMI (HR=4.25, 95% CI 1.67–10.81, p<0.01), and CMB (HR=4.12, 95% CI 2.38–7.13, p<0.01) were associated with ICH risk. Patients with the combination of CMB and SS had the highest ICH risk (HR=4.62, 95% CI 2.65–8.05, p<0.01). Conclusions MRI-defined CSVD markers are strong predictors for first-ever ICH. Brain imaging may help identify high-risk patients and guide preventive strategies. Prospective validation in larger cohorts is warranted. Conflict of interest nothing to disclose"

Evidence on the association between chronic hepatitis B virus (HBV) infection and stroke is limited, inconsistent, and confined predominantly to endemic regions in Asia. This study investigated the association between chronic HBV infection and stroke using data from the largest healthcare provider in Israel. All individuals aged 20 and older who were tested for hepatitis B surface antigen (HBsAg) between 2005 and 2023 were identified. Newly diagnosed HBV patients (HBsAg-positive) were propensity scorematched to non-HBV subjects (HBsAg-negative) in a 1:4 ratio and followed for stroke occurrence through 2024. The study included 20 544 HBV patients and 82 176 matched controls. Overall stroke was diagnosed in 472 HBV patients and 1 717 controls (incidence rates: 2.13 vs. 1.94 per 1 000 person-years). Hazard ratios were 1.09 (95% CI, 0.98-1.22) for overall stroke, 1.01 (0.89-1.14) for ischemic stroke, and 1.82 (1.35-2.45) for intracerebral hemorrhage (ICH). Ischemic stroke risk was specifically increased in younger individuals and females (p-for-interaction = 0.006 and 0.079, respectively). Results remained consistent when excluding patients with prior stroke. Exploratory analysis suggested hepatitis D coinfection is associated with increased ICH risk. In conclusion, chronic HBV infection was associated with significantly increased ICH risk, with subgroup-specific increases in ischemic stroke risk.

OBJECTIVE:Cerebral sinus venous thrombosis (CSVT) is a rare stroke subtype and data regarding the impact of ethnicity on its presentation and outcomes are limited. METHODS:The Israeli CSVT cohort, which includes databases from six academic medical centers, was retrospectively studied. Demographics, clinical presentations, risk factors, radiological findings, and outcome parameters were compared between Jewish and Arab Israeli patients. RESULTS:The study included 554 patients with CSVT, of whom 71 (13%) were of Arab ethnicity and 483 (87%) were Jewish. Arab patients were younger (mean age 38.4 ± 15.8 vs. 42.8 ± 10.1 years, p = 0.027), and more frequently male (48% vs. 33%, p = 0.013). Rates of Behcet's disease (BD) were higher among Arabs patients (13% vs. 3%, p < 0.001), antiphospholipid syndrome (23% vs. 10%, p = 0.002) and any coagulopathy (48% vs. 35%, p = 0.04), but lower rates of hypertension (4% vs. 15%, p = 0.016), and use of oral contraceptives (9% vs. 26%, p = 0.002). Differences in clinical presentation included higher rates of headache (90% vs. 74%, p = 0.004) and vomiting (39% vs. 15%, p < 0.001) in the Arab patient group. Arab ethnicity was associated with lower rates of any recanalization (aOR 0.346 [0.172-0.695], p = 0.003), and complete recanalization (aOR 0.408 [0.209-0.795], p = 0.008). Despite these differences, rates of favorable outcomes, mortality, and CSVT recurrence were similar between the groups. CONCLUSIONS:The findings highlight notable ethnic variations in the risk factors and clinical manifestations of CSVT between Arab and Jewish populations living in the same physical surroundings. Understanding these ethnic differences is crucial for creating targeted prevention and treatment strategies that cater to the specific needs of these diverse groups.

BACKGROUND:Female sex is associated with an increased risk of ischemic stroke in patients with atrial fibrillation (AF). Studies from Europe suggest that sex disparities in stroke risk have declined over time, but the generalizability of these findings to other populations remains uncertain. OBJECTIVE:The purpose of this study was to examine the 20-year temporal trends in sex differences in stroke risk among patients with newly diagnosed AF in Israel. METHODS:We conducted a population-based retrospective cohort study using the database of the largest health care provider in Israel. Nonanticoagulated patients with newly diagnosed nonvalvular AF between 2004 and 2023 were included and followed up for the occurrence of ischemic stroke or systemic embolism. The CHA2DS2-VA score-adjusted relative risk comparing the 1-year cumulative incidence function of female patients with that of male patients was estimated using the pseudo-value approach. RESULTS:The study included 112,478 patients [57,951 (51.5%) females] with AF. Females were older than males, with a median age of 76.7 years (interquartile range 68.1-83.8 years) and 69.8 years (interquartile range 60.1-78.6 years), respectively. Females consistently had a higher 1-year crude cumulative incidence of stroke, with both sexes showing an increase over time followed by a recent decline, peaking earlier in females. The CHA2DS2-VA score-adjusted relative risks for stroke in females compared with males were 1.16 (95% confidence interval 0.85-1.57), 1.20 (0.92-1.57), 1.29 (1.01-1.64), 1.06 (0.85-1.32), and 0.99 (0.79-1.23) in 2004-2007, 2008-2011, 2012-2015, 2016-2019, and 2020-2023, respectively. CONCLUSION:While the point estimates suggest a gradual attenuation in the excess stroke risk among females over time, no statistically significant temporal trend was observed.

INTRODUCTION:Embolic Stroke of Undetermined Source (ESUS) is a subtype of cryptogenic stroke with no clear etiology despite thorough evaluation. Atrial fibrillation (AF) is detected in only ~40% of cases, and trials of empiric anticoagulation have failed to reduce recurrence, suggesting other mechanisms such as subclinical atherosclerosis may contribute. Coronary artery calcium (CAC) scoring is a validated marker of atherosclerosis, yet its burden in ESUS remains underexplored. PATIENTS AND METHODS:We conducted a retrospective cohort study of consecutive ESUS patients admitted between April 2019 and December 2023 who underwent cardiac CT angiography (CCTA) during diagnostic work-up. CAC scores were calculated using the Agatston method, and percentiles were derived from the MESA database, adjusted for age, sex, and ethnicity. Patients with prior coronary interventions were excluded. RESULTS:Among 165 ESUS patients (median age 73.0 [IQR 66.5-82.0]; 47.9% female), the median CAC score was 225 [IQR 41.5-623.5] AU, and the median CAC percentile was 65 [IQR 40.05-85.0], significantly higher than population norms (p < 0.001). Patients ⩽65 years had higher CAC percentiles than older patients (80.0 [58.2-90.7] vs 61.0 [36.0-80.0], p = 0.002), despite similar CAC scores (p = 0.396). CONCLUSION:ESUS patients exhibit a high burden of coronary atherosclerosis, particularly notable in younger individuals. Elevated CAC may reflect both subclinical atherosclerosis and a broader cardiovascular risk profile, offering insight into stroke pathophysiology and the limited efficacy of empiric anticoagulation. CAC assessment could improve etiologic classification and inform tailored secondary prevention.

INTRODUCTION/AIMS:Myasthenia gravis (MG) is associated with thymic neoplasms. However, an increased prevalence of extrathymic neoplasms has also been reported. This study aimed to evaluate the rates of malignancy in MG patients while accounting for risk factors such as disease characteristics and immunomodulatory treatments. METHODS:We conducted a case-control study using the Clalit Health Services database, applying a machine learning (ML) algorithm to minimize diagnosis misclassification. We included MG patients aged 18 years and older, with a sex- and age-matched control group in a 1:3 ratio. We compared the prevalence and hazard ratios of extrathymic neoplasms between the groups. RESULTS:A total of 1558 patients with a high probability of MG, according to our ML model, were included in the cohort, alongside a control group of 4674 individuals. MG patients had a higher prevalence of malignancy prior to MG diagnosis, with an odds ratio of 1.95 (95% CI, 1.65-2.08), and a higher incidence of malignancy after MG diagnosis, with a hazard ratio of 1.56 (95% CI, 1.38-1.77). The most prevalent extrathymic neoplasms after MG diagnosis were respiratory, intrathoracic, skin (specifically non-melanoma), urinary tract, soft tissue, and myelodysplastic syndrome. Risk factors for malignancy included age, male sex, and thymoma. Immunosuppressive treatment did not increase the risk of malignancy. DISCUSSION:MG patients have a higher prevalence of both solid and hematologic neoplasms compared to non-myasthenic controls, regardless of immunosuppressive treatment. This supports the notion that malignancy is related to MG disease itself rather than external factors.

Background: Acute symptomatic seizures (ASYS) is a common presentation in cerebral sinus venous thrombosis (CSVT) patients. Objectives: We aimed to characterize CSVT patients experiencing ASYS within 7 days from presentation. Additionaly, we aimed to find predictors for ASYS within CSVT patients. Methods: Prospective CSVT databases from six academic centers (January 2010–December 2023) were retrospectively analyzed. Clinical outcomes at the 90-day follow-up included seizure occurrence and the modified-Rankin-Scale (mRS). Results: From 529 included patients (mean age 42.4 ± 18.6 years, 64.3% females), 106 (20%) had ASYS. ASYS patients were more often males (47.2% vs 20.1%, <0.001), and presented more often with focal neurological deficits (50% vs 22%, p < 0.001) but less often with papilledema (13.2% vs 29.3%, p < 0.001). On multivariate analysis cortical-vein thrombosis (odds ratio (OR) 4.17, p < 0.001), intracerebral hemorrhage (ICH; OR 3.06, p = 0.002), any superior-sagittal-sinus (SSS) thrombosis (OR 2.49, p = 0.006), predicted ASYS. Conversely, presentation with papilledema (OR 0.39, p = 0.03) negatively predicted ASYS. ASYS patients had lower rates of 90-day-mRS-0-1 (51.9% vs 83.9%, p < 0.001). Patients who experienced seizures between the second and seventh day (n = 58) had similar baseline characteristics to those with seizures only on the day of presentation (n = 48) but were less likely to achieve a good functional outcome by day 90 (42.6% vs 58.9%, p < 0.05) and had a lower rate of complete recanalization on follow-up venous imaging (25.5% vs 57.5%, p = 0.02). Status-epilepticus in comparison to non-ASYS patients achieved lower rates of 90-day-mRS-0-1 (11% vs 84%, p < 0.001) and higher 90-day-mortality (44% vs 5.6%, p < 0.001). In a multivariate analysis ASYS was a negative predictor for 90-day-mRS-0-1 (OR 3.3, 95% confidence interval 1.43–7.5, p = 0.005). Conclusion: CSVT patients experiencing ASYS, and to a greater degree patients with either status epilepticus or ASYS between second and seventh day achieved less often 90-day-mRS-0-1. Possibly, they epitomize a different course of disease that may require a more suitable treatment strategy.

BACKGROUND AND OBJECTIVES:Previous studies have shown inconsistent results regarding the association between herpes zoster (HZ) infection and stroke risk, particularly intracerebral hemorrhage (ICH). We aimed to evaluate the association between HZ infection and overall stroke, as well as ischemic stroke and ICH. METHODS:We conducted a population-based nested case-control study utilizing the Clalit Health Services database, the largest health care provider in Israel. The cohort included individuals aged ⩾25 years from 2005 to 2022, with follow-up through 2023. New stroke cases were matched with controls based on age, sex, population sector, and index date. HZ exposure was defined by International Classification of Diseases, Ninth Revision (ICD)-9 codes within 90 days prior to the index date, with concomitant acyclovir or valacyclovir treatment. Additional analyses explored longer time windows for HZ infection exposure, specifically within 1 and 5 years prior to the index date. RESULTS:A total of 66,818 stroke cases were matched with 66,818 controls. HZ infection within the prior 90 days was associated with a significantly increased overall stroke odds, with adjusted odds ratio (OR) = 1.63 (95% confidence interval (CI) = 1.26-2.10). The strength of the association weakened and did not reach statistical significance with longer prior HZ exposure windows; adjusted OR = 1.12 (0.99-1.27) within 1 year and 1.07 (1.00-1.14) within 5 years. The pattern was similar for ischemic stroke and ICH, with a significant association observed only for HZ infection within the prior 90 days with adjusted ORs 1.54 (1.18-2.02) and 2.73 (1.16-6.42), respectively. CONCLUSIONS:HZ infection is associated with increased stroke risk within 90 days post-infection and appears to be a stronger risk factor for ICH.

The Internal Jugular Veins (IJVs) and the non-jugular veins (NJVs) are two pathways responsible for intracranial blood drainage. The NJVs are usually the less prominent drainage system and have been demonstrated to become smaller during aging. This phenomenon may indicate less affective venues drainage and hence less CNS’s waste products clearance as we age. One of the pathological hallmarks in Alzheimer’s disease (AD) is amyloid betta42 (AB42) accumulation. AB42 accumulation may be the result of overproduction or clearance impairment. NJVs narrowing during aging may cause AB42 accumulation due to clearance impairment and hence plays a role in AD pathology. Our aim was to compare the venous cross-sectional area (CSA) in AD vs. cognitive normal (CN) population. Cognitive impaired patients included AD and mild cognitive impairment (MCI) patients that were recruited prospectively as part of the DIASPORA Horizon-2020 MesCobrad Project. All patients performed comprehensive neurocognitive evaluation and Brain MRI including Time-of-flight sequence for venous demonstration. Venous systems CSA were measured at the jugular foramen level and were done by senior neuroradiologist. CN were defined as subjects without CNS’s known pathology. CN Measurements were taken from a previous study of our group. T-test was used to compare between groups. A total of 39 Cognitive impaired patients and 20 CN were included in the study. Mean ages of 68 years (SD, 5.4) and 66 years (SD, 5.5), respectively. The CSA of the IJVs was similar between groups. However, NJVs CSA was significantly smaller in cognitive impaired patients (mean CSA=41.21 mm 2 (SD,21.52) vs. CSA=54.5 mm 2 (SD,27.3) P=0.045). Table 1. NJVs are significantly smaller in cognitive impaired patients compared to CN population. NJVs narrowing in AD patients may cause impaired venous drainage hence causing AB42 accumulation in this population. New treatment options for AD patients may rise if larger studies replicate our findings.

INTRODUCTION:The degree of iodine clearance from the parenchyma in acute ischemic stroke (AIS) has not been determined. The aim of our study was to measure changes in cerebrospinal fluid (CSF) density in patients with AIS relative to controls. METHODS:This is a retrospective cohort study from a single tertiary stroke center, including any patient who underwent CT angiography (CTA) and EVT and then follow-up noncontrast CT (NCCT) after 12-36 h. Control group included nonstroke patients who underwent CTA and a NCCT after 12-36 h. The density of CSF in Hounsfield units (HU) was measured in the frontal horns of lateral ventricles and in the third ventricle and was compared between baseline and follow-up NCCT (ΔHU), as well as between groups. Paired t-tests and multivariable linear regression analysis were utilized for data analysis. RESULTS:Altogether, 134 patients with AIS and 46 controls were included. In the AIS group, we found median (IQR) ΔHU of 1 (-0.34, 2.33) compared with -0.33 (-1, 0.33) in controls (p < 0.01). Early ischemic changes and onset-to-recanalization times remained significant for ΔHU following multivariable analysis. DISCUSSION:Our findings suggest that iodine contrast administration in patients with AIS leads to increased CSF density, potentially through the glymphatic clearance systems.

Introduction: Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disorder associated with both venous and arterial thrombosis, most notably ischemic stroke. Patients face a high risk of recurrence, and yet optimal strategies for secondary prevention remain uncertain. Methods: We conducted a narrative review of the literature on secondary prevention of ischemic stroke in APS. We performed a comprehensive literature search of PubMed for English-language articles on secondary stroke prevention in APS. Studies were included if they were original human research (e.g., randomized trials, cohort, or case–control studies) or relevant reviews addressing APS-related stroke prevention. Results: Vitamin K antagonists (VKAs) remain the standard of care for high-risk patients with arterial events. Several randomized controlled trials demonstrated higher recurrence rates, particularly of stroke, among APS patients treated with direct oral anticoagulants (DOACs). The optimal target INR remains debated; pooled analyses suggest no clear advantage of high-intensity anticoagulation (INR 3–4) over standard-intensity (INR 2–3), but individualized adjustment is warranted in select cases. In patients with recurrence despite adequate anticoagulation, adding an antiplatelet agent may be beneficial, although supporting evidence is limited. Adjunctive statin therapy shows promise in reducing endothelial dysfunction and prothrombotic markers, with observational data suggesting a possible protective effect, although randomized evidence is lacking. In addition, patent foramen ovale (PFO) closure has been proposed in selected APS patients with paradoxical embolisms, particularly when combined with anticoagulation. Non-pharmacological strategies, including structured lifestyle modification and rigorous vascular risk-factor management, are strongly recommended, as traditional cardiovascular risk factors synergistically increase recurrence risk. Conclusions: Secondary prevention of ischemic stroke in APS requires an individualized approach. VKAs remain first-line, with consideration of antiplatelet add-on, statins, lifestyle interventions, and PFO closure in appropriate settings. Future well-designed clinical trials are needed to refine INR targets, validate combination strategies, and clarify the role of adjunctive therapies in this complex patient population.

BACKGROUND:This study assessed the impact of cerebral small vessel disease (CSVD) on cognition in individuals with early-onset (EO; <65 years) and late-onset (LO; ≥65 years) cognitive complaints. METHODS:Participants underwent prospective evaluations including cognitive testing, hyperphosphorylated tau-217 (p-tau217) and neurofilament-light-chain (NfL), and magnetic resonance imaging (MRI). Each CSVD marker was modeled for interaction with group age on results on cognitive outcomes: Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory Questionnaire (NPI-Q), and Clinical Dementia Rating (CDR) scale plus National Alzheimer's Coordinating Center-Frontotemporal Lobar Degeneration module (NACC-FTLD). RESULTS:Altogether, 168 patients (91 EO) were included. white matter hyperintensity (WMH) volume was associated with worse CDR+NACC-FTLD in EO (β = 17.8, p = 0.013), remaining significant after adjusting for p-tau217 and NfL, but not gray matter atrophy. Lacunes were associated with worse CDR plus NACC-FTLD in EO (β = 4.3, p = 0.011), with age-dependent associations with MoCA, MMSE, CDR + NACC-FTLD, and NPI-Q (p  <  0.01). DISCUSSION:CSVD markers, although less prevalent in EO, had greater clinical impact. These findings highlight an increased vulnerability to vascular pathology in EO patients and the importance of early detection. HIGHLIGHTS:Cerebral small vessel disease (CSVD) markers were more impactful in early-onset than late-onset dementia. White matter hyperintensity (WMH) volume predicted functional decline in early onset, independent of neurodegeneration. Lacunes showed age-dependent effects on multiple cognitive outcomes. Findings support early detection of CSVD in younger individuals with dementia.

INTRODUCTION:Antiphospholipid syndrome (APS) is an acquired autoimmune disease characterized by arterial and venous thrombosis. Acute ischemic stroke (AIS) and transient ischemic attack (TIA) are common neurological manifestations in APS patients. Cerebral microbleeds (CMB) are indicators for cerebral small vessel disease and associated with intracerebral hemorrhage (ICH) and AIS. In the present study, we aimed to look at the association and clinical significance of CMB in patients with APS. METHODS:This is a retrospective cohort study that utilized data obtained from health service data of more than 5 million patients. We included patients aged 18 and older diagnosed with APS who underwent brain MRI between January 2014 and April 2020 and an age-matched control group with negative APS laboratory results. APS diagnosis was confirmed by positive laboratory findings from two separate tests conducted at least 12 weeks apart. The first available brain MRI was assessed for the presence of CMB. We compared the prevalence of CMB between patients with APS and controls. Among APS patients, we assessed the association between CMB and future AIS/TIA or ICH during 48-month follow-up using Cox proportional hazards models. RESULTS:The study included 276 patients, of which 195 were in the APS group and 81 in the control group. Patients with APS exhibited a higher prevalence of CMB (16% vs. 4%, p < 0.01). Among the APS group, those with CMB had a significantly higher risk of subsequent AIS/TIA (hazard ratio = 8.5, 95% confidence interval [CI]: 3.1-23), cumulative incidence 30% (95% CI: 13%-50%). None of the patients with APS had ICH during follow-up. CONCLUSION:Patients with APS have a higher prevalence of CMB compared with non-APS individuals, and the presence of CMB in APS patients is associated with an increased risk of AIS/TIA.

Background: Intracranial aneurysms are abnormal dilatations of arteries in the brain, often necessitating intricate endovascular interventions. Preoperative planning using 3D-printed models can enhance the understanding of complex aneurysm anatomy and improve treatment strategies. This study aims to evaluate the impact of patient-specific 3D-printed aneurysm models on procedural planning, treatment efficacy, and clinical outcomes. Methods: We conducted a retrospective analysis of patients treated for non-ruptured intracranial aneurysms at our institution between 2021 and 2023. Nine patients underwent preoperative simulation using 3D-printed models, while 32 patients received standard care without simulation. The vascular models were created using 3D Slicer for segmentation and Meshmixer for model refinement. The simulations were performed on a biplane Allura system. Data on demographics, aneurysm characteristics, hospitalization duration, procedure times, treatment changes, and unused materials were collected and analyzed using SPSS software. Statistical significance was assessed with independent one-tail t-tests, with a p-value < 0.05 considered significant. Results: The experimental group (nine patients) showed a trend towards reduced procedure times compared to the control group (126 ± 48 mins vs. 142 ± 68 mins, p = 0.253). There was no significant difference in mean hospitalization days between the groups (4 ± 0.9 days vs. 4 ± 1.7 days, p = 0.502). Interestingly, the treatment strategy was altered in four cases based on 3D simulation insights. The 3D simulation group also experienced fewer procedural complications (22.2 % vs. 31.2 %). Conclusions: simulation using 3D-printed models shows potential in enhancing procedural planning and reducing complication rates in the treatment of intracranial aneurysms. While the study did not demonstrate statistically significant differences in procedure time and hospitalization days, the observed trends and changes in treatment strategies suggest that 3D printing technology can provide valuable insights for neurointerventionists. Further research with larger sample sizes and prospective designs is warranted to validate these findings and establish standardized protocols for integrating 3D printing into clinical practice.

Background and ObjectivesSusac syndrome (SuS) is a rare disorder characterized by encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss, often accompanied by vertigo. Recent updates to diagnostic criteria and treatment guidelines have been made. This study examines clinical manifestations; disease activity; and risk factors of disability, dependency, and return to work in patients with SuS.MethodsA retrospective multicenter study was conducted on 20 consecutive patients with SuS with at least 2 years of follow-up. Clinical and paraclinical activities were assessed and rated according to the severity at onset and the end of follow-up. Cognitive function was assessed using the Montreal Cognitive Assessment while disability and dependence in daily activities were measured using the modified Rankin Scale. Employment status was graded.ResultsThe mean age at onset was 38.9 years, with a mean follow-up of 55.9 months. The female-to-male ratio was 1.86, and 45% of patients had the complete clinical triad. Severe cerebral involvement at onset was associated with a higher risk of cerebral exacerbations within the first year and with an increased long-term disability and dependency. Cognitive function improved in 75% of patients during follow-up. At disease onset, hearing loss excluding low frequencies occurred in 46.7%. Relapse of hearing loss was associated with greater impairment in daily activities. Male sex and elevated CSF protein levels were linked to poorer prognosis. Cerebral and inner ear exacerbations were most common in the first year while retinal exacerbations occurred more frequently, mainly within the first 2 years. Approximately 50% of patients resumed employment while 25% did not return to work.DiscussionCurrent treatment strategies for SuS do not fully prevent relapses. Severe brain manifestation at onset, male sex, and high CSF protein levels are risk factors of a worse prognosis of disability and dependence, indicating the need for intensive treatment. High-frequency hearing loss does not exclude SuS diagnosis.

BACKGROUND:In 2024, Israel experienced its largest West Nile Virus (WNV) outbreak, with 922 confirmed cases. WNV is a leading global cause of viral encephalitis. This study aimed to identify clinical features and prognostic factors associated with neuroinvasive WNV in hospitalized patients. METHODS:We retrospectively reviewed hospitalized patients with confirmed WNV at a tertiary center in Israel (January-September 2024). Patients were categorized as neuroinvasive or non-neuroinvasive. Demographic, clinical, and outcome data were analyzed. Primary outcome was 16-week mortality; secondary was functional decline (modified Rankin Scale, mRS). RESULTS:Of 166 hospitalized patients, 93 (56 %) had neuroinvasive WNV, primarily encephalitis (90 %). Neuroinvasive disease was linked to higher mortality (36 % vs. 13 %, p < 0.01) and worse functional outcomes (median mRS 4 ± 2 vs. 2 ± 2, p = 0.02). No significant differences in age, sex, comorbidities, or immunosuppression were found between groups. Among neuroinvasive cases, encephalitis, seizures, and autonomic dysfunction were associated with poorer outcomes. Lower pre-morbid function did not predicted greater decline. EEG in 28 encephalitis patients showed abnormalities in 71 %, mainly diffuse slowing; epileptiform activity was rare. Quantitative EEG revealed increased delta power and more frequent paroxysmal slow wave events(PSWE), which correlated with worse functional status. CONCLUSIONS:Neuroinvasive WNV is associated with substantial morbidity and mortality. Traditional risk factors like age were not predictive of poor outcomes. Instead, clinical features such as autonomic dysfunction and novel markers like quantitative EEG abnormalities may serve as valuable prognostic tools. These findings underscore the need for improved risk stratification strategies in WNV neuroinvasive disease.