Stroke is a devastating disease, but the disability due to stroke can be avoided or reduced through timely access to treatment and care. This study surveyed all designated stroke centres across Canada to better understand the national acute stroke treatment landscape.

An online survey designed to obtain information on each stroke hospital’s designation level, most responsible physician for acute reperfusion treatment decision-making, availability of stroke coordinators, stroke research activity and level of transition to tenecteplase for intravenous thrombolysis was distributed to stroke centres in Canada via a network of stroke administrators and physician leads from each province. The survey responses were collated and audited for completeness and accuracy, and final responses were analysed using descriptive statistics and graphical distributions as appropriate.

There are a total of 205 designated stroke centres in Canada; 13.2% (n = 27) are endovascular thrombectomy (EVT) capable (n = 26 provide 24/7 access), while the rest provide thrombolysis alone, comprising primary stroke centres (n = 70, 34.1%) and thrombolysis-ready centres (n = 108, 52.7%). The presence of neurologists in the thrombolysis-capable centres is minimal, although compensated for by a high use of telestroke in making thrombolysis decisions. Participation rate in stroke clinical trials was heavily restricted to the EVT-capable centres. There were variabilities among provinces in the availability of stroke coordinators.

The acute ischaemic stroke landscape in Canada is variable between provinces, presenting unique opportunities for collaboration. There is a need for greater availability of stroke neurologists and stroke coordinators and for diversifying site participation in clinical trials.

Hypothalamic hamartomas (HHs) are a known cause of refractory focal epilepsy. Advancement in microsurgical techniques and introduction of stereotactic ablative methods have led to improved complication rates, but the effect on seizure control is still to be determined. In this systematic review, we present a thorough analysis of published literature on the outcomes of various surgical treatments of HHs for refractory epilepsy.

A literature search using the MedLine, SCOPUS and Cochrane databases was conducted. All English language studies describing surgical treatment of HH with refractory epilepsy, with a minimum of three patients and a follow-up of at least one year, were identified.

An initial selection of 55 studies was reduced to 41 after combining studies from the same groups; 14 open, 4 endoscopic, 8 Gamma Knife radiosurgery (GKRS), 9 laser interstitial thermal therapy (LITT) and 6 radiofrequency thermocoagulation (RF-TC) studies were included. From a total of 832 patients, 209 underwent open (25.1%), 80 endoscopic (9.6%), 124 GKRS (14.9%), 229 LITT (27.5%) and 190 RF-TC (22.8%). Engel I or ILAE 1 or 2 was achieved in: open 115 (55.0%), endoscopic 38 (47.5%), GKRS 49 (39.5%), LITT 176 (76.9%) and RF-TC 128 (67.4%). Invasive surgeries (open and endoscopic) had a higher incidence of neurological complications (27.0%) than ablative surgeries (GKRS, LITT, RF-TC) (7.2%). Reoperation rates were higher for ablative surgeries (23.8%) than invasive surgeries (9.0%).

Surgical treatment of HH causing refractory epilepsy is effective. RF-TC and LITT surgery types have the highest Engel class I outcomes, and ablative surgeries have a lower neurological complication profile compared to open and endoscopic approaches.

Fall from height is common in all age groups. In 2020 alone, over 6000 people in Canada died from fall-related injuries. Most of the published literature investigating fall-related injuries are often focused on fracture patterns, survival and recovery. Fatal falls are not well studied. The objective of this study is to characterize the demographics and craniocerebral and vertebrospinal injury patterns related to fatal falls within Southwestern Ontario.

A retrospective case review was conducted at the Department of Pathology, London Health Sciences Centre, for deaths attributed to falls from 2000 to 2020. Only cases with complete autopsy and detailed neuropathology reports were included. Demographic data, comorbidity profiles and craniocerebral and vertebrospinal injuries, along with scene details, were collected and analyzed.

45 cases were included, with a male sex predominance and a mean age of 60.3 ± 18.1 years. The most common head injuries were hematoma, cerebral contusions and skull base fractures. Falls from stairs were the most common. Low fall (<3 m) was associated with subfalcine herniation and was more commonly seen in older individuals (>65 years). Younger individuals were more prone to falls from a high height (>3 m), with frontotemporal lobe contusions as the most common finding.

This study provides a detailed depiction of craniocerebral and vertebrospinal injury patterns of the fatal falls in Southwestern Ontario. Our findings show low falls are a more common cause of fatalities in individuals 65 years and older, and age is a significant predictor of frontal contusions and subdural hematomas.

Moyamoya disease (MMD) is characterized by progressive carotid fork steno-occlusion and the development of “puff-of-smoke” collaterals on angiography. However, a subset of patients present with similar vascular changes but lack these hallmark collaterals, complicating both diagnosis and management. This “smokeless” phenotype, associated with ring finger protein 213 (RNF213) gene variants, challenges the traditional description of MMD. We describe a series of such patients who responded favorably to revascularization.

In this ambispective observational study, we evaluated 12 patients with carotid fork steno-occlusive disease but without “puff-of-smoke” collaterals. Clinical, radiological and genetic assessments were assessed. Structural modeling of RNF213 protein variants was conducted through 3D homology modeling, validated via Ramachandran plots and further refined with COOT and PyMOL. Functional insights were derived through ConSurf analysis.

Of the 12 patients, 9 carried the RNF213 p.R4810K variant, 1 harboured a novel variant, 1 had both p.R4810K and a novel variant and 1 had p.R4859K. Initial misclassification as intracranial atherosclerosis or vasculitis led to inappropriate treatment. Following genetic confirmation, 9 patients underwent revascularization, with no stroke recurrence and a favorable clinical outcome. Structural modeling revealed minimal functional impact for the Val1529Met variant, whereas other variants significantly disrupted RNF213 stability and functionality.

“Smokeless moyamoya,” characterized by carotid fork steno-occlusion without typical angiographic collaterals, represents a distinct clinical phenotype responsive to revascularization. RNF213 genetic screening enhances diagnostic precision, reshaping traditional paradigms and supporting tailored therapeutic approaches.

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbances, cognitive impairment and urinary dysfunction. Early diagnosis is essential to ensure timely shunt treatment. However, patient identification remains challenging due to limited studies, mostly from Asia and Europe, which restrict generalizability to other geographic areas. Moreover, demographic factors (age, sex, education) influence cognitive and gait performance in other neurological conditions, but their impact on iNPH remains unclear. This study aimed to characterize the demographic, vascular, cognitive and gait profiles of iNPH patients in Eastern Quebec (Canada) and determine how demographic factors influence performance outcomes.

A retrospective chart review was conducted on 175 patients diagnosed with probable iNPH at a specialized neurology center in Eastern Quebec. Demographic data, vascular risk factors and cognitive and gait outcomes were extracted from medical records. Descriptive statistics were used to characterize the sample, and multiple linear regressions assessed the effect of demographic factors on performance outcomes.

The cohort had a mean age of 73.9 years and a mean education level of 11.9 years. Age and education significantly predicted over half of the cognitive test results, while age was the only significant predictor of gait. Hypertension (58%) and hyperlipidemia (47%) were more prevalent than diabetes (26%), differing from previous studies where diabetes was the second most reported vascular risk factor after hypertension.

Clinical heterogeneity characterizes iNPH patients in Eastern Quebec. Differences in the prevalence of vascular risk factors compared to previous studies may reflect geographic variability in the clinical presentation of this condition.

To describe motor, respiratory and quality of life changes in a mixed cohort of adults with spinal muscular atrophy (SMA) from a single tertiary rehabilitation center in Canada and to report preliminary psychometric evidence of a nationally recommended core outcome set over 12 months.

This real-world, mixed-treatment cohort, exploratory, single-site, prospective observational study followed fifteen adults with SMA over 12 months. Participants completed the Spinal Muscular Atrophy Recommended Toolkit (SMART), which consists of eight outcome measures (OM) assessed at baseline and 12 months. Concurrent and predictive validity were assessed using Spearman’s Correlation Coefficient (SCC). Longitudinal change and sensitivity to change were evaluated using the Wilcoxon signed-rank test and standardized response mean.

Ten participants were receiving disease-modifying treatments. None of the OMs demonstrated statistically significant changes over 12 months. Respiratory and motor function measures are independently clustered into two clusters. Only the Children’s Hospital of Philadelphia – Adult Test of Neuromuscular Disorders (CHOP-ATEND) exhibited high sensitivity to change. Forced vital capacity (FVC) >2 L or peak cough flow (PCF) >200 L/min corresponds with ceiling effects of the Revised Upper Limb Module (RULM) and SMA Functional Rating Scale (SMAFRS).

This exploratory study identified two collinear clusters between SMART OMs, suggesting measurement redundancy. SMART OMs did not demonstrate significant changes over 12 months in this small mixed-treatment cohort. Developing new OMs that are valid, reliable and responsive, and optimizing OM selection will reduce clinic and patient burden, and improve clinical utility in a real-world setting.

Poorly managed inpatient flow can lead to adverse health outcomes, including increased mortality and readmission rates. In neurosurgery, optimizing inpatient flow is crucial to improving patient experience and outcomes, but the factors influencing it are unclear. A preliminary analysis revealed suboptimal average length of stay (ALOS) and expected length of stay (ELOS) rates – key metrics used to assess inpatient flow – across Alberta, Canada. The purpose of this study was to evaluate the current state of inpatient flow in Alberta’s neurosurgical care and explore strategies for enhancement.

This study used mixed methods: a rapid scoping review and a retrospective cohort study. The rapid scoping review synthesized peer-reviewed and gray literature (after a three-stage screening process) to identify factors impacting neurosurgery inpatient flow across jurisdictions. The cohort study analyzed Alberta’s adult neurosurgical patient data from 2009 to 2019 to explore how patient- and system-level factors relate to ALOS/ELOS rates.

Nine of the 391 screened articles were included in the review. Three main themes emerged influencing neurosurgery inpatient flow: interdisciplinary care pathways, introducing new roles and identification of risk factors. Building on these themes, patient- and system-level factors impacting ALOS/ELOS were explored. ALOS/ELOS rates varied among the five Alberta Health Services zones, with Rural Zone 1 having the highest and significantly different rate. Age, sex, zone and comorbidities significantly accounted for differences in ALOS/ELOS rates (p < 0.001).

Neurosurgery patients in Alberta are experiencing longer hospital stays than expected. Several areas requiring further research have been identified, along with potential strategies to enhance patient care and outcomes.

Tenecteplase has been shown to be non-inferior to alteplase for the treatment of acute ischemic stroke within 4.5 hours of stroke onset. While not formally approved by regulatory authorities, many jurisdictions have transitioned to using tenecteplase for routine stroke treatment because it is simpler to use and has cost advantages.

We report a three-phase time-series analysis over 2.5 years and the process for transition from use of alteplase to tenecteplase for the routine treatment of acute ischemic stroke from a system-wide perspective involving an entire province. The transition was planned and implemented centrally. Data were collected in clinical routine, arising from both administrative sources and a prospective stroke registry, and represent real-world outcome data. Data are reported using standard descriptive statistics.

A total of 1211 patients were treated with intravenous thrombolysis (477 pre-transition using alteplase, 180 transition period using both drugs, 554 post-transition using tenecteplase). Baseline characteristics, adverse events and outcomes were similar between epochs. There were four dosing errors with tenecteplase, including providing the cardiac dose to two patients. There were no instances of major hemorrhage associated with dosing errors.

The transition to using intravenous tenecteplase for stroke treatment was seamless and resulted in identical outcomes to intravenous alteplase.

Historically, it has been proposed that functional neurological symptoms occur more frequently on the left side of the body due to a distinct body representation and emotional processing of the right hemisphere, yet objective imaging data to support this are lacking. We aimed to investigate whether patients with acute left-sided symptoms (right hemisphere) suspected of having a minor stroke are more likely to show negative diffusion-weighted imaging (DWI) compared to those with right-sided symptoms.

Data are from the SpecTRA (Spectrometry for Transient Ischemic Attack Rapid Assessment) multicenter prospective cohort study conducted between 2013 and 2017. Patients with mild persistent unilateral hemiparesis and/or hemisensory symptoms (National Institute of Health Stroke Scale ≤ 3) and available DWI were included. The primary outcome was the proportion of patients with a negative DWI.

Of 1731 patients, 584 (30.8%) were included. Of these, 310 (53.1%) patients presented with left-sided symptoms and 274 (46.9%) with right-sided symptoms. Overall, 214 (36.6%) patients had a negative DWI, 126 (58.9%) with left-sided symptoms and 88 (41.1%) with right-sided symptoms: risk ratio (RR) 1.27 (95% CI = 1.02–1.57). Left-sided hemiparesis was associated with negative DWI (RR 1.42 [95% CI = 1.08–1.87]), while left-sided hemisensory symptoms were not (RR 1.11 [95% CI = 0.87–1.41]). There was no effect modification by age or sex on this association (Pinteraction 0.787 and 0.057, respectively).

Unilateral left-sided neurological symptoms were more frequently associated with negative DWI compared to right-sided symptoms in suspected minor stroke patients. This observation is exploratory, as the final diagnosis in DWI-negative cases was not established.