Although carotid endarterectomy (CEA) or carotid artery stenting (CAS) is recommended for symptomatic extracranial carotid stenosis of 50–99%, the COVID-19 pandemic significantly impacted resources. CAS therefore offered potential advantages as access to the angiosuite was seemingly easier than access to operating rooms. The primary objective was to determine the frequency of serious and non-serious complications following CAS before and during the COVID-19 pandemic.

We performed a retrospective cohort study of consecutive patients who received CAS at the Ottawa Hospital, Canada, from June 2019 to May 2021. We reviewed baseline demographics, imaging, as well as intraprocedural and postprocedural complications based on chart review. We performed multivariable logistic regression to determine associations between clinical and safety outcomes.

We included 47 patients in the pre-pandemic period and 93 patients in the pandemic period (mean age = 70.4 years; 54% female; P = 0.287 for age and P = 0.962 for sex, respectively). The combined rate of intraprocedural and postprocedural serious complications (ischemic stroke, intracerebral hemorrhage, myocardial infarction or death) was 7.1%. Eight strokes occurred, and one patient with a postprocedural ischemic stroke died 11 days after stenting. Complication rates were similar before and during the pandemic (aOR 1.040, 95% CI 0.466–2.321). The number of referrals for CEA during the pandemic period decreased by 50%.

In this cohort of consecutive patients undergoing CAS at a Canadian comprehensive stroke center before and during the COVID-19 pandemic, the rates of stroke and death were similar to pre-pandemic conditions and were generally consistent with the published literature.

Stroke due to basilar artery occlusion (BAO) carries poor outcomes despite advancements in endovascular therapy (EVT). Predictors of recovery remain underexplored. This study evaluates clinical and imaging predictors of outcomes following EVT, including a Critical Area Diffusion Score (CADS), assessing infarct location and extent in critical brainstem regions on post-EVT MRI.

This retrospective study analyzed 48 BAO patients treated with EVT at a provincial stroke center (2015–2021). Patients were categorized by outcomes (favorable: modified Rankin Scale [mRS] 0–3; unfavorable: mRS 4–6). Clinical, demographic and imaging data – age, baseline National Institutes of Health Stroke Scale (NIHSS), reperfusion success (thrombolysis in cerebral infarction [TICI] 2b–3) and post-EVT CADS from diffusion-weighted MRI – were assessed using univariate and multivariate logistic regression.

Patients with favorable outcomes were younger (median 64.0 vs. 73.0 years, p = 0.031), had lower NIHSS scores at presentation (median 8 vs. 16, p = 0.018) and achieved higher successful reperfusion rates (81.0% vs. 48.1%, p = 0.020). CADS ≤ 3 was linked to better outcomes (median mRS 3 vs. 5, p = 0.026) and higher odds of recovery in univariate analysis (OR = 10.89, p = 0.038). However, in multivariate analysis, CADS was not an independent predictor, with successful reperfusion (OR = 18.8, p = 0.044) as the strongest factor.

Age, NIHSS scores and successful reperfusion predict recovery in BAO patients undergoing EVT. Although CADS ≤ 3 is linked to favorable outcomes, it is not independently predictive. CADS holds promise as a prognostic tool, but its utility should be considered alongside clinical markers to enhance outcome prediction in BAO.

Adult-onset PLA2G6-associated neurodegeneration (PLAN) has a diverse phenotypic presentation.

Detailed description of the clinical, imaging and genetic profile of adult-onset PLAN; comparison of the Indian cohort with Asian, Middle East and European cohorts; genotype–phenotype correlations; and determination of ethnic phenotypic and genotypic differences of adult-onset PLAN.

Report of two patients of adult-onset PLAN and review of reported cases of adult-onset PLAN since 2015 from Indian, Asian, Middle East and European cohorts.

There were 12 cases in the Indian cohort, 45 in the Asian cohort, 10 in the Middle East cohort and 17 in European cohort. Patients in the Indian and Asian cohorts had a later age at onset as compared to the Middle East and European cohorts. The median duration of disease was similar among all cohorts. Dystonia, myoclonus and gaze palsy were common in the Indian cohort; parkinsonism and tremor in the Asian cohort; parkinsonism, tremor, spasticity and cognitive impairment in the Middle East cohort; and parkinsonism and behavioural disturbances in the European cohort. Early-onset parkinsonism was common in all cohorts. Mineralisation on MRI was less frequent in the Asian and Middle East cohorts. Cerebral/cerebellar atrophy was less frequent in the Asian cohort. The homozygous missense variant (c.2222G > A,p.R741Q) was common in the Indian and Middle East cohorts, whereas the homozygous/compound heterozygous variant (c.991G > T, p.D331Y) was the most common variant in the Asian cohort. Milder clinical and neuroimaging phenotypes were noted with c.991G > T (p.D331Y) variant and a relatively severe phenotype in c.2222G > A,p.R741Q variant.

Adult-onset PLAN has a variable phenotype. We found ethnic phenotypic and imaging differences among the cohorts.

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.

Patients with Guillain–Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) have mental health sequelae that impact their quality of life. The burden of mental health disorders in these patients is poorly established.

To review the literature on the frequency and risk of mental disorders in GBS and CIDP.

A systematic review was conducted to identify primary studies that reported mental health outcomes in patients with GBS and CIDP. Screening, full-text review, data extraction and quality assessment were performed in duplicate, with discrepancies resolved by a third party.

This systematic review included 19 studies. Three studies reported mental health diagnoses using the International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders criteria: up to 82%, 67%, 25% and 22% of patients following GBS were diagnosed with anxiety, depression, brief reactive psychosis and post-traumatic stress disorders, respectively. The risk of anxiety disorders following GBS normalized after 3 months, but the risk of depressive disorders remained elevated for 2 years. Although 30%–50% of patients with CIDP described mental health symptoms, no studies reported mental health diagnoses. Active disease and neuropathic pain were associated with more depressive symptoms in patients with CIDP.

Many patients following GBS or with active CIDP experience symptoms that may fulfill the criteria for mental health diagnoses, but the paucity of literature suggests that mental health disorders are underdiagnosed and undertreated in this population. These patients are at higher risk of developing mental health disorders, thereby emphasizing the need for timely mental health care and assessment of their disease-specific risk factors.

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.

We assessed whether the motor component of the Glasgow Coma Scale (GCSm) is independently associated with unfavorable outcomes in aggressively treated poor-grade subarachnoid hemorrhage (SAH) patients.

Retrospective cohort of poor-grade SAH patients (World Federation of Neurosurgical Societies (WFNS) grades IV and V). The best GCSm score achieved within 24 h of admission was stratified into four categories (<4, 4, 5 or 6). Outcomes were classified as favorable [modified Rankin Scale (mRS) ≤ 2] or unfavorable (mRS ≥ 3). Multivariable logistic regression was performed to identify independent predictors of unfavorable outcome.

A total of 179 patients were admitted during the study period (mean age 55.9 ± 12.1; 68.2% female). Thirty-three patients (33/179 – 18%) died before aneurysm treatment, one patient had missing GCSm data at 24 h and sixteen patients (16/179; 9%) were lost to follow-up. One hundred and twenty-nine patients (129/179 – 72%) were included in the final analysis. No patient with GCSm < 4 had a favorable outcome (sensitivity 22.4%, specificity 100%, positive predictive value 100% and negative predictive value 67.8% for unfavorable outcome). Delayed cerebral ischemia-related cerebral infarction (odds ratio (OR) 4.06; 1.56−11.11 95% CI, p = 0.004) and the best GCSm score were independently associated with unfavorable outcome. There was a stepwise decrease in the rate of unfavorable outcome from GCSm < 4 to GCSm = 6 (<4 = 100%; 4 = 80%; 5 = 46% and 6 = 20%). Each one-point decrease in GCSm score was associated with an OR of 3.52 (1.77−7.92 95% CI, p = < 0.001) for unfavorable outcome.

The GCSm score was independently associated with unfavorable outcome. All patients with a GCSm score < 4 experienced an unfavorable outcome.

Chronic subdural hematoma (cSDH) is a common condition, especially in the older population, and causes considerable morbidity. Recently, middle meningeal artery embolization (MMAE) has shown promise as a minimally invasive intervention for cSDH by disrupting the flow to the hematoma neomembranes and thus reducing recurrence.

We performed a systematic review of the literature using PubMed/Medline and Google Scholar to identify studies reporting on MMAE for cSDH over the past 30 years. After screening 4103 articles and reviewing 600 full-text studies, 176 studies were selected, including case reports, case series, retrospective and prospective studies and randomized controlled trials. Patient demographics, embolic agents used, frequency, type and severity of complications, hematoma recurrence and need for repeat surgery were extracted from the included studies.

Our analysis included 9780 patients (75.9% male), with mean/median ages ranging from 62.1 to 82.5 years. MMAE-related complications were reported in approximately 3%. Procedure-related neurological complications were the most frequent, followed by systemic complications, access site, non-procedure-related neurological complications, procedure-linked vascular complications specific to MMA and miscellaneous complications. Hematoma recurrence was reported in 6%, and repeat or rescue surgery was necessary in 6.1%. These results are consistent with major clinical trials evaluating MMAE safety and efficacy in cSDH.

Based on current published literature, MMAE appears to be an effective and overall safe treatment option for cSDH. Complications, although infrequent, can occur, and some of these are disabling. Meticulous pre-procedural planning and imaging are essential to reduce the risk of complications.

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.