The association between age and frailty and the use of thrombolysis or thrombectomy for acute ischemic stroke in females and males is not well understood.

In a population-based retrospective cohort study of adults hospitalized with an ischemic stroke between April 1, 2018, and March 31, 2022, in Ontario, Canada, frailty was determined using a hospital-based frailty index (categorized as low, medium and high). In sex-stratified modified Poisson models estimated using generalized estimating equation methods, we evaluated the associations between age and frailty and the receipt of thrombolysis, thrombectomy, and 30-day mortality. Using interaction terms, we evaluated the modifying effect of frailty on the association between age and receipt of reperfusion therapy and mortality.

We included 59,346 patients with ischemic stroke, of whom 57.6% had medium and 38.9% had high frailty scores. In both sexes, older patients were less likely than younger patients to receive thrombolysis or thrombectomy and more likely to die within 30 days. Compared to those who were least frail, patients with high frailty were less likely to receive thrombolysis (adjusted risk ratio [aRR] female = 0.66 [0.57–0.77]; male = 0.72 [0.63–0.82]), but not thrombectomy (female = 0.87 [0.69–1.09]; male = 1.11 [0.88–1.39]). High frailty was associated with an increased risk of 30-day mortality in males (2.09, 1.52–2.87), but not females (1.22, 0.90–1.66).

Frailty is independently associated with lower rates of thrombolysis in both sexes and increased mortality in males. Frailty should be accounted for when comparing the quality of acute stroke care and outcomes across jurisdictions.

This study aimed to define the clinical and electrodiagnostic characteristics of COVID-19-associated Guillain-Barré syndrome (C + GBS) diagnosed during a multicenter GBS study performed in Istanbul.

From the patients with GBS who were prospectively included in the multicenter study conducted from April 2019 to March 2022, two groups were extracted: (1) pre-pandemic patients (PP, April 2019–February 2020); and (2) C + GBS, consisting of patients with a positive COVID-19 polymerase chain reaction test within 4–6 weeks before the onset of symptoms. Clinical features and electrodiagnostic data acquired twice in the first 21 days of GBS and between the 4th and 6th weeks of the illness were compared between the groups.

There were 22 patients in the C + GBS and 69 in the PP groups. Patients with C + GBS were older than those in the PP group (58.9 ± 15.4 vs. 49.8 ± 17.5, p = 0.047). Motor signs/symptoms were more prevalent in the C + GBS group than in the PP group. In the C + GBS group, demyelinating subtype was significantly more frequent (82% vs. 52%, p = 0.031), and CSF cell count was lower (0.8 ± 1.8 vs. 5.7 ± 11.7 cells/all, p = 0.007) compared with the PP group. The clinical severity scores, treatment strategies and the time from the symptom onset to the nadir did not differ between the groups. None of the C + GBS patients, except one, had anti-ganglioside antibodies. The only significant parameter was the demyelinating subtype in the multivariate analysis.

Patients with C + GBS seemed to show a predominantly demyelinating subtype with no discernible differences in clinical features.

Tenecteplase is a genetically modified variant of alteplase that is administered as an intravenous bolus and has greater fibrin-specificity and a longer half-life. Data from the Alteplase compared to Tenecteplase (AcT) trial showed non-inferiority of tenecteplase compared to alteplase in patients with acute ischemic stroke (AIS) treated within 4.5 hours of symptom onset, with the direction of effect favoring tenecteplase. Based on this evidence, the Canadian Stroke Best Practice Recommendations added tenecteplase as an alternative to alteplase. Its cost-effectiveness in the Canadian setting, however, remains to be determined.

A cost-effectiveness analysis of tenecteplase versus alteplase for AIS in the Canadian setting was performed. The model combined a decision tree for the 90 days post-index stroke, where patient distributions across seven modified Rankin Scale states were informed by the AcT trial, and a Markov model for the remainder of the lifetime horizon. Cost-effectiveness was assessed as the incremental cost per quality-adjusted life-year (QALY) gained.

The analysis demonstrated tenecteplase to dominate alteplase (i.e., produced 0.138 more QALYs and ＄877 savings per AIS patient). Tenecteplase dominance was achieved as early as 90 days post-AIS and confirmed by numerous sensitivity/scenario analyses.

This analysis represents the first to assess the cost-effectiveness of tenecteplase as an alternative to alteplase in the treatment of AIS in the Canadian setting. Though all benefits related to its simplified bolus administration were not considered, results robustly demonstrate tenecteplase represents a high-value strategy. Together with the accumulating clinical evidence, this study may help support decisions to adopt tenecteplase on hospital formularies.

Adult-onset cerebellar ataxia (AOCA) comprises a heterogeneous group of hereditary and sporadic disorders characterized by progressive cerebellar dysfunction. While motor features define these conditions, non-motor symptoms (NMS) are increasingly recognized as contributors to disease burden. We sought to characterize NMS in patients with AOCA to improve phenotypic characterization and inform targeted therapeutic approaches.

We conducted a retrospective review of records from a tertiary movement disorders clinic between 2000 and 2020. Adults with ataxia as their primary complaint were identified, and those with progressive cerebellar ataxia with age of onset after 18 were included, regardless of genetic diagnosis. Cases of multiple system atrophy or secondary causes of ataxia were excluded. NMS were recorded, including pain, sleep disturbances, cognitive impairment and neuropsychiatric symptoms, and compared across diagnostic categories.

We identified 145 patients (58.6% male; mean age at diagnosis of 49.9 years). Autosomal dominant spinocerebellar ataxias (SCAs) accounted for 28.3% of cases, while 60.7% were classified as sporadic adult-onset ataxia of unknown etiology. The most common NMS were mood disorders (28.9%), cognitive impairment (24.1%) and pain (18.6%). Depression and anxiety were more frequently documented in patients with SCAs compared to non-SCAs (41.5% vs. 23.9%, p = 0.03). An inverse correlation was observed between depression/anxiety and age at diagnosis (r = −0.22, p = 0.007), independent of sex and inheritance pattern.

NMS are common in AOCA and warrant routine clinical assessment. Mood disorders should be carefully screened for in patients with earlier disease onset, given their strong inverse association with age at diagnosis.

Inappropriate diagnostic testing using electroencephalography (EEG) not only burdens the healthcare system but is especially concerning in Canada, where EEG demand is rising alongside a nationwide shortage of technologists. Understanding factors that influence yield, as well as patterns in requisition quality and completeness, may help improve both clinical utility and resource allocation.

We performed a single-center retrospective cohort study analyzing EEGs performed at Kingston Health Sciences Centre from March to August 2024. Demographic and clinical data were collected from paper EEG requisitions and digital reports. Diagnostic yield was assessed across clinical variables, physician specialty and patient setting using descriptive statistics, logistic regressions and odds ratios.

EEGs detected abnormalities in ∼40% of 1077 EEGs, mostly non-epileptiform. Yield was higher among older adults (60+ years), inpatients in critical care, emergency patients, and those on anti-seizure medications or sedatives. Indications like “neuro-prognostication” and “concern for non-convulsive status epilepticus” had high yield (100%), whereas “syncope/presyncope” had poor yield (12.8%). Sleep-deprived EEGs did not significantly differ in yield compared to routine EEGs. Over half (56%) of the EEG requisition forms were incomplete. Requisition completeness varied by physician specialty: neurologists were found least likely to complete requisition forms compared to other specialties.

By identifying clinical factors, physician specialties and settings associated with low diagnostic yield, interventions can be tailored to improve requisition practices and guide efficient resource allocation.

To evaluate long-term postoperative symptoms, recovery and treatment responses at least 12 months after surgical repair of spinal CSF leaks in patients with spontaneous intracranial hypotension (SIH) and iatrogenic CSF leaks.

This cross-sectional, self-report, online survey was conducted from January to April 2025, with participants recruited through international patient support groups. Descriptive analyses included 92 individuals with SIH and 136 with iatrogenic CSF leaks. The questionnaire assessed pre- and postoperative symptoms, functional recovery, complications and the perceived effectiveness of pharmacological and interventional treatments.

Among 228 respondents, complete recovery was reported by 13.6% (12/92) of patients with SIH and 5.8% (8/136) of those with iatrogenic CSF leaks. Orthostatic headache showed the greatest postoperative improvement, whereas fatigue, cognitive impairment and tinnitus improved only moderately. The median duration of sick leave was eight months, and 18% of participants remained on medical leave at the time of assessment. Clinician-diagnosed long-term complications were reported by 14.9% of respondents, including peripheral nerve injury. Acetazolamide was the most effective treatment for rebound high-pressure headache, particularly in patients with SIH. Occipital nerve blocks and therapeutic lumbar punctures provided moderate benefit in selected patients, while most other pharmacological treatments showed limited effectiveness.

Many patients in this self-report cohort experience persistent symptoms years after undergoing surgery to repair spinal CSF leaks. These findings emphasise the importance of structured, multidisciplinary and long-term postoperative care.

Direct cerebral revascularization remains a central therapeutic approach for Moyamoya disease (MMD) and Moyamoya syndrome (MMS). However, existing outcome data are largely derived from East Asian populations, with limited evidence characterizing North American cohorts. This study presents the experience of a Canadian university hospital with superficial temporal artery–middle cerebral artery (STA–MCA) bypass for MMD and MMS, focusing on perioperative management, surgical outcomes and graft durability.

A retrospective case series was conducted, including nine patients with MMD/MMS who underwent STA–MCA bypass between December 2021 and March 2026 at the Hôpital du Sacré-Coeur de Montréal. Data on demographics, clinical presentation, perioperative care and follow-up outcomes were analyzed. Primary outcomes included bypass graft patency and ischemic or hemorrhagic events. Secondary outcomes included functional status assessed via the modified Rankin Scale and perioperative complications.

All patients (n = 9) demonstrated sustained graft patency, with a median clinical follow-up of 16 months and a median radiological follow-up of 14 months. Eight patients (89%) experienced stable functional outcomes, while one (11%) experienced significant neurological decline due to postoperative complications. No ischemic events were observed during follow-up; however, one patient experienced a subdural hematoma in the immediate postoperative period, necessitating surgical intervention.

Direct STA–MCA bypass is a viable revascularization strategy for MMD/MMS, achieving high graft patency and preventing recurrent ischemic events. It can be safely established in a Canadian center. However, the potential for complications, particularly in high-risk patients, highlights the critical importance of meticulous perioperative management and careful patient selection.

Status epilepticus (SE) is a neurologic emergency characterized by prolonged or recurrent seizures leading to significant secondary brain injury, complications, morbidity and mortality. Timely and aggressive management is paramount to mitigate this disease burden, but response rates to first- and second-line antiseizure medications (ASMs) remain suboptimal. Cenobamate (CBM), a novel ASM, has shown great promise in clinical trials as an adjunctive agent for patients with refractory focal epilepsy, but little is known about its efficacy and safety for SE.

This systematic review aims to evaluate the efficacy and safety of CBM for managing SE, refractory SE and super-refractory SE (SRSE).

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A literature search was conducted across MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL. Original research involving adult patients with SE treated with CBM were included, and study quality was assessed. Data on patient demographics, treatment protocols and outcomes were extracted.

Of 62 articles screened, 4 studies met the inclusion criteria, comprising 2 full manuscripts and 2 conference abstracts. A total of five patients with SRSE were treated with CBM. Seizure cessation was observed in two patients (40%). Reported adverse events included somnolence and gastrointestinal disturbances.

Evidence supporting the use of CBM for the management of patients with SE is limited. Further structured studies are needed to establish optimal dosing, efficacy and safety of CBM for patients with SE.

Functional neurological disorder (FND) is a neuropsychiatric condition that causes disabling neurological symptoms. Despite its frequent occurrence, FND has a long history of misclassification, and this is reflected in inconsistencies in how healthcare providers code for FND patients in the medical record.

We aim to (1) assess if an electronic medical record (EMR) case definition(s) for FND or its subtypes has been created or validated, (2) explore what yet-to-be-validated definitions and codes have been used and (3) understand how the EMR is currently being used to study FND.

We conducted a scoping review, searching EMBASE, MEDLINE and APA PsycInfo for peer-reviewed literature that identifies FND patients using the EMR. Included studies were published after 2000, written in English or French, and were original research.

Our search identified 31 articles. Thirty-two diagnostic codes have been used for FND, most commonly F44.x International Classification of Diseases (ICD)-10-CM codes in 21 of 31 studies (68%) and 300.x ICD-9 codes in 8 of 31 studies (26%). Additionally, nine distinct case definitions, which combined various data-driven identification methods, were used inconsistently, and validation was only attempted in five studies. Functional dissociative seizure was the most frequently studied subtype. Epidemiology and comorbidities were the topics explored most often.

The EMR holds great promise as a tool for FND research, although a validated case definition is needed. Of great concern are the inconsistent coding practices for FND. Future efforts should focus on tackling stigma to remove barriers to diagnosis and improve coding practices.