Adjunctive intraarterial (IA) thrombolysis after endovascular thrombectomy may improve clinical outcomes in patients with large vessel occlusion (LVO) stroke possibly due to improvement in microvascular reperfusion.

We conducted a meta-analysis of randomized controlled trials (RCTs) evaluating IA thrombolysis with tenecteplase, alteplase or urokinase in anterior or posterior circulation LVO stroke after successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b–3). Efficacy outcomes were excellent functional outcome (modified Rankin Scale [mRS] 0–1), functional independence (mRS 0–2) and recovery without any disability (mRS 0) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (ICH), any ICH and death. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using random-effects models.

Seven RCTs (n = 2,130; 2022–2025) were included. IA thrombolytic drugs used were alteplase, tenecteplase and urokinase with doses ranging from 10 % to 50% of recommended IV dosage. IA thrombolysis significantly improved excellent functional outcome (mRS 0–1: OR 1.45, 95% CI 1.19–1.76) and recovery without any disability (mRS 0: OR 1.34, 95% CI 1.09–1.64), without safety risks (symptomatic ICH: 5.05% with IA thrombolytics vs. 4.49% in standard). Paradoxically, there was no difference in functional independence (mRS 0–2) (OR 1.09, 95% CI 0.99–1.20). Additionally, tenecteplase or alteplase at doses equivalent to 25% or 50% of recommended IV dosage significantly improved excellent functional outcome.

IA thrombolysis offered immediately following EVT with successful reperfusion improved excellent functional outcome and recovery without disability at 90 days with an acceptable safety profile.

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.

Retinal artery occlusion (RAO) is a vision-threatening condition with limited therapeutic options. Hyperbaric oxygen therapy (HBOT) has emerged as a potential treatment to enhance retinal oxygenation and salvage ischemic tissue, though its efficacy and safety remain debated.

We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Databases were searched through November 2024 for studies comparing HBOT with control in RAO patients. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analyses evaluated visual acuity (VA), best-corrected visual acuity (BCVA) and adverse events (AEs).

Nine studies with 499 patients (286 HBOT, 213 non-HBOT) met the inclusion criteria. HBOT was associated with improved BCVA (MD: –0.63, 95% CI: [–1.14, –0.12], p = 0.01) after sensitivity analysis. No significant differences were observed in uncorrected VA or lines of improvement. AEs included seizures (1.47%), ear barotrauma (1.65%) and epistaxis (0.83%) in the HBOT group. Notably, HBOT was associated with lower rates of neovascular glaucoma (7.89% vs. 15.79%) and stroke (4.3% vs. 16.6%) compared to controls.

HBOT demonstrates potential for improved visual outcomes in RAO patients, particularly BCVA, with a generally favorable safety profile. However, heterogeneity among studies and limited sample sizes highlight the need for robust prospective trials to clarify its role in RAO management.

Early diagnosis of neurodegenerative diseases (NDs) is a priority with the advent of disease-modifying therapies. The study of prodromal non-motor symptoms (NMS) in ND could help guide early diagnosis, facilitating adequate treatment. The primary objective of this study was to determine the prodromal association between NMS and ND.

A retrospective cohort study was planned. Records of subjects attending the movement disorders and NDs unit from Hospital Civil de Guadalajara “Fray Antonio Alcalde,” from 2012 to January 2025, were evaluated. Subjects with NMSQuest questionnaire in ND were included. Descriptive and inferential parametric statistics (Student’s t-test for independent samples and ANOVA) were used, and odds ratios (OD) with 95% confidence interval were calculated using binary logistic regression. A p value < 0.05 was considered significant.

The most frequent prodromal NMS in ND were depression, constipation, insomnia, anxiety and pain. There was an average of 7.7 ± 7.6 years of prodromal NMS prior to the diagnosis of ND. Prodromal depression [OR 1.9 (1.1–3.5 p < 0.001) and confusion/delusional thoughts [OR 7.2 (1.3–39.2) p = 0.02] were associated with dementia (time onset prior to diagnosis 9.9 ± 12.2 and 5.5 ± 9.7 years, respectively). Prodromal restless legs syndrome was associated with movement disorders [OR 3.3 (1.1–9.7) p = 0.02] (time onset 4.7 ± 6.9 years prior to diagnosis).

Evidence points to a potential association of prodromal NMS in ND. Prospective studies are required to confirm and characterize the association between prodromal NMS and ND, as their early identification may contribute to the timely diagnosis of ND.

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.

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.

Temporal arteritis (TA) is the most common vasculitis over age 50. Untreated, many patients will suffer blindness or stroke. Gold standard diagnosis is achieved by temporal artery biopsy. The aim of this study was to investigate the relevance of small vessel inflammation.

Our dataset was comprised of 72 temporal artery biopsies subjected to a blinded uniform re-examination paired with clinical data including demographics, history, physical examination and laboratory findings. Documented pathology variables included the presence or absence of TA, angiitis of vasa vasorum (AVV) and inflammation of small peri-adventitial vessels (small vessel vasculitis, SVV).

Clinical and pathological variables were subjected to multivariate analysis. In brief, 25% of cases were identified as TA, 20% as isolated AVV, 7% as isolated SVV and 5% as mixed isolated AVV/SVV, while 43% had no inflammation (NI). All cases of TA were accompanied by small vessel inflammation: 95% exhibited AVV with or without SVV, and 5% exhibited SVV alone, demonstrating a strong association between TA and small vessel inflammation. Of the 24 cases with isolated AVV/SVV, 26% received a clinical diagnosis of TA within one year in comparison to 13% of cases that had NI. Furthermore, isolated AVV/SVV was identified in 25% of patients with a high clinical probability for TA, 60% of whom acquired a diagnosis of TA on clinical grounds within one year of follow-up.

Our findings suggest that isolated AVV/SVV identifies a subgroup of patients with a higher risk of harboring or developing TA.

Neurofibromatosis type 1 (NF1) is a genetic disorder. Up to 50% of NF1 patients develop plexiform neurofibromas (PN). Despite revisions in diagnostic standards, there remains a lack of consensus on referral, treatment, monitoring and transition processes for NF1-PN. The study aimed to establish a Canada-wide consensus on the best practice for referral and management of patients with NF1-PN to help generate guidance where evidence on the long-term use of MEK inhibitors is lacking.

The study used a modified Delphi method. The steering committee (SC) identified 4 topics of focus and developed 44 consensus statements. Following ratification, 43 statements were developed into an online survey sent to 113 healthcare practitioners (HCPs) involved in NF1-PN management across Canada. Respondents used a 4-point Likert scale to indicate agreement with each statement. The threshold for consensus agreement was 75%.

A total of 56 responses were received, predominantly from Ontario. Most respondents were neuro-oncologists (34%) and had over 11 years of experience (57%). Consensus was reached on 41 of 43 statements (95%), enabling the SC to develop recommendations for NF1-PN patient care and a treatment algorithm outlining key timings for treatment and management.

To our knowledge, this is the first national Delphi consensus on NF1-PN. Strong agreement was seen from HCPs on critical timings in NF1-PN treatment and management. The proposed recommendations and treatment algorithm provide a framework to enhance patient care and support ongoing research into optimizing care for NF1-PN patients, not just in Canada but globally.

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.

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant genetic disorder leading to vascular malformations in different organ systems. Approximately 10% of patients with HHT have brain vascular malformations (BVMs). Due to the negative health consequences related to BVMs, screening with MRI is recommended. There are no health jurisdictional standards for medical imaging protocols in North America or elsewhere. The objective of this project is to adopt a provincial standardized operating protocol (SOP) to improve diagnostic accuracy and reduce inappropriate imaging in patients with and without HHT in Alberta.

Multiple fora were held among the five Alberta Health Services zones with stakeholders from urban, suburban and rural radiology groups, neurology, pulmonology and hematology. The consensus process took five years to complete between 2015 and 2020. The content of the fora was approved by all participants.

The SOP was implemented in February 2020 and defines that screening for BVMs must include standard unenhanced brain MRI (sagittal T1, axial fluid-attenuated inversion recovery and axial T2) with susceptibility-weighted imaging (SWI), a 3T or 1.5T magnet strength and minimum imaging standards to include 3 mm contiguous slice thickness.

Incorporation of SWI allowed for the elimination of MR contrast to improve access to the local performance of studies within the province, facilitating virtual care.

A provincial SOP for BVM screening in patients with suspected or confirmed HHT was successfully implemented in Alberta. Gadolinium was avoided, as it was felt to be unnecessary for screening purposes and might complicate imaging at more remote sites.

Individuals undergoing cranioplasty may encounter persistent functional impairments. Quality-of-life (QoL) assessment to address this is essential. This study aims to evaluate the long-term improvement in QoL after a cranioplasty at our center.

In this observational, retrospective study, we assessed the QoL of patients who underwent cranioplasty and could be contacted by our research team. QoL was evaluated using EuroQol-5D-3L and SF-36 scales through phone interviews. We evaluated QoL changes at 3, 6 and 12 months. Friedman’s test and repeated measures ANOVA were used to assess QoL improvement through time. An exploratory analysis to search for possible modifiers of QoL improvement was conducted.

We included 28 patients with a median age of 30 (IQR 20−52) years, of whom 19 (79.2%) had a history of trauma. Twenty (71.4%) patients underwent cranioplasty with custom-made 3D-modeled implants. Long-term improvements in general QoL were observed in mobility, self-care, usual activities and pain/discomfort (p < 0.001). Improvement in SF-36 scores showed significant mean differences in role limitations due to physical health (−32.14, 95% CI −50.37 to −13.91; p < 0.001), role limitations due to emotional problems (−21.43, 95% CI −38.5 to −4.35; p = 0.010) and pain (−9.65, 95% CI −16.36 to −2.93; p = 0.003). There were no significant modifiers of QoL improvement.

This study showed promising results about QoL improvement experienced by patients with low-cost customized implants. Further research is necessary to preserve clinical and self-reported improvement and conduct patient-centered neurosurgical care.

Spine simulators offer learners risk-free environments to develop psychomotor skills for pedicle screw insertions. The virtual reality TSYM simulator deconstructs and simulates pedicle screw insertions. This case series study investigates face, content, construct, and convergent validity of an L4–L5 bilateral pedicle screw insertion on the TSYM simulator.

Neurosurgical-orthopedic residents, fellows, and spine surgeons performed an L4–L5 bilateral pedicle screw insertion on the TSYM simulator. Participants were classified a priori into skilled (postgraduate year (PGY) 5–6, fellows, and consultant neurosurgeons or orthopedic surgeons) or less skilled (PGY 1–4) groups. Face and content validity were assessed utilizing a 7-point Likert scale. Construct validity was determined by investigating group differences in simulation-derived performance metrics and the Objective Structured Assessment of Technical Skills (OSATS) ratings. Convergent validity was examined by correlating simulation-derived performance metrics and OSATS ratings.

Thirteen skilled and 14 less skilled participants were included in this study. Eight of nine face and content validity statements were rated a median ≥ 4. Significant differences between the groups were found for four simulation-derived performance metrics (P < 0.05) and all OSATS categories (P < 0.001). Three simulation-derived performance metrics (maximum force and tool contact using the simulated screwdriver and three-dimensional velocity using the tap) significantly correlated with OSATS ratings.

The L4–L5 bilateral pedicle screw insertion simulation on the TSYM platform demonstrated mixed and variable evidence for face, content, construct and convergent validity, supporting its educational potential for spine surgery training, but improvements are needed to optimize learning.