Background: Cerebral amyloid angiopathy (CAA) is a common cause of spontaneous intracerebral hemorrhage (ICH) in elderly individuals, and it is characterized by the deposition of amyloid β protein (Aß) in the walls of small-caliber cortical and leptomeningeal vessels. The diagnostic criteria for CAA highlight its association with spontaneous lobar hemorrhage, convexity subarachnoid hemorrhage (SAH), and cortical superficial siderosis but not with subdural hematoma (SDH). This article presents a three-patient case series of CAA who experienced a lobar ICH associated with an SDH, underscoring a potentially under-recognized correlation between an acute ICH and coexistent SDH. Case presentation: We present a case series of three patients in a single university medical center who experienced acute-onset lobar ICH with a concurrent SDH, treated with evacuation. Histopathological examination established the diagnosis of CAA in all three cases. This case series underscores a potentially under-recognized association between an acute ICH and coexistent SDH in the context of CAA. Conclusions: Considering our findings, we emphasize the possibility that SDH may be a more frequent manifestation of CAA than previously recognized. Therefore, patients with CAA who initially present with acute SDH may be underdiagnosed, consequently leading to delayed identification and missed opportunities for proper risk assessment and management.

Tenecteplase (TNK), a genetically modified tissue plasminogen activator, has emerged as a promising alternative to alteplase (ALT) for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Our aim was to synthesize the current clinical evidence on TNK use in AIS patients, comparing efficacy, safety, and workflow benefits to ALT. A narrative review was conducted by searching PubMed and Scopus (January 2024–March 2025) for studies comparing TNK and ALT in AIS. A total of 35 eligible papers were included. Data were grouped by treatment scenario: IVT-only, bridging before endovascular therapy (EVT), and intra-arterial thrombolysis (IAT). The results showed that TNK is non-inferior—and in some analyses, superior—to ALT regarding functional outcomes, especially in large vessel occlusion. TNK facilitates shorter treatment delays due to its single-bolus administration. While some trials report higher rates of intracranial hemorrhage, overall safety and mortality are comparable. In conclusion, TNK appears to exert equivalent or superior efficacy and safety compared to ALT in multiple AIS scenarios. Its pharmacological and logistical advantages support its broader clinical adoption. Further trials are needed, especially for IAT, central retinal artery occlusion, and patients on dabigatran.

Background: Cerebral amyloid angiopathy (CAA) is a small- and medium-vessel cerebrovascular disease characterized by β-amyloid accumulation within cortical and leptomeningeal arterial walls. Although it most commonly manifests in older individuals as spontaneous lobar hemorrhage, uncommon cases have been reported in younger patients, especially those with risk factors such as previous head trauma, genetic predisposition, or prior exposure to cadaveric dura. Case Description: We describe a diagnostically challenging case of suspected CAA in a 42-year-old man with a history of multiple traumatic brain injuries, prior neurosurgical interventions, neuropsychiatric symptoms, and late-onset seizures. Importantly, during treatment for head trauma in early adulthood, he received a cadaveric dura transplant. Over subsequent years, he developed recurrent lobar hemorrhages and progressive cognitive and behavioral changes, raising concern for an atypical, possibly iatrogenic, form of CAA. Conclusion: This case highlights the need to consider CAA – even in younger patients – when recurrent lobar hemorrhages and neuropsychiatric symptoms occur in the context of relevant risk factors such as previous head trauma or cadaveric dura exposure. We believe that such exposure may underlie this patient’s gradual but persistent neurological and cognitive decline.

The light cupula phenomenon is an uncommon vestibular disorder characterized by persistent, direction-changing positional nystagmus with rapid onset without fatigue. While often reported in the horizontal semicircular canal, involvement of all three semicircular canals is remarkably rare. We present a case of a 55-year-old male with acute-onset vertigo and distinctive geotropic horizontal nystagmus in the supine position accompanied by a vertical downbeat component in the upright position, suggesting simultaneous cupula activation in all three semicircular canals of a single vestibular apparatus. Neurological and imaging evaluations ruled out central causes. In accordance with clinical and radiological findings, the light cupula phenomenon caused by heavier endolymph appeared to best explain our patient's findings. This case highlights the diagnostic complexity of light cupula syndrome, particularly regarding its vertical canal manifestations, which remain poorly understood. Future comprehensive research of the anatomy and pathophysiology of the light cupula phenomenon across the whole vestibular apparatus is needed to improve clinical recognition and management.

Background/Objectives: Acute carotid tandem lesions (TLs), defined by concurrent cervical internal carotid artery (ICA) stenosis or occlusion and intracranial large vessel occlusion, occur in 10–20% of patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Optimal periprocedural antiplatelet management during emergent carotid artery stenting (eCAS) remains uncertain, particularly regarding the balance between preventing stent thrombosis and avoiding hemorrhagic complications. Methods: A narrative review was conducted using PubMed and Scopus (until 6 March 2026) to identify English-language studies evaluating antiplatelet therapies during eCAS for TLs. We included seven real-world studies and registry analyses. Data on study design, patient characteristics, procedural strategies, angiographic results, functional outcomes, and safety metrics were extracted. Results: No randomized controlled trials (RCTs) were identified. The available evidence is derived exclusively from observational studies. Across these cohorts, glycoprotein IIb/IIIa inhibitors (GPIs), particularly tirofiban, were generally associated with lower rates of in-stent thrombosis and higher reperfusion success, with symptomatic intracranial hemorrhage (sICH) rates that appeared comparable to or lower than those reported with acetylsalicylic acid (ASA). Cangrelor, an intravenous (IV) P2Y₁₂ inhibitor, was associated with improved stent patency and increased likelihood of complete reperfusion, although reported effects on clinical outcomes were inconsistent when compared with GPIs or ASA. Aside from abciximab, potent IV antiplatelet agents did not consistently show an increased sICH signal. Oral dual antiplatelet therapy was also associated with improved technical outcomes without a clear excess in bleeding complications. Conclusions: Current real-world observational data suggest that rapid-acting IV antiplatelet agents—particularly GPIs and, increasingly, cangrelor—may represent feasible periprocedural options during eCAS for TLs, with potential benefits for technical success and no consistent evidence of increased hemorrhagic risk. However, interpretation is limited by study heterogeneity and non-randomized designs. The absence of RCTs highlights the need for prospective comparative studies and standardized periprocedural antiplatelet protocols.