Background: Cerebral vasospasm is a frequent and severe complication after aneurysmal subarachnoid hemorrhage (aSAH), often causing delayed cerebral ischemia (DCI) and poor outcomes. Despite progress in neurocritical care, early vasospasm prediction after aSAH remains challenging due to its multifactorial nature but is essential for timely intervention. Methods: We retrospectively analyzed 503 consecutive patients with spontaneous subarachnoid hemorrhage (SAH) treated between 2013 and 2018. Of these, 345 with angiographically confirmed aSAH were included in the primary analysis, and 158 SAH cases in a sensitivity analysis. We extracted demographic, clinical, and imaging parameters including age, sex, Hunt and Hess grade, Fisher scale, aneurysm and treatment features, external ventricular drainage (EVD), and central nervous system (CNS) infection. Seven supervised machine learning (ML) models, including logistic regression and gradient-boosted trees, were trained using nested cross-validation and evaluated by AUC-ROC, AUC-PR, accuracy, precision, sensitivity, specificity, and F1 score. Results: Over half of aSAH patients developed moderate to severe vasospasm. Independent predictors included younger age, higher Hunt and Hess and Fisher grades, and EVD placement (all p < 0.001). Logistic regression achieved the best discrimination (AUC-ROC 0.723), while tree-based models reached higher sensitivity (0.867) at the expense of specificity. Aneurysmal etiology further increased vasospasm risk (OR 4.72). Conclusions: Routinely available clinical and imaging parameters enable reliable ML-based vasospasm prediction after aSAH. Logistic regression provided the best balance between accuracy and interpretability, while tree-based models optimized sensitivity. This web-based, interpretable ML tool—one of the first using routine clinical data—may support the bedside prediction of vasospasm and requires prospective validation.

The flow behavior of fluids can be characterized by rheology and is especially used in the field of polymeric materials. This study focused on characterizing cerebrospinal fluid (CSF) of patients who developed hydrocephalus after subarachnoid hemorrhage (SAH) with rheology. Samples were drawn from an external ventricular drainage (EVD) at four pre-defined time points after the initial hemorrhage. The CSF samples were analyzed using a rotational rheometer with a double gap geometry. In addition to the characterization of viscoelastic parameters, the cumulative storage factor was calculated to determine the interactions in the fluid. In order to investigate the temperature dependence of the CSF properties, the oscillatory measurements were implemented at certain temperatures that simulated specific conditions, such as 5 °C, at which temperature the CSF samples were stored; 35 °C for hypothermic conditions; 37 °C for physiologic conditions; and 40 °C for elevated body temperature. The overall goal was to evaluate whether rheology-based parameters may help in the prediction of shunt dependence for post-hemorrhagic hydrocephalus patients. For this aim, rheological parameters were correlated to certain laboratory parameters, such as erythrocyte and leukocyte count, glucose, lactate, and total protein concentration.

Background: Superior cerebellar artery (SCA) infarction is a rare but clinically significant subtype of posterior circulation stroke. Extensive swelling in the SCA territory may cause downward brainstem compression and appear as brainstem hypodensity on computed tomography, potentially leading to premature treatment withdrawal. Methods: We report the case of a 50-year-old woman with acute SCA-territory infarction (NIHSS = 7) present-ing with vertigo, dysphagia, dysarthria, and diplopia. Initial computed tomography sug-gested extensive brainstem infarction, prompting withdrawal of treatment. Diffu-sion-weighted MRI revealed reversible edema with brainstem sparing. The patient un-derwent suboccipital decompressive craniectomy and ventricular drainage with favorable neurological recovery. In addition, a systematic literature search was conducted according to PRISMA 2020 guidelines in PubMed, Web of Science, and Scopus (studies published since 1 January 2015). Fifteen studies met predefined eligibility criteria. Results: Magnetic resonance imaging findings were decisive in avoiding a falsely dismal prognosis and in-appropriate withdrawal of care. Across literature, infarct volume (> 30–35 mL), brainstem involvement and bilateral cerebellar infarction emerged as key predictors of malignant course. Early decompressive surgery was consistently associated with improved survival, though functional outcomes varied. Fast magnetic resonance imaging techniques and volumetric imaging improved risk stratification and surgical decision-making. Conclu-sions: SCA infarction can mimic brainstem infarction on computed tomography due to secondary compression rather than true ischemia. Magnetic resonance imaging is essen-tial to guide treatment and prevent avoidable mortality. Multimodal imaging combined with interdisciplinary management allows for accurate prognostication and optimized surgical timing in malignant SCA infarction.

Background/Objectives: Superior cerebellar artery (SCA) infarction is a rare but clinically significant subtype of posterior circulation stroke. Extensive swelling in the SCA territory may cause downward brainstem compression and appear as brainstem hypodensity on computed tomography, potentially leading to premature treatment withdrawal. Methods: We report the case of a 50-year-old woman with acute SCA-territory infarction (NIHSS = 7) presenting with vertigo, dysphagia, dysarthria, and diplopia. Initial computed tomography suggested extensive brainstem infarction, prompting withdrawal of treatment. Diffusion-weighted MRI revealed reversible edema with brainstem sparing. The patient underwent suboccipital decompressive craniectomy and ventricular drainage with favorable neurological recovery. In addition, a systematic literature search was conducted according to PRISMA 2020 guidelines in PubMed, Web of Science, and Scopus (studies published since 1 January 2015). Fifteen studies met predefined eligibility criteria. Results: Magnetic resonance imaging findings were decisive in avoiding a falsely dismal prognosis and inappropriate withdrawal of care. Across the literature, infarct volume (>30–35 mL), brainstem involvement and bilateral cerebellar infarction emerged as key predictors of malignant course. Early decompressive surgery was consistently associated with improved survival, though functional outcomes varied. Fast magnetic resonance imaging techniques and volumetric imaging improved risk stratification and surgical decision-making. Conclusions: SCA infarction can mimic brainstem infarction on computed tomography due to secondary compression rather than true ischemia. Magnetic resonance imaging is essential to guide treatment and prevent avoidable mortality. Multimodal imaging combined with interdisciplinary management allows for accurate prognostication and optimized surgical timing in malignant SCA infarction.

Objectives: Compression neuropathies such as Anterior Tarsal Tunnel Syndrome are usually associated with focal thickening at the compression site. This study aimed to determine the frequency and location of thickenings of dorsal foot nerves in asymptomatic, healthy volunteers. We hypothesized that focal nerve thickening of dorsal foot nerves is a frequent finding in asymptomatic individuals and occurs at anatomically plausible locations, potentially limiting the specificity of ultrasound in the diagnosis of anterior tarsal tunnel syndrome. Materials and Methods: In this prospective study, the nerves at the dorsal foot were examined with ultrasound in 60 volunteers without clinical signs of neuropathy. Cross-sectional area (CSA) changes along the nerve course were assessed, their anatomical location recorded, and demographic data collected. Results: Focal deep peroneal nerve (DPN) thickening was observed in 45% of participants, with a median CSA of 2.14 mm² (range: 0.84–5.16) and median length of 3.98 mm (range: 1.46–9.95). The most frequent site was the first tarsometatarsal joint (41%). Thickening occurred across all age groups. Superficial peroneal nerve (SPN) thickening was found in 13.3% of participants, primarily affecting the intermediate branch, with a median CSA of 1.82 mm² and length of 3.02 mm. No thickening was observed in the sural nerve (SN). A strong correlation was found between CSA and length of DPN thickening (r = 0.67, p < 0.001). Conclusions: Asymptomatic, focal thickening of dorsal foot nerves, particularly the DPN, is a frequent sonographic finding in healthy volunteers. These findings highlight the potential for false-positive ultrasound results and the necessity of correlating imaging findings with clinical examination when evaluating for anterior tarsal tunnel syndrome and similar neuropathies.

BACKGROUND AND OBJECTIVES: Stereoelectroencephalography (SEEG) is central to invasive presurgical evaluation in drug-resistant epilepsy (DRE). We evaluated the accuracy, safety, and workflow efficiency of frameless neuronavigation-guided SEEG in routine clinical practice. METHODS: This retrospective single-center cohort included consecutive adult and pediatric patients with DRE who underwent SEEG between July 2016 and August 2025. Entry-point and target-point deviations were measured on postoperative computed tomography fused to the preoperative planning data set. Safety end points were perioperative complications. Operative duration and time per electrode were recorded. Comparative analyses between AdTech and Dixi systems were restricted to the primary-surgery cohort to maintain independent samples. A subgroup analysis examined procedures performed by experienced surgeons, defined as more than 250 implanted electrodes. RESULTS: Seventy-seven patients underwent 82 SEEG procedures. Across all procedures, 984 electrodes were implanted. The median number of electrodes per surgery was 13. The median entry-point and target-point deviations were 2.1 and 1.8 mm, respectively. Entry-point deviation did not differ between AdTech and Dixi electrodes in the primary-surgery cohort (2.1 vs 2.1 mm; P = .579), whereas target-point deviation was slightly lower with Dixi (1.6 vs 1.9 mm; P = .030). The duration of Dixi procedures was shorter than AdTech procedures (102 vs 186 minutes P < .001) and had lower time per electrode (10 vs 14 minutes; P < .001). Four minor hemorrhagic complications occurred (4.9%/procedure; 0.4%/electrode); no permanent neurological deficits, reoperations, hardware-related complications, or procedure-related deaths occurred. A seizure-onset zone was localized in 48 patients (62%), enabling subsequent resective or disconnective surgery. CONCLUSION: Frameless neuronavigation-guided SEEG achieved reproducible millimetric accuracy, low morbidity, and efficient workflow in a consecutive real-world cohort. These findings support frameless neuronavigation as a safe and scalable option for invasive presurgical evaluation in DRE.