BACKGROUND: Neurenteric cysts are rare congenital lesions of the CNS, typically found in the cervical or thoracic spine and presenting in early life. Only 5% of spinal neurenteric cysts are intramedullary. The authors report the case of an intradural intramedullary neurenteric cyst in a 68-year-old woman. OBSERVATIONS: The patient presented with 4 months of progressive left extremity numbness, weakness, and imbalance consistent with cervical myelopathy. MRI revealed a 1-cm cystic lesion in the intradural intramedullary cervical spine. Multilevel posterior cervical laminectomy for cyst resection was performed with gross-total resection. Histopathological analysis revealed squamous, columnar, and pseudostratified epithelium positive for epithelial membrane antigen and cytokeratin and negative for glial fibrillary acidic protein and S100 protein, consistent with a neurenteric cyst. Her symptoms and examination significantly improved after surgery. LESSONS: Neurenteric cysts comprise 1% of spinal lesions, and 5% are intradural intramedullary. Symptoms progress gradually but may fluctuate with cyst size changes. MRI is the preferred imaging, with histopathological analysis required for diagnosis. Operative intervention for gross-total resection is the recommended management. This case emphasizes that neurenteric cysts should be considered in older adults with cervical myelopathy and a cystic intramedullary mass and demonstrates the benefit of complete surgical removal. https://thejns.org/doi/10.3171/CASE25253

Introduction: The Rhode Island Stroke Prevention and Treatment Act aimed to establish a standardized system of care for stroke patients through designated stroke centers, revise emergency medical services (EMS) protocols, and establish a centralized stroke database. While Stroke Systems of Care (SSOC) laws have proven effective in reducing overall stroke mortality, their benefits among racial minorities and economically disadvantaged groups remain unclear. This study investigates the impact of the Act on stroke mortality rates across different racial groups. Methods: Data from the Rhode Island Department of Labor and Training, CDC Atlas of Heart Disease and Stroke, and U.S. Census Bureau for 2005–2019 were analyzed. A difference-in-difference analysis compared mortality rates among White, Black, and Hispanic residents before and after the Act’s implementation. Trends were further validated using a mixed-effects model. Results: Following SSOC implementation, the White group had significant reductions in ischemic stroke mortality (-5.38 per 100,000, 95% CI [-6.63, -4.12]; P<0.001). Analysis did not identify a difference in ischemic stroke mortality in the Hispanic (-2.67, 95% CI [-1.49, 6.83]; P=0.174) or Black group (4.69, 95% CI [-25.40, 16.01]; P=0.638). After Act-driven field triage implementation, there was a decline in all-stroke mortality among Black (-15.9 per 100,000, 95% CI [-30.52, -1.19]; P=0.035) and Hispanic (-7.07 per 100,000, 95% CI [-11.81, -2.32]; P=0.005) groups. However, the Black group maintained higher all-stroke mortality compared to the White population (RR 1.34, 95% CI [1.27, 1.41]; P<0.001). Conclusion: While SSOC significantly reduced overall stroke mortality in Rhode Island, the benefits were not equitably distributed across racial groups. These findings underscore the need for future stroke legislation to incorporate culturally competent, evidence-based strategies addressing social determinants of health to reduce disparities and ensure equitable care.

Background/Objectives: To evaluate the safety, efficacy, and predictors of rhBMP-2 use in atlantoaxial (C1–2) fusion through institutional outcomes and a pooled analysis from the literature. Methods: We retrospectively analyzed adult patients who underwent C1–2 fusion at a tertiary care center between 2015 and 2020. Primary outcomes included radiographic fusion and postoperative complications. Univariate logistic regression was used to identify predictors of intraoperative rhBMP-2 use. A subset of eight patients who underwent isolated C1–2 fusion using rhBMP-2 were analyzed and evaluated against 260 cases from a PRISMA-compliant systematic review of the literature. Results: Among our 49 patients (mean age, 61.8 ± 22.8 years; 57% female), 24 (49%) received rhBMP-2. Radiographic fusion or early signs were observed in 89.8% of patients, with no significant difference between rhBMP-2 and non-rhBMP-2 groups (p = 0.678). Complications were similar (12.5% vs. 25.0%, p = 0.702). All postoperative instabilities occurred in non-rhBMP-2 patients (p = 0.043). Degenerative pathology was associated with increased use of rhBMP-2 (OR of 7.96, p = 0.051), while trauma was associated with decreased use (OR of 0.21, p = 0.019). Among the eight local isolated cases, seven achieved fusion and none required revision. Our literature review yielded a group of 260 patients, 241 of which achieved successful fusion with a complication rate of 10.8% and a revision surgery rate of 3.8%. Conclusions: rhBMP-2 appears to be a safe and effective adjunct in C1–2 fusion, with outcomes comparable to alternative techniques. Although off-label, its selective use may benefit patients at risk of nonunion. Interpretation should be tempered by the retrospective design and heterogeneity across cohorts; pooled rates are descriptive. Further prospective studies are needed to establish standardized protocols, optimal dosing, and long-term efficacy.

Introduction: The Rhode Island Stroke Prevention and Treatment Act aimed to establish a standardised system of care for stroke patients through designated stroke centres, revise emergency medical services (EMS) protocols, and establish a centralised stroke database. While Stroke Systems of Care (SSOC) laws have proven effective in reducing overall stroke mortality, their benefits among racial minorities and economically disadvantaged groups remain unclear. This study investigates the impact of the Act and its amendment on stroke mortality rates across different racial groups. Methods: Data from the Rhode Island Department of Labor and Training, Centers for Disease Control Atlas of Heart Disease and Stroke, and US Census Bureau for 2006–2019 were analysed. A linear regression model analysed mortality rates among White, Black and Hispanic residents before and after the Act’s implementation. Trends were further validated using a segmented regression and mixed-effects model. Results: Difference-in-differences analysis showed SSOC implementation reduced statewide all-stroke mortality by 8.56 deaths per 100 000 (95% CI −10.56 to −6.56; p<0.001). White and Hispanic groups declined, but the Black population diverged significantly from White (+20.80; 95% CI 4.83 to 36.77; p=0.011). Interrupted time series confirmed higher Black baseline mortality (β=9.70; 95% CI 2.00 to 17.40; p=0.014) and an abrupt post-implementation increase (β=29.14; 95% CI 16.64 to 41.63; p<0.001), followed by annual decline (β=−6.98; 95% CI −10.24 to −3.61; p<0.001). After amendment, Black mortality rose immediately (+19.80; 95% CI 2.15 to 37.44; p=0.028) and annually (+8.40; 95% CI 1.33 to 15.47; p=0.020). White and Hispanic groups showed no significant amendment-period changes. Conclusion: While SSOC significantly reduced overall stroke mortality in Rhode Island, the benefits were not equitably distributed across racial groups. These findings underscore the need for future stroke legislation to incorporate culturally competent, evidence-based strategies addressing social determinants of health to reduce disparities and ensure equitable care.