Background The human brain, depending on aerobic glycolysis to cover its metabolic needs and having no energy reserves whatsoever, relies on a constant and closely regulated blood supply to maintain its structural and functional integrity. Cerebral autoregulation, that is, the brain's intrinsic ability to regulate its own blood flow independently from the systemic blood pressure and cardiac output, is an important physiological mechanism that offers protection from hypoperfusion injury. Discussion Two major independent mechanisms are known to be involved in cerebral autoregulation: (1) flow–metabolism coupling and (2) myogenic responses of cerebral blood vessels to changes in transmural/arterial pressure. A third, less prominent component of cerebral autoregulation comes in the form of neurogenic influences on cerebral vasculature. Conclusion Although fragmentation of cerebral autoregulation in separate and distinct from each other mechanisms is somewhat arbitrary, such a scheme is useful for reasons of simplification and to better understand their overall effect. Comprehension of cerebral autoregulation is imperative for clinicians in order for them to mitigate consequences of its impairment in the context of traumatic brain injury, subarachnoid hemorrhage, stroke, or other pathological conditions.

Blister aneurysms are rare carotid lesions characterized by a thornlike appearance in combination with prominent fragility. Comprising less than 2% of all intracranial aneurysms, they are considered to be either dissecting or false aneurysms. Etiogenesis remains poorly understood, though atherosclerosis seems to be playing a prominent role. Although many approaches have been tried throughout the years, treatment of blister lesions remains debatable. Both surgical and endovascular modalities can be used, with every technique having though its own limitations and pitfalls. In this context, when confronted with such a lesion, physicians should consider all available alternatives in order to maximize the chances of a good outcome.

Background: External ventricular drainage (EVD) is one of the most common neurosurgical procedures. Complications are rather rare and mostly include hemorrhage and infection. Hematomas may form during placement or even after the removal of an EVD. Regarding the latter, the literature is scarce, with only nine clinically significant cases reported. Case Description: We present the case of a young woman who suffered an extensive hemorrhage after removal of an EVD, in the setting of a posterior fossa stroke. We discuss the management and possible consequences of such an event and we emphasize the need for alertness to avoid such complications. Conclusion: Removal of an EVD is a safe procedure, with rare cases of hemorrhagic complications being reported. A case of a large hematoma that formed after the removal of an EVD is presented. Stricter follow-up protocols should be implemented to better estimate the risk of hemorrhage.

Intrathecal baclofen infusing pumps are nowadays commonly implanted in patients suffering from severe, intractable spasticity with a background of multiple sclerosis.

Background: The insula and thalamus are components of the central autonomic network, which supports cardiovascular autonomic regulation and the integration of cognitive and affective processes. Both regions are therefore relevant to understanding the neuropsychological sequelae and cardiovascular autonomic dysfunction following stroke. Objective: This narrative review aimed to synthesize current evidence on the neuropsychological and cardiovascular autonomic consequences of insular and thalamic stroke using a narrative approach and to identify gaps in the integration of these domains. Methods: A structured literature search was conducted in PubMed, Scopus, and Web of Science from database inception through 3 October 2026. Eligible studies investigated domain-specific neuropsychological outcomes and/or physiological measures of cardiovascular autonomic function following thalamic or insular stroke. Data on study design, participant characteristics, assessment timing, outcome measures, main findings, and methodological limitations were synthesized according to lesion location and outcome domain. Results: Fourteen studies representing 13 independent cohorts met the eligibility criteria: 11 studies of thalamic stroke representing 10 independent cohorts and three studies of insular involvement representing three independent cohorts. Thalamic-stroke studies reported heterogeneous impairment across multiple neuropsychological domains, particularly attention, executive function, memory, and language. The three insular-stroke studies reported alterations in physiological measures relevant to cardiovascular autonomic function, including heart rate variability and circulating catecholamines, with heart rate and blood pressure additionally assessed in one study. Cardiac arrhythmias and mortality were additionally reported as secondary outcomes in individual studies. None of the included thalamic-stroke studies assessed cardiovascular autonomic function, whereas none of the included insular-stroke studies assessed domain-specific neuropsychological outcomes. No included study integrated neuropsychological and cardiovascular autonomic assessment within the same patient cohort. Interpretation is limited by the small and methodologically heterogeneous evidence base, particularly for insular stroke, as well as variability in lesion characterization, assessment timing, outcome measures, and longitudinal follow-up. Conclusions: The studies included in this review represent two distinct lines of research addressing neuropsychological outcomes following thalamic stroke and cardiovascular autonomic alterations following insular stroke. Among the included studies, none assessed both neuropsychological and cardiovascular autonomic outcomes within the same patient cohort. Larger prospective, longitudinal, and multimodal studies are needed to determine whether and how these outcomes are associated with lesion characteristics and how they evolve during post-stroke recovery.