Background and Purpose: Ancillary testing is essential for diagnosing brain death/death by neurologic criteria (BD/DNC) when clinical determination (neurologic exam and apnea testing) cannot be fully or safely performed. Transcranial Doppler ultrasound (TCD) has been recommended as an ancillary test; however, the technical descriptions have been heterogeneous. We aimed to consolidate the technical considerations related to the use of TCD as an ancillary test in the evaluation of BD/DNC. Methods: We performed a scoping review of the available literature from inception to December 2024. Articles describing TCD as an ancillary test for BD/DNC were included using appropriate Medical Subject Headings terms. The focus was on technical details and clinimetric properties of TCD (e.g., signal quality, frequency, gate, probe location, etc.). Technical categories were curated as full‐text reviews were completed. Results: We reviewed 181 articles to extract technical descriptions of TCD under several categories. Image acquisition was divided into machine‐related factors (59 studies, four questions), exam‐related aspects (82 studies, 13 questions), and patient anatomical factors (19 studies, three questions). Image interpretation concerns were addressed in 50 studies (three questions). Patient‐related clinical factors affecting TCD utility were addressed in 44 studies (seven questions). Legislative priorities were discussed in 19 studies; in 13 studies, authors commented on their recommendations for research priorities. Conclusion: We found significant inconsistencies and a lack of technical details described in the literature. Next steps include a national survey of current TCD protocols for BD/DNC evaluation, and an expert consensus guidelines report on the technical use of TCD as an ancillary test.

Atrial fibrillation (AF) is a major contributor to cardioembolic stroke. Anticoagulation, guided by CHA2DS2-VASc and HAS-BLED scores, is critical for secondary prevention, yet challenges persist in timing, patient-specific tailoring, and balancing efficacy with bleeding risk. This umbrella review synthesizes evidence on anticoagulation strategies for secondary prevention of cardioembolic stroke in AF patients. We searched PubMed, Scopus, Cochrane Library, Web of Science, and Embase for systematic reviews and meta-analyses (inception to May 2025) assessing oral anticoagulants (OACs) [vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs)] in AF patients with prior stroke or transient ischemic attack (TIA). Outcomes included recurrent stroke, systemic embolism, major bleeding, intracranial hemorrhage (ICH), and mortality. Quality was assessed using AMSTAR-2. Data were narratively synthesized, with quantitative metrics extracted where feasible. Eight reviews (2007–2025) were included, comprising 4–52 studies and 6893–94 656 participants. DOACs demonstrated superior efficacy over VKAs [apixaban odds ratio (OR) 0.79, 95% confidence interval (CI) 0.66–0.94], and VKAs outperformed antiplatelets (relative risk reduction 64%, absolute risk reduction 8.4%/year). DOACs showed lower major bleeding and ICH rates than VKAs, with apixaban exhibiting the most favorable safety profile (OR 0.71, 95% CI 0.61–0.81). Early versus delayed OAC initiation post-stroke improved efficacy (OR 0.68, 95% CI 0.55–0.84) with comparable safety. Identified knowledge gaps include optimal timing of OACs, outcomes in high-risk subgroups (elderly, renal impairment, and post-ICH), and cost-effectiveness. DOACs are superior to VKAs for secondary prevention of cardioembolic stroke in AF. However, individualized approaches are needed for timing and high-risk subgroups.

BACKGROUND: Intravenous sinus meningiomas are rare tumors that may mimic idiopathic intracranial hypertension when they obstruct venous outflow. Biopsy of such lesions is challenging due to their deep location and the risks associated with open surgical approaches. OBSERVATIONS: A 40-year-old woman presented with worsening headaches, papilledema, and elevated intracranial pressure. Imaging revealed a homogeneously enhancing lesion within the right transverse-sigmoid sinus junction, causing venous occlusion. Despite medical therapy, symptoms persisted. An endovascular biopsy was performed using a NeVa NET stent retriever with aspiration. Three passes were made across the lesion, successfully yielding tissue for histopathological analysis. A diagnosis of benign meningioma was confirmed. The patient subsequently underwent ventriculoperitoneal shunt placement with significant clinical improvement. LESSONS: Endovascular biopsy using a stent retriever offers a safe, minimally invasive alternative to open surgical biopsy for intrasinus lesions. This technique is especially valuable in anatomically complex or high-risk locations where traditional approaches carry substantial morbidity. The use of newer-generation stent retrievers with integrated mesh structures may enhance tissue acquisition and diagnostic yield, guiding appropriate management in cases of isolated venous sinus lesions. https://thejns.org/doi/10.3171/CASE25456

The growth of brain health initiatives in the United States and worldwide has led to a movement to protect the brain from avoidable injury across the lifespan. With the advancement of our armamentarium of neurologic treatments and preventives during the past several decades, the field of preventive neurology has spawned. Under the umbrella of preventive neurology is perioperative brain health, an under-addressed but important topic in the field of neurology. Perioperative brain health is important because perioperative mortality may be relatively high, and morbidity as quantified by brain injury biomarkers (e.g., MRI brain) and clinical phenotypic manifestations related to stroke can be common. In this perspective, in relation to periprocedural stroke, we review the stroke mechanisms, epidemiology and risk factors, risk stratification measures and long-term outcomes, and potential mitigation and treatment opportunities. As perioperative brain health crosses many medical disciplines, multidisciplinary action is needed to bridge the knowledge gaps and reduce brain injury and attendant neurologic complications. Anesthesiologists and other healthcare professionals working in the surgical and procedural field are well-positioned to make important contributions to this growing discipline of the prevention of brain injury in the perioperative period.

Diabetic neuropathy is a major cause of morbidity among diabetics, usually affecting patients with long-standing diabetes and advancing age. We present a case of atypical first clinical presentation of type 1 diabetes mellitus (T1DM) in a pediatric patient. A 15-year-old male patient presented to the emergency department with complaints of right foot weakness associated with mild paresthesia of 1-week duration. There were complaints of polyuria, polydipsia and weight loss in the same timeframe. On subsequent examination, the patient exhibited signs of right-sided foot drop with weak ankle dorsiflexion and eversion, accompanied by impaired sensation over the dorsum of the right foot. Lab results confirmed a diagnosis of T1DM and the patient was started on subcutaneous insulin injections. The patient's foot drop recovered within one month of insulin initiation. This case highlights that T1DM may present atypically as acute onset neuropathy in pediatric patients, making it an important differential diagnosis.