Background: Intracranial atherosclerotic stenosis (ICAS) is a significant cause of ischemic stroke worldwide, with high recurrence rates despite optimal medical therapy. While endovascular stenting has been proposed as an adjunctive treatment, its clinical benefit remains controversial as a first line therapy. Objective: To evaluate the efficacy and safety of stenting plus medical therapy (STN+MT) compared to medical therapy alone (MT) in patients with symptomatic ICAS through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: We systematically searched PubMed, Web of Science, the Cochrane Library, Embase, Scopus, and EBSCO for RCTs comparing STN+MT with MT in adult patients with symptomatic ICAS. Primary outcomes included transient ischemic attack (TIA), stroke, intracerebral hemorrhage (ICH), and death at 30 days and 1 year. Pooled risk ratios with 95% confidence intervals were calculated using random-effects or fixed-effects models as appropriate. Meta-regression was conducted to assess effect modification by study-level characteristics. Results: Four trials comprising 990 patients were included. STN+MT was associated with significantly higher 30-day risk of stroke and ICH compared to MT alone. No significant differences in TIA, stroke, ICH, or death were found at 1 year. Meta-regression revealed no significant effect modifiers, suggesting consistent findings across subgroups. Conclusions: Our meta-analysis consolidates the evidence that intracranial stenting as a first line therapy offers no significant advantage over medical therapy in preventing stroke in symptomatic ICAS, while it does pose added early risks. This holds true across different trials, patient demographics, and clinical scenarios examined. The consistency of this message across multiple RCTs provides a high level of evidence to guide practice. At present, aggressive medical therapy alone should be the default management for most patients. Endovascular intervention should be reserved for clinical trial settings or carefully selected salvage cases, until and unless new evidence emerges to change the risk–benefit calculus such as the promising use of balloon angioplasty in the BASIS trial.

Candidozyma auris (formerly known as Candida auris) is an emerging multidrug-resistant fungal pathogen that has become increasingly implicated in healthcare-associated infections; however, its involvement in spondylodiscitis is exceedingly rare. We report the case of a 65-year-old Saudi male with multiple comorbidities who presented with altered mental status and was subsequently diagnosed with Candidozyma auris spondylodiscitis and bilateral psoas abscesses. Despite broad-spectrum antifungal therapy and multidisciplinary management, the patient’s condition rapidly deteriorated. This case highlights the significant challenges in diagnosing and managing multidrug-resistant C. auris infections and underscores the need for early suspicion, effective source control, and novel antifungal strategies in high-risk populations.

Multiple sclerosis (MS) causes physical as well as psychosocial disability in young adults. Various sleep‐related disorders have been reported in patients with multiple sclerosis (pwMS). We determined the frequency and patterns of various sleep‐related disorders in pwMS and correlated those with the sleep quality. This was an IRB‐approved study done at King Abdulaziz Medical City, MNGHA, Riyadh, KSA. Informed consent was obtained. Validated questionnaires including Pittsburgh Sleep Quality Index (PSQI), Sleep Disorders Questionnaire (SDQ), and STOP‐BANG Questionnaire were used. Data were analyzed using SPSS. A total of 169 pwMS were included; 116 (69%) were females. Mean age was 35 ± 10 years; mean BMI was 27.6 ± 16.8 kg/m². Almost half (47%) of the patients were employed, and most worked in day shift (85%). Caffeinated beverages were used by 87%; 16% were smokers. Relapsing remitting MS was the commonest type in 93%; 82% were using disease‐modifying therapy (DMT). Sleep‐related medications were used by 18%. Disability measured by EDSS was mild in 64%, moderate in 18%, and severe in 18%. Poor quality of sleep was reported by 74% (mean PSQI 7.8 ± 3.9). Circadian rhythm disorders were reported in 22%, psychiatric disorders in 18%, and parasomnias in 14%; 4% had high risk for sleep apnea. Psychiatric disorders (p = 0.05) and movement disorders (p = 0.05) were more frequently reported in women. Risk for insomnia (p = 0.03), circadian rhythm disorders (p = 0.013), and psychiatric disorders (p = 0.002) were associated with poor sleep quality. Type of MS and current treatment did not affect the frequency of sleep disorders or sleep quality. In our cohort of pwMS, sleep‐related disorders were common. Risk for insomnia, psychiatric disorders, and circadian rhythm disorders were associated with poor sleep quality. Certain disorders showed a trend toward female preponderance. Disease severity and use of DMTs did not affect sleep quality in our cohort.

Cerebral small vessel disease (CSVD) is a major contributor to stroke, cognitive impairment, and gait disturbance. Data describing its burden and determinants in Middle Eastern populations remain limited. This study aimed to estimate the prevalence, clinical predictors, and neuroimaging characteristics of CSVD among adults undergoing brain MRI in Saudi Arabia and to examine associations with vascular risk factors and antihypertensive therapy. We conducted a retrospective cross-sectional study of adults aged 40–70 years who underwent brain MRI at King Abdulaziz Medical City, Riyadh, between January 2018 and January 2019. CSVD markers were identified according to the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) criteria, and white matter hyperintensities were graded using the Fazekas scale. Multivariable logistic regression models were constructed to identify factors independently associated with CSVD. Among 644 participants undergoing brain MRI, CSVD was identified in 36.5% of patients. Prevalence increased markedly with age, rising from 18.2% in individuals aged 40–50 years to 54.1% in those aged 60–70 years (p < 0.001). In the multivariable etiological model, hypertension emerged as the strongest independent vascular predictor of CSVD. White matter hyperintensities were the most frequent imaging manifestation and increased in severity with advancing age. Among hypertensive patients, certain antihypertensive classes, particularly calcium channel blockers and ACE inhibitor/ARB monotherapy, were associated with lower odds of CSVD compared with untreated hypertension. In this MRI-based clinical cohort from Saudi Arabia, CSVD was present in more than one-third of adults aged 40–70 years undergoing neuroimaging. Disease prevalence increased substantially with advancing age and vascular comorbidities. These findings highlight the importance of vascular risk factor control and provide important regional data on the clinical and imaging profile of CSVD in Middle Eastern populations.