Large Vessel Occlusion Prediction in the Emergency Department with National Institutes of Health Stroke Scale Components: A Machine Learning Approach.

Objective: To determine the feasibility of using a machine learning algorithm to screen for large vessel occlusions (LVO) in the Emergency Department (ED).

Materials And Methods: A retrospective cohort of consecutive ED stroke alerts at a large comprehensive stroke center was analyzed. The primary outcome was diagnosis of LVO at discharge.

Auditing RadExam: Employing Psychometrics to Improve Exam Quality.

Introduction: RadExam is a question item and exam database jointly developed by the Association of Program Directors in Radiology and the American College of Radiology to provide formative resident assessment, offering performance metrics benchmarked against institutional and national resident performance. Beyond resident performance, data is available on question and exam performance. Despite considerable investment in the education and training of its question writers and editors and meticulous attention to current psychometrically validated methods, it was anticipated a minority of exam questions would still perform poorly.

Creating the Black Box: A Primer on Convolutional Neural Network Use in Image Interpretation.

Convolutional neural networks have been shown to demonstrate high diagnostic performance in radiologic image interpretation tasks ranging from recognition of acute stroke on computed tomography to identification of tuberculosis on plain radiographs. To a radiologist not immersed in computer science jargon, it may seem that this inscrutable black box is best treated warily, at arm's length. In this work, we illustrate how a radiologist without a deep background in computer science may be able to set up a state-of-the-art convolutional neural network for image interpretation tasks through transfer learning.

Lacunar Stroke in Cryptococcal Meningitis: Clinical and Radiographic Features.

Objective: Cryptococcal meningitis carries a high mortality, and survivors are left with considerable neurologic sequelae and marked disability. We lack a clear understanding of the pathogenesis of neurologic sequelae and description of stroke features in this population. We aim to describe clinical and radiographic features and predictors of stroke in a cohort of patients with cryptococcal meningitis.

A Clinical Paradigm for Classifying Neurologic Symptoms to Screen for Emergent Large Vessel Occlusions.

Background: With newly-extended treatment windows for endovascular therapy in emergent large vessel occlusions, it is increasingly important to identify thrombectomy-eligible patients without overwhelming resources dedicated to acute stroke care. We devised a simple paradigm to classify patient's presenting neurologic symptoms to screen for large vessel occlusions.

Methods: We reviewed the presenting symptoms, imaging findings, and final diagnoses of consecutive emergency department stroke alert cases.

Cultivating Meaningful Work in Healthcare: A Paradigm and Practice.

The socioeconomic dynamics of the current healthcare system can challenge physicians to remain engaged with meaningful work, which is problematic given its role in mitigating burnout. In Man's Search For Meaning, Victor Frankl proposes that meaningful work is a prerequisite for a meaningful life. This article provides a road map for radiologists by applying key guiding principles outlined by Frankl as they intersect with current evidence in the field of physician burnout.

Beyond the embolus: "do not miss" diffusion abnormalities of ischaemic and non-ischaemic neurological disease.

Unlabelled: Given the rapid evolution and technological advances in the diagnosis and treatment of acute ischaemic stroke (AIS), including the proliferation of comprehensive stroke centres and increasing emphasis on interventional stroke therapies, the need for prompt recognition of stroke due to acute large vessel occlusion has received significant attention in the recent literature. Diffusion-weighted imaging (DWI) is the gold standard for the diagnosis of acute ischaemic stroke, as images appear positive within minutes of ischaemic injury, and a high signal-to-noise ratio enables even punctate infarcts to be readily detected. DWI lesions resulting from a single arterial embolic occlusion or steno-occlusive lesion classically lateralise and conform to a specific arterial territory.

The Addition of Endovascular Intervention for Dural Venous Sinus Thrombosis: Single-Center Experience and Review of Literature.

Background: Dural venous sinus thrombosis (DVST) is a cause of infarction and intracranial hemorrhage (ICH) that can lead to significant morbidity. Endovascular therapy has emerged as an adjunctive therapy in select cases but has been associated with increased hemorrhagic complications. We present our experience with a large single-center cohort of DVST cases treated with current-generation thrombectomy devices.

Launchpad for Onboarding New Faculty Into Academic Life.

We developed a faculty professional development seminar series in order to facilitate the integration of our numerous new faculty into academics. The changing nature of the healthcare system, increasing clinical and administrative responsibility, and lack of access to senior mentors can hinder junior faculty productivity and possibly increase attrition. Given that no ready-made resources existed to address these issues we established a Professional Development Committee, developed a curriculum that covers relevant topics including promotion, mentorship, conflict management and feedback, and effective presentation of scientific data, and instituted changes iteratively based upon feedback.

Imaging of Laser Therapy in Epilepsy.

Background And Purpose: MR-guided laser interstitial thermal therapy (MRgLITT) is an increasingly popular neuroablative method for the surgical treatment of epilepsy patients. This article intends to demonstrate the utility and pitfalls of imaging in the context of patient care with MRgLITT.

Material And Methods: A retrospective review of the medical records and imaging database with six illustrative cases selected to demonstrate the use of imaging throughout patient management with MRgLITT in diverse clinical situations and pathologies.

Cement technique correlates with tuberosity healing in hemiarthroplasty for proximal humeral fracture.

Background: Tuberosity healing correlates with clinical outcomes after hemiarthroplasty for 4-part proximal humeral fractures (4PHFs). We seek to examine variables that affect tuberosity healing.

Methods: This was a retrospective comparative study.

Arterial spin labeling: Pathologically proven superiority over conventional MRI for detection of high-grade glioma progression after treatment.

Background: Standard of care for high-grade gliomas (HGGs) includes surgical debulking and adjuvant chemotherapy and radiation. Patients under treatment require frequent clinical and imaging monitoring for therapy modulation. Differentiating tumor progression from treatment-related changes can be challenging on conventional MRI, resulting in delayed recognition of tumor progression.

Postoperative Risk of Hepatic Decompensation after Orthopedic Surgery in Patients with Cirrhosis.

Background And Aims: Previous studies have shown increased hepatic decompensation in patients with cirrhosis undergoing surgery. However, there are little data available in cirrhotics undergoing orthopedic surgery compared to cirrhotics who did not undergo surgery. The aim of this study was to examine the demographics, comorbid conditions, and clinical factors associated with hepatic decompensation within 90 days in cirrhotics who underwent orthopedic surgery.

Diagnostic, treatment, and surgical imaging in epilepsy.

Dedicated epilepsy centers are growing in hospitals throughout the USA and abroad, with a continuously increasing role of imaging in multidisciplinary meetings. Imaging is paramount in diagnosis, treatment, and surgical decision-making in lesional and nonlesional epileptic disease. Besides being up-to-date with technical developments in imaging that may make an impact in patient care, familiarity with clinical and surgical aspects of epilepsy is fundamental to better understanding of patient management.

Neuroimaging of Concussion.

In this review, we discuss the literature regarding both concussion and mild traumatic brain injury. We focus on the role for neuroimaging in the concussed patient and describe the recommended practices related to imaging in concussion. This discussion first focuses on the exclusion of severe injuries and is followed by a discussion of the potential utility of various advanced imaging techniques in research and clinical practice.

Neuroimaging of Natalizumab Complications in Multiple Sclerosis: PML and Other Associated Entities.

Natalizumab (Tysabri) is a monoclonal antibody (α4 integrin antagonist) approved for treatment of multiple sclerosis, both for patients who fail therapy with other disease modifying agents and for patients with aggressive disease. Natalizumab is highly effective, resulting in significant decreases in rates of both relapse and disability accumulation, as well as marked decrease in MRI evidence of disease activity. As such, utilization of natalizumab is increasing, and the presentation of its associated complications is increasing accordingly.

Morphologic changes in the mesolimbic pathway in Parkinson's disease motor subtypes.

Background: Parkinson's disease (PD) is a common neurodegenerative disorder associated with gray matter atrophy. Cortical atrophy patterns may further help distinguish between PD motor subtypes. Comparable differences in subcortical volumes have not been found.

The Dotter method revisited: early experience with a novel method of rapid internal carotid artery revascularization in the setting of acute ischemic stroke.

Background: Tandem occlusive disease in the setting of acute ischemic stroke involving cervical and cerebral arteries has been associated with poor neurological outcome and poses significant challenges to neurointerventionists. Previously described endovascular methods typically involve carotid revascularization with stent placement prior to or following intracranial thrombectomy. Stent-based approaches, however, require the use of antiplatelet therapy which may increase the risk of hemorrhagic transformation.

Beneficial remodeling of small saccular intracranial aneurysms after staged stent only treatment: a case series.

Background: We evaluated the effect of stent alone treatment for small intracranial aneurysms that were not amenable to coil embolization without prior stent reconstruction.

Methods: This case series was conducted in the neurosurgical service at a tertiary care hospital in Denver, Colorado. Nine patients were electively treated for intracranial aneurysms.

Utilization of CT perfusion patient selection for mechanical thrombectomy irrespective of time: a comparison of functional outcomes and complications.

Background: Patient selection for acute ischemic stroke has been largely driven by time-based criteria, although emerging data suggest that image-based criteria may be useful. The purpose of this study was to directly compare outcomes of patients treated within a traditional time window with those treated beyond this benchmark when CT perfusion (CTP) imaging was used as the primary selection tool.

Methods: A prospectively collected database of all patients with acute ischemic stroke who received intra-arterial therapy at the Medical University of South Carolina was retrospectively analyzed, regardless of time from symptom onset.

Report of two cases of a rare cause of subarachnoid hemorrhage including unusual presentation and an emerging and effective treatment option.

Purpose: To report two cases of a rare cause of subarachnoid hemorrhage (SAH), including unusual presentation and an emerging and effective treatment option.

Case Reports: Ruptured basilar perforator artery aneurysm is a rare cause of SAH. Catheter angiography in the immediate post hemorrhage period may be unrevealing.