Neurologist最新文献

{"title":"Off-label Use of Intravenous Thrombolysis in an Acute Ischemic Stroke Patient With Multiple Contraindications.","authors":"Odysseas Kargiotis, Eirini Tsiamaki, Anastasia Angelopoulou, Ioanna Zafeiropoulou, Matina Gkliati, Petros Zampakis, Elisabeth Chroni, Georgios Tsivgoulis, John Ellul","doi":"10.1097/NRL.0000000000000668","DOIUrl":"10.1097/NRL.0000000000000668","url":null,"abstract":"<p><strong>Introduction: </strong>Intravenous thrombolysis (IVT) is a powerful treatment for acute ischemic stroke, yet its use remains limited due to numerous absolute and relative contraindications.</p><p><strong>Case report: </strong>We present the case of a 54-year-old man who received intravenous thrombolysis (IVT) for an early recurrent wake-up ischemic stroke caused by a tandem left internal carotid artery and M2 middle cerebral artery occlusion, occurring <48 hours after the initial ischemic event, which had been misdiagnosed as a peripheral-type facial nerve palsy. Moreover, in the context of the initial work-up, the patient had undergone a diagnostic lumbar puncture <24 hours before IVT. Despite the history of a very recent acute ischemic stroke, which is listed as a contraindication for IVT, as well as the recent lumbar puncture, the patient demonstrated marked clinical improvement without any complications.</p><p><strong>Conclusion: </strong>IVT may be considered even in the presence of multiple relative contraindications, provided the risks and benefits are carefully weighed for each patient.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"120-123"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Utility of POCUS Hands-On Training Course in Neurocritical Care: Trainee's Perspective.","authors":"Chi-Hung Liu, Ming-Ju Hsieh, Sung-Chun Tang, Jian-Xun Lu, Elaine S Huang, Jiann-Shing Jeng, Lung Chan","doi":"10.1097/NRL.0000000000000664","DOIUrl":"10.1097/NRL.0000000000000664","url":null,"abstract":"<p><strong>Objectives: </strong>Few studies have evaluated the applicability of a point-of-care ultrasound (POCUS) training program in neurocritical care. In this study, we aimed to investigate the clinical utility of expert-endorsed topics of the integrated POCUS program from a trainee's perspective.</p><p><strong>Methods: </strong>Between 2022 and 2024, we held an annual \"1-day POCUS hands-on training program.\" The program was comprised of a \"3-hour lecture\" followed by a \"5-hour hands-on workshop\" on the following topics: carotid duplex examination, transcranial color-coded Doppler techniques, ultrasound examination for posterior circulation, chest ultrasonography, and echocardiography. Sixty trainees were recruited each year and were separated into 10 groups during hands-on workshop rotation. The trainees were asked to complete an anonymous survey after the workshop to evaluate their opinions, which was rated using a 5-point Likert scale and open questions. In addition, the trainees were required to complete multiple-choice tests both before and after the lecture.</p><p><strong>Results: </strong>A total of 179 trainees (85 attending physicians and 94 resident doctors) were recruited. The median clinical utility rating scores were 5 for all topics, and the mean score was highest for the carotid duplex lecture (4.91±0.29) and lowest for the echo-guided lumbar puncture lecture (4.38±0.97). In addition, the mean posttest score was significantly higher than the pretest score (9.65±1.86 vs. 7.69±1.70, P <0.001).</p><p><strong>Conclusions: </strong>Our study suggested the POCUS topics suitable for neurocritical care should integrate medical care and cerebral vascular evaluations, including anterior and posterior circulation. Our results may help to guide training courses and assessment tool design in the future.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"82-87"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Malignant Brain Edema Based on Contrast Agent Exudation After Mechanical Thrombectomy for Anterior Circulation Occlusion.","authors":"Youcai Bi, Shengwu Wang, Yingying Mu Rong, Maolan Wei, Na Jiang, Yi Ding, Huan Liao, Xing Liu, Xin Zeng, Yun B Chen","doi":"10.1097/NRL.0000000000000659","DOIUrl":"10.1097/NRL.0000000000000659","url":null,"abstract":"<p><strong>Objective: </strong>Malignant brain edema (MBE) after mechanical thrombectomy (MT) for anterior circulation occlusion leads to poor outcomes. Although contrast agent extravasation (CAE) indicates blood-brain barrier disruption, its predictive value for MBE remains uncertain. This study evaluated whether the CAE-Alberta Stroke Program Early CT Score (CAE-ASPECTS) derived from dual-source computed tomography (CT) could predict MBE after anterior circulation recanalization with MT.</p><p><strong>Methods: </strong>Patients with anterior circulation occlusion undergoing mechanical thrombectomy (MT) were divided into malignant brain edema (MBE) and non-MBE groups. The primary outcome was to determine whether postoperative CAE-ASPECTS scores predicted MBE. The secondary outcomes were to identify factors influencing malignant brain edema and to examine the association between CAE-ASPECTS and 90-day modified Rankin Scale (mRS) and 72-hour intracerebral hemorrhage.</p><p><strong>Results: </strong>The MBE group had a significantly lower median postoperative CAE-ASPECT score. After adjusting for confounding factors, CAE-ASPECTS remained independently associated with MBE. Lower CAE-ASPECTS, higher National Institutes of Health Stroke Scale (NIHSS) score, and longer operative time were associated with increased MBE risk. The regression model yielded a predictive accuracy of 93%. Favorable 90-day mRS (0 to 2) was more common in the non-MBE group, and mortality was lower. Finally, cerebral hemorrhagic transformation was inversely correlated with CAE-ASPECTS.</p><p><strong>Conclusion: </strong>Lower CAE-ASPECTS scores were significantly correlated with increased MBE incidence. Moreover, CAE-ASPECTS was an independent predictor of MBE, while cerebral hemorrhage transformation was negatively correlated with the CAE-ASPECTS after successful thrombectomy. Finally, CAE-ASPECTS, preoperative NIHSS, ASPECTS, and operative time collectively predict MBE with 93% sensitivity, providing a useful imaging biomarker for post-MT risk assessment.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"74-81"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The \"Paradoxical Dilation\" Sign as an Indicator for Overlooked Collateral Arterial Supply in Chronic Subdural Hematoma.","authors":"Mingxi Li, Yin Niu, Zhouyang Jiang, Wenyan Li, Zhi Chen","doi":"10.1097/NRL.0000000000000669","DOIUrl":"10.1097/NRL.0000000000000669","url":null,"abstract":"<p><strong>Introduction: </strong>Middle meningeal artery embolization (MMAE) is a safe and effective established treatment for chronic subdural hematoma (CSDH). However, treatment failures and recurrences remain a concern, with underlying causes still unclear. Collateral arterial supply, while sporadically reported, have not yet been attached full importance.</p><p><strong>Case report: </strong>A 60-year-old male presenting with left CSDH exhibited a marked morphologic asymmetry of middle meningeal artery (MMA) on 7T time-of-flight MR angiography (TOF-MRA), with notably right MMA dilation. Digital subtraction angiography (DSA) confirmed this paradoxically dilated right MMA as the primary arterial supply to the hematoma membrane. Subsequent bilateral MMA embolization resulted in immediate symptom resolution and near-complete hematoma regression at 1-month follow-up.</p><p><strong>Conclusion: </strong>\"Paradoxical dilation\" sign might indicate overlooked collateral arterial supply in CSDH, necessitating systematic vascular evaluation to achieve the \"hematoma membrane supply embolization\" over unilateral MMA embolization. Noninvasive imaging such as TOF-MRA could facilitate preoperative detection of this collateral arterial supply.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"117-119"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147617082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of Initiation of Pharmacologic Venous Thromboembolism Prophylaxis in Patients With Intracerebral Hemorrhage.","authors":"WeA'am Ayesh, Erin Houry, Georgeanne Hodges","doi":"10.1097/NRL.0000000000000662","DOIUrl":"10.1097/NRL.0000000000000662","url":null,"abstract":"<p><strong>Objective: </strong>Optimal timing of initiation of pharmacologic venous thromboembolism (VTE) prophylaxis following intracerebral hemorrhage is controversial. This study aims to assess the association between the timing of pharmacologic VTE prophylaxis initiation and the risk of VTE and hemorrhagic complications.</p><p><strong>Methods: </strong>This was a multicenter, retrospective cohort study completed at 7 community hospitals. This study included patients with nontraumatic intracerebral hemorrhage admitted from August 1, 2023, to July 31, 2024. A total of 111 patients were assessed and categorized based on the administration of early (≤48 h) versus delayed (>48 h) initiation of VTE prophylaxis.</p><p><strong>Results: </strong>Findings showed no statistically significant difference in the primary outcome of the incidence of VTE with early versus delayed initiation of VTE prophylaxis (5% vs. 8%, P =0.713). Secondary outcomes included incidence of deep vein thrombosis (5% vs. 8%, P =0.713), pulmonary embolism (0% vs. 0%), hematoma enlargement (16% vs. 15%, P =0.623), median intensive care unit (ICU) length of stay (3 vs. 3.5 d, P =0.670), hospital length of stay (7 vs. 8 d, P =0.724), inpatient all-cause mortality (8% vs. 7%, P =1.000), and discharge disposition.</p><p><strong>Conclusion: </strong>Early pharmacologic VTE prophylaxis (≤48 h from ICH onset) was not found to be statistically significant in lowering the incidence of VTE. This occurred with no statistically significant differences in hematoma enlargement, increased inpatient mortality, or increased length of ICU/hospital stay. Additional adequately powered studies are needed to determine if early pharmacologic VTE prophylaxis is associated with a lower incidence of VTE.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"65-69"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147617093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemic Stroke and Mitral Annular Caseous Calcification: A Neglected Embolic Risk in Cardio-Neurological Interface?","authors":"Ezgi Yilmaz, Selin A Duzgun, Ethem M Arsava, Burak S Çakir, Ziya B Soylu, Tuncay Hazirolan, Mehmet A Topcuoglu","doi":"10.1097/NRL.0000000000000667","DOIUrl":"10.1097/NRL.0000000000000667","url":null,"abstract":"<p><strong>Objectives: </strong>Case reports indicate that caseous mitral annulus calcification (MAC), also termed mitral annulus caseous granuloma, may contribute to stroke and systemic embolism. This retrospective case-control study aimed to assess the prevalence of caseous MAC detected through cardiac computed tomography (CT) in an acute stroke cohort and to identify factors associated with its occurrence.</p><p><strong>Methods: </strong>A total of 149 patients with acute ischemic stroke who underwent emergency cardiac CT, 300 acute ischemic stroke patients who did not undergo cardiac CT, and 268 individuals who underwent cardiac CT but had no history of stroke were included. The first group was consecutively selected (January 2022 to November 2024), while the other 2 groups were identified through propensity matching based on age and sex. Various regression models were applied to determine the degree of association.</p><p><strong>Results: </strong>Caseous MAC was detected in 5.4% of stroke patients who underwent cardiac CT, a prevalence significantly higher than in the control group (1.1%, P =0.02). Regression models demonstrated that caseous MAC significantly ( P =0.011) and independently increased stroke risk by a factor of 7.57 to 10.81 (95% CI: 1.54-36.20).</p><p><strong>Conclusions: </strong>These findings suggest that caseous mitral annulus calcific granuloma may be a potential cause of embolic stroke. Further prospective, multicenter studies are needed to validate these results.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"88-92"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Flow Dysregulation Encephalopathy Following Carotid Stenting Procedure: Multiparametric CT and EEG Characteristics.","authors":"Edoardo Ricci, Giovanni Furlanis, Milos Ajčević, Emanuele Vincis, Gabriele Prandin, Laura Mancinelli, Federica Palacino, Magda Quagliotto, Paola Caruso, Maja Ukmar, Marcello Naccarato, Paolo Manganotti","doi":"10.1097/NRL.0000000000000658","DOIUrl":"10.1097/NRL.0000000000000658","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral hypoperfusion syndrome (CHS) involves a range of neurological symptoms originally recognized as a complication of carotid endarterectomy but also observed after carotid artery stenting. CHS is a rare cause of stroke mimic, posing a challenging differential diagnosis, especially in the hyperacute phase.</p><p><strong>Case presentation: </strong>In this case report, we investigate the potential diagnostic and predictive roles in the acute phase through a novel approach using multiparametric CT [including non-enhanced CT (NECT), single-phase CT angiography (CTA), perfusion CT (CTP)] and electroencephalogram (EEG) in a 75-year-old male with acute hypoperfusion encephalopathy/cerebral flow dysregulation after carotid stenting. Follow-up imaging was performed with NECT, CTP, and EEG at 24 and 72 hours.</p><p><strong>Conclusions: </strong>This clinical case supports the hypothesis that multiparametric CT, combined with EEG and clinical evaluation, may be useful in the differential diagnosis between CHS, ischemic events, status epilepticus, and stroke mimics in the emergency setting. Moreover, the repeated use of these tests offers a valuable and innovative approach to monitoring the clinical progression of this condition.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"105-107"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optical Coherence Tomography Abnormalities in NOTCH3 Mutation Carriers: A Matched Case-Control Study From UK Biobank.","authors":"Sai Krishna Vallamchetla, Amro Badr, Xin Li, Yalin Wang, James F Meschia, Oana M Dumitrascu, Michelle P Lin","doi":"10.1097/NRL.0000000000000655","DOIUrl":"10.1097/NRL.0000000000000655","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to identify retinal biomarkers of NOTCH3 mutation carriers using optical coherence tomography (OCT) data from the UK Biobank.</p><p><strong>Methods: </strong>We conducted a cross-sectional, matched case-control study of individuals with or without NOTCH3 mutation from the UK Biobank between 2006 and 2010. All participants had macular OCT scan and cognitive assessment. Cases were identified based on pathogenic/likely pathogenic NOTCH3 mutations and 1:1 matched with controls based on age, sex, hypertension, diabetes mellitus, and cigarette smoking status. Baseline characteristics and cognitive test scores were compared using χ 2 or Mann-Whitney U test appropriately. Macular thickness at central, inner, and outer subfields and at each retinal layer was compared using Wilcoxon signed-rank test.</p><p><strong>Results: </strong>Our analysis included 134 participants (67 cases, 67 controls) with a mean age of 54 ± 9 years. NOCTH3 mutation carriers performed worse in prospective memory ( P =0.043), verbal and numerical reasoning ( P =0.178), visual memory ( P =0.227), and processing speed ( P =0.101) than matched controls. There were no differences in visual acuity between the 2 groups. NOTCH3 mutation carriers had significantly thinner macular inner subfield at the superior ( P =0.006), temporal ( P =0.008), and nasal ( P =0.034) quadrants, and significantly thinner macular RNFL ( P =0.008) compared with age-, sex-, and vascular risk factor-matched controls.</p><p><strong>Conclusion: </strong>The presence of NOTCH3 mutation is associated with reduced thickness in the inner macular subfield and macular RFNL. These retinal changes may reflect early pericyte dysfunction and microvascular ischemia. Longitudinal studies are needed to assess the temporal relationship between these retinal changes, cerebrovascular disease progression, and clinical severity of disease.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"93-98"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Effectiveness of Routine Tenecteplase Use in a Large Telestroke Network.","authors":"Arpan Dutta, Arnab Sarkar, Subhadeep Gupta, Uddalak Chakraborty, Chayan Mondal, Soumozit Banerjee, Deep Das, Alapan Paul, Snehansu S Samanta, Sujoy Sarkar, Susanta Chakrabarty, Chinmoy Barik, Diptak Bhowmick, Sanat K Jatua, Snehasis Das, Samiran Misra, Biswajit Ray, Phalguni Das, Binod Das, Barun Das, Avijit Naskar, Dhiraj Roy, Bichitra Biswas, Amit K Das, Dipanjan Das, Aniruddha Sarkar, Rabiul Alam, Kaushik Pal, Kalyan K Das, Samir K Datta, Somnath Ghosh, Sishir K Naskar, Prasenjit Majumdar, Amit K Ghosh, Souvik Sen, Soumya Ghosh, Nitai C Mandal, Subhransu S Datta, Asit K Biswas, Swapan Saren, Manimoy Bandopadhyay, Biman K Ray","doi":"10.1097/NRL.0000000000000657","DOIUrl":"10.1097/NRL.0000000000000657","url":null,"abstract":"<p><strong>Objectives: </strong>Tenecteplase is an emerging alternative to Alteplase in the management of acute ischemic stroke (AIS). Strong evidence supports the noninferiority of Tenecteplase compared with Alteplase in AIS. Tenecteplase is often preferred due to its affordability, ease of administration, and superior recanalization potential in large vessel occlusion. In this study, we report on the safety and effectiveness of routine Tenecteplase use in a large telestroke network in eastern India.</p><p><strong>Methods: </strong>This retrospective observational study analyzes patient records collected under the Swasthya Ingit Telestroke Program in West Bengal, India. AIS patients who underwent thrombolysis in the 41 hospitals of the Swasthya Ingit Telestroke Network between January 2022 and December 2024 were included in this study. Patients receiving Tenecteplase were compared with those receiving Alteplase. The percentage of patients achieving a good outcome (defined as a score of 0 to 2 on the modified Rankin scale at 90 d), the rate of symptomatic intracranial hemorrhage, and all-cause mortality within 3 months were the main parameters of comparison between the 2 thrombolytic agents.</p><p><strong>Results: </strong>A total of 1526 patients were included in this study. Of these, 1389 patients received Tenecteplase, while 137 patients received Alteplase. Mixed-effects multivariable logistic regression did not demonstrate any association between the thrombolytic agent used and favorable outcomes [Tenecteplase odds ratio: 1.03 (95% CI: 0.56-1.87), P =0.93], symptomatic intracranial hemorrhage [Tenecteplase odds ratio: 0.63 (95% CI: 0.21-1.87), P =0.41], or all-cause mortality [Tenecteplase odds ratio: 0.54 (95% CI: 0.24-1.24), P =0.15].</p><p><strong>Conclusion: </strong>The routine use of Tenecteplase for managing acute ischemic stroke appears to be safe and effective in real-world practice.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"70-73"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Convexity Subarachnoid Hemorrhage Due to Large Artery Atherosclerotic Stenosis or Occlusion: A Report of 3 Cases.","authors":"Changhao Li, Shun Mu, Tao Tao","doi":"10.1097/NRL.0000000000000663","DOIUrl":"10.1097/NRL.0000000000000663","url":null,"abstract":"<p><strong>Introduction: </strong>Convexity subarachnoid hemorrhage (cSAH) is a rare subtype of nontraumatic subarachnoid hemorrhage. Large artery atherosclerotic stenosis or occlusion has emerged as a prevalent etiology in China. The diagnosis of cSAH is primarily based on imaging examinations. However, there are no established guidelines or consensus for its treatment.</p><p><strong>Case report: </strong>This report presented 3 cases of cSAH associated with atherosclerotic stenosis or occlusion. All 3 patients had significant large-artery stenosis or occlusion. In 2 cases (cases 1 and 3), computed tomography (CT) angiography revealed stenosis of the right middle cerebral artery and internal carotid artery, while the third case (case 2) exhibited bilateral internal carotid and middle cerebral artery stenosis. Two patients (cases 1 and 2) were treated with antiplatelet therapy under close monitoring of vital signs and serial CT scans, resulting in significant symptom improvement and no evidence of rebleeding on the follow-up CT scan. The other patient (case 3), who underwent balloon angioplasty of the right internal carotid artery, experienced symptom worsening, including brain herniation and poor prognosis.</p><p><strong>Conclusion: </strong>This report summarized the clinical presentations, imaging findings, etiology, treatments, and prognoses of 3 cSAH cases, which may provide a reference for the standardized diagnosis and management of such patients.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"108-116"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}