Idiopathic intracranial hypertension (IIH) typically presents with bilateral papilledema; however, highly asymmetric and rare unilateral cases have been reported. We report three cases of IIH meeting modified Dandy criteria presenting with unilateral papilledema. Magnetic resonance imaging (MRI) demonstrated bilateral distention of the optic nerve sheaths and computed tomography (CT) of the orbits demonstrated a smaller diameter of the optic canal in the unaffected eye in two cases. Papilledema fully resolved in all with acetazolamide. Of postulated mechanisms, we suspect that differences in bony optic canal diameter, compliance of the lamina cribrosa, and optic nerve sheath anatomy may contribute to asymmetry.

Background: Trials of endovascular thrombectomy (EVT) for acute stroke have excluded patients with pre-morbid disability. We performed a meta-analysis to assess the effectiveness and safety of EVT in patients with pre-morbid disability. Methods: According to PRISMA guidelines, we searched for studies describing outcomes in patients with pre-morbid disability (modified Rankin Scale [mRS] 2-5), treated with EVT or medical management (MM). Random-effects meta-analysis was used to pool outcomes including return to baseline mRS at 90 days, symptomatic ICH (sICH), and 90-day mortality. Results: We analyzed 14 studies of patients with pre-morbid disability (mRS2-5: EVT=1,373, MM=253). Compared to medical therapy, EVT was associated with higher likelihood of return to baseline mRS (OR=2.37, 95%CI:1.39-4.04) and a trend towards lower mortality (OR=0.68, 95%CI:0.46-1.02), with similar odds of sICH (OR 1.01, 95%CI:0.49-2.08). In studies comparing patients with vs. without pre-morbid disability treated with EVT, similar results were found except that pre-morbid disability, when defined more strictly as mRS 3-5, was associated with mortality (OR 3.49, p<0.001). Conclusions: In patients with pre-morbid disability, EVT carries a higher chance of return to baseline mRS compared to patients treated with MM or without pre-morbid disability, although with higher mortality than patients without pre-morbid disability. These findings merit validation with randomized controlled trials.

We investigated the feasibility and effectiveness of virtual team-based learning (TBL) in teaching neurolocalisation (NL) in a sample of 18 student volunteers. Student satisfaction and knowledge outcomes were evaluated using the modified TBL Student Assessment Instrument and Extended Matching Questionnaire (EMQ), respectively. Mean student satisfaction rating was good at 3.9 out of 5.0 (SD 0.3). Participants achieved high mean EMQ scores of 84.2% (SD 2.9) with moderate correlation between individual assessment scores and EMQ scores (ρ = 0.587, p = 0.01). Virtual TBL is feasible for teaching NL with good student satisfaction and knowledge outcomes.

Corpus callosum (CC) is the primary fiber system bridging the cerebral hemispheres and is of critical importance for glioma migration which downgrades the prognosis. Here we present the specific pattern of CC restructuring in glioma patients. We probe that the magnetic resonance imaging-based fiber count decrease can be a ready noninvasive indicator of glioma aggressivity and prognosis. We find that to maintain the callosal neural transmission efficiency, the optimum architectural density of white matter fibers remains unchanged, even though there is gross fiber loss. This adaptation occurs by CC’s isotonic restructuration, a protective compensatory behavior for maintaining CC’s optimal functional efficiency despite malignant infiltration.

Background: Previous studies of neonatal cerebral venous sinus thrombosis (CVST) have focused on term infants, and studies of preterm infants are lacking. In this study, we examined the clinical and radiological features, treatment and outcome of CVST in preterm infants. Methods: This was a retrospective cohort study of preterm infants (gestational age <37 weeks) with radiologically confirmed CVST. All MRI/MRV and CT/CTV scans were re-reviewed. Clinical and radiological data were analysed using descriptive statistics, ANOVA and chi-square tests. Results: A total of 26 preterm infants with CVST were included. Of these, 65% were late preterm, 27% very preterm and 8% extreme preterm. Most (73%) were symptomatic at presentation with seizures or abnormal exam. Transverse (85%) and superior sagittal (42%) sinus were common sites of thrombosis. Parenchymal brain injury was predominantly periventricular (35%) and deep white matter (31%) in location. Intraventricular hemorrhage occurred in 46%. Most infants (69%) were treated with anticoagulation. None of the treated infants had hemorrhagic complications. Outcome at follow-up ranged from no impairment (50%), mild impairment (25%) and severe impairment (25%). Conclusions: Preterm infants with CVST are often symptomatic and have white matter brain lesions. Anticoagulation treatment of preterm CVST appeared to be safe and was not associated with hemorrhagic complications.

We investigated the effects of botulinum toxin on gait in Parkinson’s disease (PD) patients with foot dystonia. Six patients underwent onabotulinum toxin A injection and were assessed by Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), visual analog scale (VAS) of pain, Timed Up and Go (TUG), Berg Balance Test (BBT), and 3D gait analysis at baseline, 1 month, and 3 months. BFMDRS (p = 0.002), VAS (p = 0.024), TUG (p = 0.028), and BBT (p = 0.034) were improved. Foot pressures at Toe 1 (p = 0.028) and Midfoot (p = 0.018) were reduced, indicating botulinum toxin’s effects in alleviating the dystonia severity and pain and improving foot pressures during walking in PD.

Daytime sleepiness and fatigue are prominent symptoms of myotonic dystrophy type 1 (DM1) that can be amenable to treatment in the context of randomized controlled trials. No study has yet documented whether self-reported measures of daytime sleepiness and fatigue can detect change over time and the meaning of this change. The aim was to explore indicators of responsiveness to change and interpretability for the Daytime Sleepiness Scale and the Fatigue Severity Scale in 115 DM1 prospectively followed patients. Results suggest that these two self-reported questionnaires are sufficiently sensitive to detect changes beyond expected measurement error over time in this population.

Background: Genetic neuromuscular diseases (NMD) are a heterogeneous group of disorders comprised hundreds of genes. Despite the advanced genetic testing modalities, about 40 % of patients with NMD do not have a diagnosis. Muscle MRI has been proven as a useful tool to orientate the genetic testing by looking at the muscle involvement severity pattern. Moreover, muscle MRI patterns can be specific and informative for muscular dystrophies and yet can be characteristic and diagnostic. Methods: Systematic review was conducted to review muscle MRI patters for all Limb Girdle Muscle Dystrophies (LGMD). Then, we applied artificial intelligence (AI) on muscle MRI patterns for LGMDs and other NMDs using open database containing muscle MRIs Mercuri scores from 950 individuals. Results: AI and machine learning were applied on 10 types of NMD muscle MRI Mercuri scores that represented muscle involvement based on the degree of fatty infiltration. Different models were generated, the one with highest accuracy was used. When tested on new patients, it achieved a 90% accuracy. Subsequently, was turned into a mobile application. Conclusions: Muscle MRI is a valuable tool to help in NMD diagnosis. Specific muscle involvement pattern can be predictive. Besides, AI facilitates the interpretation and comprehension of muscle imagining in NMD.