bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 102: Pseudo‐Internuclear Ophthalmoplegia in a Patient with an Acute Globus Pallidus Infarct: A Case Report
Authors: Idris Anas 
Published: March 2024

Introduction
Internuclear ophthalmoplegia (INO) is an ocular movement disorder typically due to a lesion in the medial longitudinal fasciculus (MLF). Rarely, similar ocular movement abnormalities can be observed in the absence of an MLF lesion. This case report aims to highlight a potential association between acute globus pallidus (GP) infarct and an ocular movement abnormality resembling INO.

Methods
N/A

Results
Case Presentation: A 72‐year‐old male with a medical history significant for chronic myeloid leukemia, prostate cancer, type 2 diabetes mellitus, hypertension, prior stroke, and heart failure presented with dizziness. Examination revealed right INO, skew deviation with right hypertropia, left lower extremity weakness, left upper extremity dysmetria, right facial weakness (prior deficit), and ataxic gait. MRI of brain confirmed an acute lacunar infarct in the right globus pallidus with no apparent brainstem or cerebellar lesion. The patient was started on dual antiplatelet therapy and discharged with home rehabilitation services to improve his balance. Discussion: The patient presented with pseudo‐INO in the setting of an acute globus pallidus infarct. This case introduces the idea that ocular motor abnormalities resembling INO could occur due to a GP lesion, which was not previously reported. The basal ganglia control saccadic eye movements by means of their connection to the superior colliculus (SC). GP was shown to have a role in this connection which may provide a plausible explanation for this observation. Another possible explanation can be based on the concept of diaschisis, where a lesion in a specific area of the brain (GP in this case) can lead to deficits or impairments in various functions associated with that region (the SC and its pathway for controlling saccadic eye movement).

Conclusion
This case emphasizes that slow adducting saccades and associated nystagmus is not always INO.
Abstract 104: Fetal Posterior Cerebral Artery (PCA) Occlusion from Occluded Cavernous ICA Stent
Authors: Kahriman Aydan , Borchert William , Blenden Adam , Masoud Hesham 
Published: March 2024

Introduction
Posterior Cerebral Artery (PCA) is a medium vessel occlusion (MVO) which is 5‐10% of all acute ischemic events. Safety and efficacy of mechanical thrombectomy in posterior circulation MVO is unclear compared to medical treatment only (1). There is concern that fragility of distal, smaller vessels may have an increased risk of procedural complications (e.g., arterial dissection and or perforations). More people are getting flow divertors over the years and rate of flow diverter of ICA occlusion is 0.05%‐0.08% (2). Here we present a case of embolic fetal PCA stroke with ICA stent occlusion.

Methods
We report a case of fetal origin posterior cerebral artery occlusion from ICA with literature search of Pubmed.

Results
77 years old female with left cavernous‐ICA stent presented from a rehab facility with complaints of word finding difficulty, confusion, right hemiparesis, right sided neglect, and visual disturbance. In the emergency department (ED), her NIHSS was 28. ED presentation was 2.5 hrs after the last known well (LKW). Of note, patient had a with left cavernous‐ICA stent placement a month before the presentation and was noncompliant to antiplatelets. CT head was negative for intracranial bleeding and ASPECT score was 7. CT angiography head and neck was obtained, showing new complete interval occlusion of the intracranial extradural left ICA with reconstitution of distal branches through anterior communicating artery. Patient received IV thrombolytics, intubated for airway protection and was transferred to a comprehensive stroke center for possible mechanical thrombectomy. Time of the arrival was approximately 6 hours after the LKW, reexamination was hindered by the sedation and intubation but was concerning for possible PCA occlusion rather than ICA occlusion. As the localization of ischemic area was unclear, CT perfusion (CTP) was obtained. CTP showed 27 ml penumbra without core infarct in left PCA territory. As fetal origin of left PCA from ICA is occluded, without ability to access through occluded stent, noted risk of left ICA complications with attempts to recanalize stent for noted PCA hypoperfusion outweigh the benefits. With the exam improvement post thrombolytics administration and small penumbra, mechanical thrombectomy was not indicated.

Conclusion
In acute large vessel occlusion, utility of CT perfusion (CTP) usually recommended after 6 hours from last well known. In this case, patient presented within the 6 hours but the reexamination post thrombolytics was not localizing to suggest large vessel occlusion (LVO) and the territory at risk was unclear. We described a left intracranial ICA flow diversion occlusion without anterior circulation ischemia and left PCA ischemia demonstrated. In this case, CTP was employed to differentiate the territory at risk for triage to appropriate intervention, to differentiate the LVO vs MVO.
Abstract 106: CHANTER Syndrome: A Case Report Of A 59 Year Old Man With Positive Outcome
Authors: Elsayed Sherif , Al‐Ani Mina , Balabhadra Anvesh , Elmashad Ahmed 
Published: March 2024

Introduction
Cerebellar, Hippocampal, and Basal Nuclei Transient Edema with Restricted Diffusion (CHANTER) syndrome was first described in 2019 [1] as a pattern of radiographic findings that are distinct from ischemic, anoxic, or toxic brain injury. Pathophysiology is still uncertain, but some proposed theories include a primary metabolic etiology or a mitochondrial failure of gray matter. Clinically, patients typically present with altered level of consciousness. Radiographically, diffusion weighted imaging shows restriction in the bilateral hippocampi, bilateral cerebelli, and basal nuclei. The cerebral cortex, thalamus, and subcortical white matter are usually spared. Despite the morbid clinical picture on presenation, positive outcomes were reported with early intervention. We describe a case of CHANTER syndrome in a 59 year old man with history of illicit substance abuse.

Methods
Case report with electronic medical record review.

Results
59‐year‐old man with history of illicit substance abuse including cocaine, opioid, and phencyclidine presented to the hospital after being found down at a drug store. Patient did not respond to Naloxone and was eventually intubated due to respiratory compromise. Non‐contrast CT head showed hypoattenuation of the bilateral cerebellar hemispheres with mild effacement of the fourth ventricle. MRI brain showed diffusion signal abnormalities with corresponding T2 FLAIR hyperintensities in the bilateral cerebellar hemispheres, bilateral hippocampi, and bilateral basal ganglia with some involvement of the left occipital lobe suggestive of CHANTER syndrome. As vasogenic edema worsened, hydrocephalus ensued requiring administration of hypertonic saline and eventual external ventricular drain (EVD) insertion in the neurocritical care unit. Despite initial improvement in his level of consciousness after the EVD insertion, his intracranial pressure (ICP) continued to increase and midazolam and ketamine infusion drips were added. A fine balance between lowering the ICP and avoiding respiratory suppresion with sedating infusions was maintained. Consecutive MRI brain images over the course of the following 4 weeks of his stay showed decrease of the abnormal diffusion weighted imaging signal along with improvement in his overall mental status and eventual discharge 12 weeks from his initial presentation.

Conclusion
This case further strengthens the relationship between CHANTER syndrome and illicit substance use as a likely etiology along with other cases in the literature. Aggressive management in the neurocritical care to control vasogenic edema and avoid ICP elevation is essential to give patients the highest chance of recovery. Clinical improvement At least partial reversal of the radiographic findings of CHANTER syndrome can be attained with treatment, however, unclear if complete reversal is possible.
Abstract 108: Artery Of Percheron Infarctions (AOP): A Tale of Two Outcomes
Authors: Beck Eric N. , Cabrera Nynoshka M. Bassatt , Ngo Melanie , Elwan Sherif , Wee Claribel D. 
Published: March 2024

Introduction
The AOP is a rare anatomic variant in which a solitary arterial trunk arises from the proximal segment of the posterior cerebral artery (PCA) and supplies the bilateral paramedian thalami and rostral midbrain. Occlusion may result in variable bilateral thalamic and midbrain infarcts. The clinical presentation is most commonly lethargy and somnolence thought to lack other localizing features. Often the diagnosis and treatment of stroke is delayed.

Methods
Here we present two cases of likely AOP infarcts which highlight the importance of considering this diagnosis on the differential of acute lethargy as timely treatment can lead to a significant difference in morbidity and mortality.

Results
Case 1: A 68‐year‐old male was initially admitted to an outside hospital with acute lethargy. He was transferred to our institution where he was found to be somnolent and required repeated stimulation to participate with interview. On further exam he was noted to have left ptosis, anisocoria, restricted left supra‐ and add‐ duction, and dysarthria. CT angiogram (CTA) showed no large vessel occlusion (LVO) or significant stenosis. Magnetic resonance imaging (MRI) demonstrated acute infarcts in the medial thalami and subthalamic nuclei bilaterally and uppermost portion of the midbrain. He was out of the window for IV thrombolytic. He was ultimately discharged to inpatient rehab with a persistent CN III palsy. Case 2: A 71‐year‐old female was evaluated emergently via telestroke for acute lethargy and was found to additionally have vertical diplopia, right facial palsy, and subsequent bilateral numbness of the face, arms, and legs. NIHSS 10 for LOC questions (1), facial palsy (2), motor drift (1 pt for each limb), sensory loss (1), aphasia (1), and dysarthria (1). She was treated with IV tenecteplase 179 minutes after the last known well and ultimately had complete symptom resolution. CTA was negative for LVO or significant stenosis. MRI brain demonstrated acute infarcts in the medial thalami bilaterally.

Conclusion
Here we present two cases of acute onset lethargy. MRI Brain revealed relatively symmetric restricted diffusion in the bilateral thalami of both patients suggesting the presence of an AOP variant. In contrast to the first case, signs of a posterior circulation infarct were quickly recognized in the second patient and IV thrombolytic administration resulted in return to baseline. In both cases there were subtle neurologic findings that suggested midbrain involvement – ptosis, restricted ductions, anisocoria. A high level of suspicion for bilateral thalamic infarct and potential AOP variant should be maintained in cases of acute lethargy. Careful neurologic exam often reveals other signs suggestive of posterior circulation infarct and timely therapeutics can significantly improve morbidity and mortality.
Abstract 119: VP‐shunting for IIH complicated by CVST, Dural AV Fistula and Status Epilepticus ‐ Endovascular Perspective
Authors: Choudhury Omar 
Published: March 2024

Introduction
Cerebral venous sinus thrombosis (CVST) presents diagnostic challenges, especially in its overlap with idiopathic intracranial hypertension (IIH). Timely neuroimaging using MRI and MRV is crucial to avoid misdiagnosing CVST as IIH [1]. VP shunts, although beneficial in IIH, have significant failure rates and potential complications [2]. Few cases in the literature report occurrence of CVST or worsening of CVST after VP‐shunt placement [3]. The close relationship between CVST and dural AVF further complicates the clinical picture [4]. Endovascular intervention may present challenges with respect to chronic CVST, which can be mistaken for IIH.

Methods
We report a rare case of a 73‐year‐old woman with a past medical history of diabetes, hypertension, and hyperlipidemia who presented with confusion, disorientation, and lethargy. Comprehensive neurological evaluation, neuroimaging, lumbar puncture, EEG monitoring and treatment interventions, including VP shunt placement, cerebral angiogram, onyx embolization, and systemic anticoagulation, were performed.

Results
The patient initially presented with symptoms of progressive headaches, transient visual obscurations, and papilledema, suggestive of IIH. After lumbar puncture revealed elevated opening pressures, she underwent VP shunt placement. Her postoperative period was complicated by status epilepticus, extensive venous sinus thrombosis, and multiple dural AV fistulas. A cerebral angiogram showed a left occipital AV fistula, treated with onyx embolization. Repeat imaging indicated dural over‐shunting, yet this was negated upon Neurosurgical evaluation. A subsequent diagnostic cerebral angiogram was unable to clear the chronic CVST, but the patient responded positively to systemic anticoagulation and seizure management.

Conclusion
This case underscores the need for caution when considering VP shunting in patients with elevated intracranial pressure symptoms. Our findings emphasize the importance of an early MRV to rule out CVST and determine the appropriate treatment approach. Iatrogenic progression of CVST, VP shunt over‐drainage, and status epilepticus are serious complications that can arise from a misdiagnosis of IIH. Additionally, this case offers an endovascular perspective on patients who have chronic CVST, which can be misdiagnosed as IIH. Endovascular interventions including onyx AV fistula embolization and angiographic evaluation of the patient provided significant diagnostic and therapeutic benefits, and ultimately the patient was discharged with improved mentation.
Abstract 128: Endovascular Thrombectomy for Severe Cerebral Venous Thrombosis: A Comprehensive Meta‐analysis Assessing Safety and Efficacy
Authors: Tolba Hatem , Ghozy Sherief , Orscelik Atakan , Abdelghaffar Mariam , Kobeissi Hassan , Ghaith Hazem , Abbas Alzahraa , Kadirvel Ramanathan , Brinjikji Waleed , Kallmes David 
Published: March 2024

Introduction
Cerebral sinus venous thrombosis (CSVT) has traditionally been treated medically with systemic anticoagulation. Recent advances in endovascular therapy (EVT) may represent an alternative treatment to medical therapy for CSVT. We conducted a systematic review and meta‐analysis to evaluate the use of EVT for CSVT.

Methods
We conducted a systematic literature review using PubMed, Embase, Scopus, and Web of Science. We included studies that reported outcomes following EVT for CSVT. The primary outcome of interest was rate of modified Rankin Scale (mRS) 0‐2. Secondary outcomes of interest were rates of complete, partial, and failed recanalization, mortality, and new or expansion of hematoma. We calculated pooled rates (%) and their corresponding 95% confidence intervals (CI).

Results
Thirty‐eight studies with 682 patients were included. Rate of mRS 0‐2 was 82.6% (95% CI, 75.3%‐88.0%). Rate of complete recanalization was 60.9% (95% CI, 49.1%‐71.5%), rate of partial recanalization was 34.2% (95% CI, 24.1%‐45.9%), and rate of failed recanalization was 5.4% (95% CI, 3.1%‐9.2%). Rate of mortality was 6.7% (95% CI, 4.1%‐10.8%) and rate of new or expansion of hematoma was 5.1% (2.9%‐8.8%).

Conclusion
In this systematic review and meta‐analysis, EVT for CSVT was associated with favorable rates of mRS 0‐2 and recanalization. Furthermore, EVT was associated with a promising safety profile. Future prospective, comparative studies are warranted to assess EVT for CSVT.
Abstract 130: Endovascular Therapy for Cerebral Venous Sinus Thrombosis: A Systematic Review of 267 patients
Authors: Sultany Abdullah , Qudah Abdullah M. Al , Kakamyradov Guvanch , Doheim Mohamed F. 
Published: March 2024

Introduction
Cerebral venous sinus thrombosis (CVST) is a rare form of stroke that usually affects young females especially during pregnancy and the postpartum period. Several risk factors can contribute to the development of cerebral venous sinus thrombosis including hypercoagulable states, dehydration, infections, head or neck injuries, cancer, and some rheumatological diseases (1). The symptoms of cerebral venous sinus thrombosis can vary depending on the location and extent of the clot. Common signs and symptoms may include severe headaches, visual disturbances, seizures, focal neurological deficits, altered mental status, and in severe cases, coma. The initial treatment for CVST is systemic anticoagulation (2‐3). However, endovascular treatment (EVT) of CVST is typically reserved for cases associated with significant thrombus burden and lack of clinical improvement or worsening of symptoms despite systemic anticoagulation therapy without current conclusive evidence of its benefit. The aim of this study is to evaluate the evidence of EVT in patients with CVST.

Methods
A systemic literature search was conducted via PubMed to identify relevant studies. Only studies with sample sizes larger than 10 were included. We excluded small case series, meta‐analyses, systematic reviews, and studies that lack the main outcomes of interest. Our main outcomes included functional outcome defined as modified Rankin Scale score (mRS 0‐3), mortality, new or expanded ICH and recanalization rates.

Results
We finally included 10 studies (4‐13) in our qualitative synthesis. Only one study was a small, randomized clinical trial while the rest were observational studies. In our included studies, 267 patients underwent EVT for CVST. Among them, the median age was ranging from 12 to 75 and 162 (60 %) of patients were females. Patients were followed up for a mean ranging from 3 to 12 months. Recanalization was observed in 161 patients, out of which 111 were complete recanalization (68.9%) and 50 were partial recanalization (31.1%). Good functional outcome defined as mRS 0‐3 was achieved in a total of 181 patients. Additionally, 26 (9.7%) patients had a new onset or expanded ICH while 26 patients had died (9.7%).

Conclusion
EVT for CVST was associated with improved clinical outcomes with acceptable safety profile in severe cases. There is a lack of evidence from large randomized clinical trials so more prospective studies are needed to confirm these results.
Abstract 139: Super Distal Access using the Vecta46 Intermediate Catheter in Embolization of the MMA for cSDH
Authors: Meyer Benjamen M. , Khan Muhammad W. , Campos Jessica K. , Laghari Fahad A. , Zarrin David A. , de Beaufort Jonathan C. Collard , Amin Gizal , Golshani Kiarash , Beaty Narlin B. , Bender Matthew T. , Lin Li‐Mei P. , Colby Geoffrey P. , Coon Alexander L. 
Published: March 2024

Introduction
There is increasing literature to support the efficacy of middle meningeal artery (MMA) embolization in the treatment of chronic subdural hematomas (cSDH). Techniques for optimal embolization of the MMA are yet to be elucidated. We hypothesized utilization of a novel 046” intermediate catheter within the proximal MMA trunk carry procedural advantages for multiple pedicle embolizations and ease of navigation to distal MMA vasculature.

Methods
We retrospectively reviewed and analyzed a prospectively maintained IRB‐approved database of the senior authors.

Results
Twenty‐one (21) consecutive cases of Vecta46 utilization with MMA embolization were identified (2023), in patients 69±13 years (range 49‐83 years), 4 (19%) women. Four (19%) patients were on antiplatelet/anticoagulants. At presentation, recurrent cSDH in 9 patients (43%) were previously managed with burr holes (n=2, 22%), craniotomy (n=3, 33%), or without drainage (n=4, 44%). Average admission cSDH thickness was 8.8±1.6mm, midline shift of 3±0.7mm. Access was performed through a 5‐ or 6‐French arteriotomy. Both anterior and posterior MMA branches were embolized in 16 (76%) cases, and adjunctive coiling of the proximal MMA trunk was performed in all cases. Vecta46 was successfully placed in the proximal MMA trunk in all cases. There were no vessel irregularities, vasospasm, or dissection noted along the course of the MMA Vecta46 placement. No immediate procedural complications were noted and all cases achieved complete distal MMA occlusion.
Figure 1: (A) Ophthalmic (black) and petrous (white) collaterals off the anterior and posterior MMA branches, respectively. (B) Contralateral (green) and falx (orange) penetration of the MMA branches. (C) Proximal coiling of the anterior and posterior MMA branches (black).

Conclusion
The Vecta46 intermediate catheter is a powerful tool for MMA embolization that allows the safe and effective placement of an intermediate catheter in the proximal MMA trunk. This allows for simple catheter exchange for multiple liquid embolic pedicle embolizations and significant support for navigating microcatheters to distal MMA branches.
Abstract 151: Age‐Related Increases in Carotid Artery Calcification: Insights from NaF PET/CT Imaging
Authors: Teichner Eric M. , Subtirelu Robert C. , Werner Tom , Alavi Abass 
Published: March 2024

Introduction
Atherosclerosis, the hardening and narrowing of the arteries, occurs due to the buildup of plaque on the inner walls of the arteries which can result in reduced blood flow to the organs and tissues. Risk factors such as smoking, chronic kidney disease, and aging can contribute to plaque formation. The gradual loss of elasticity in arterial walls and the presence of other risk factors, such as high blood pressure and diabetes, contribute to the increased risk of cardiovascular disease (CVD) observed in aging populations. Early detection through sensitive and specific imaging methods is important for the detection and treatment of CVD. 18F‐Sodium Fluoride positron emission tomography/computerized tomography (NaF‐PET/CT) can be utilized to detect and quantify molecular calcification and therefore early atherosclerosis in patients with CVD. Research has shown a positive correlation between NaF uptake in the common carotid arteries/thoracic aorta and cardiovascular/thromboembolic risk. This study aims to assess the effect of aging on NaF uptake in the left common carotid artery (LCC) in subjects with known cardiovascular risk factors.

Methods
In total, 36 subjects (mean age 55.4 ± 12.3 years, 50% males) with known cardiovascular risk factors underwent FDG‐PET/CT. Participants were recruited from a group of patients with chest pain syndromes who were referred for coronary CT angiography. Individuals who were not taking any blood pressure medications and who had a greater than 1% increased risk of fatal CVD, estimated by the systematic coronary risk evaluation tool, were eligible for inclusion into the at‐risk for CVD group. NaF PET/CT was performed 90 min after the intravenous injection of 2.2 MBq of NaF/kg. NaF uptake in the LCC was quantitatively assessed by measuring the blood‐pool‐corrected maximum standardized uptake value (SUVmean) on each axial slice. Pearson’s R was calculated and evaluated for significance in all variables. The threshold for significance was set at P < 0.05.

Results
A significant association between age in patients with cardiovascular risk factors and NaF uptake in the LCC artery was found. Age positively correlated with NaF uptake (r=0.472, p= 0.004) across all 36 patients.

Conclusion
Our results demonstrate that NaF uptake increases in the LCC with age in subjects with known cardiovascular risk factors. The strong association between age and calcification of the carotid arteries within a population of individuals with unfavorable cardiovascular and thromboembolic risk profiles demonstrates the potential of NaF PET/CT. NaF PET/CT may allow physicians to evaluate effectiveness of treatment and determine a patient's risk for CVD. However, additional trials are needed to further evaluate the associations found in this study and determine relevance in a clinical setting.