Faculty Bibliography

Non-invasive, continuous monitoring of carotid artery hemodynamics may provide valuable insights on cerebral blood perfusion (CBP). Near-infrared spectroscopy (NIRS) is a non-invasive modality that may be a good candidate for real-time carotid artery monitoring. We designed a wearable NIRS system to monitor the left and right radial and carotid arteries in 20 healthy subjects. The changes in total hemoglobin concentration (HbT) and tissue oxygen saturation (StO₂) in all 80 arteries were continuously monitored in response to changes in oxygen supply. Wilcoxon non-parametric equivalence testing was used to compare changes in the radial (reference) and carotid arteries. The system-derived HbT and StO₂ trends matched the expected physiological responses over time in the radial and carotid arteries. The mean peak-to-peak amplitude [uM] of HbT during sustained deep breathing was practically equivalent between the left radial (0.9 ± 0.8) and left carotid (1.6 ± 1.1) arteries (p = 0.01). The mean peak-to-peak amplitude [%] of StO₂ was practically equivalent between the left radial (0.3 ± 0.2) and left carotid (0.3 ± 0.2) arteries (p < 0.001) and the right radial (0.4 ± 0.5) and right carotid (0.5 ± 0.4) arteries (p = 0.001). These findings indicate that NIRS may be a good option for monitoring the carotid arteries to track changes in CBP.

The sport of tennis involves unique nutritional demands for the physical and technical aspects of match play and training, as well as the nutritional challenges associated with extensive travel and a lengthy competition calendar. An expert group assembled by The International Tennis Federation, the Women's Tennis Association, and the Association of Tennis Professionals has produced a scientific review of current evidence to inform practical recommendations for high-performance tennis. The narrative summary considers the diversity within the tennis community, including male and female players, youth players, and wheelchair players. The Expert Group Statement addresses nine specific topics: (a) introduction to tennis; (b) physiological characteristics of tennis training and match play; (c) training nutrition; (d) body composition, low energy availability, and relative energy deficiency in sport; (e) match-day nutrition; (f) dietary supplements for tennis performance; (g) environmental and travel issues; (h) nutrition guidelines during periods of illness and injury rehabilitation; and (i) special population groups. The statement advocates for an evidence-based approach to nutrition in high-performance tennis and emphasizes a "food first" philosophy, prioritizing food over supplements to meet nutrient requirements effectively. In recognition of the benefits of sound nutrition, strategies in supporting health and performance over a player's career, academies, national federations, and international organizations are encouraged to engage professionals with appropriate nutrition-related qualifications and professional registrations to support players effectively.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Temporal lobe epilepsy (TLE) is commonly associated with mesiotemporal pathology and widespread alterations of gray and white matter structures. Evidence supports a progressive condition, although the temporal evolution of TLE is poorly defined. In this ENIGMA-Epilepsy study, we aim to investigate structural alterations in gray and white matter across the adult lifespan in patients with TLE by charting both gray and white matter changes and explore the covariance of age-related alterations in both compartments. METHODS:scores of all patients. Covariance analyses examined the coupled correlations of gray and white matter lifespan curves for each region. RESULTS: DISCUSSION/CONCLUSIONS:This study highlights that patients with TLE exhibit more pronounced and widespread gray and white matter atrophy across the lifespan. The cross-sectional nature of our study limits definitive conclusions on whether the atrophy shown is progressive but emphasizes the importance of prompt diagnosis and intervention in patients. Collectively, our results motivate future longitudinal studies to clarify consequences of drug-resistant epilepsy.

BACKGROUND:Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by fragile bones and vascular fragility, increasing the risk of vessel dissection and potentially complicating endovascular intervention. The authors present the first case of cranial bypass in a patient with OI. OBSERVATIONS/METHODS:A 38-year-old male with OI type I presented with a symptomatic left internal carotid artery (ICA) occlusive dissection managed with endovascular revascularization and stenting. Follow-up surveillance imaging identified an incidental right ICA dissection, also treated with stenting. Four years later, the patient experienced new right hemispheric symptoms. He was found to have progressive right ICA dissection on best medical management. Following an unsuccessful restenting attempt, he underwent a successful double-barrel superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass to restore cerebral perfusion with no perioperative complications. Six-month follow-up DSA confirmed a patent bypass with robust flow, and the patient remained asymptomatic 1 year postoperatively. LESSONS/CONCLUSIONS:STA-MCA bypass can serve as a viable and effective revascularization option in patients with OI, whose disease predisposes them to vascular dissection. In these high-risk patients, cranial bypass is a safe method for effective flow augmentation to hypoperfused brain regions when endovascular interventions fail. https://thejns.org/doi/10.3171/CASE25378.

RATIONALE AND OBJECTIVES/OBJECTIVE:To evaluate the performance, stability, and decision-making behavior of large language models (LLMs) for title and abstract screening for radiology systematic reviews, with attention to prompt framing, confidence calibration, and model robustness under disagreement. MATERIALS AND METHODS/METHODS:We compared five LLMs (GPT-4o, GPT-4o mini, Gemini 1.5 Pro, Gemini 2.0 Flash, Llama 3.3 70B) on two imaging-focused systematic reviews (n = 5438 and n = 267 abstracts) using binary and ternary classification tasks, confidence scoring, and reclassification of true and synthetic disagreements. Disagreements were framed as either "LLM vs human" or "human vs human." We also piloted autonomous PubMed retrieval using OpenAI and Gemini Deep Research tools. RESULTS:LLMs achieved high specificity and variable sensitivity across reviews and tasks, with F1 scores ranging from 0.389 to 0.854. Ternary classification showed low abstention rates (<5%) and modest sensitivity gains. Confidence scores were significantly higher for correct predictions. In disagreement tasks, models more often selected the human label when disagreements were framed as "LLM vs human," consistent with authority bias. GPT-4o showed greater resistance to this effect, while others were more prone to defer to perceived human input. In the autonomous search task, OpenAI achieved moderate recall and high precision; Gemini's recall was poor but precision remained high. CONCLUSION/CONCLUSIONS:LLMs hold promise for systematic review screening tasks but require careful prompt design and circumspect human-in-the-loop oversight to ensure robust performance.

BACKGROUND/UNASSIGNED:that requires emergent postoperative MR confirmation of the classical "white cord" (i.e., high intrinsic T2W MR cord signal reflecting edema/swelling). METHODS/UNASSIGNED:Most frequently, postoperative MR studies in newly paretic/injured patients following cervical operations will show evidence of direct intraoperative ("iatrogenic") spinal cord injury. Less frequently, findings may include new non-operative vs. operative pathology (i.e., hematomas/hematomyelia, graft extrusions/malpositioning, new/residual/recurrent disc/stenosis/Ossification of the Posterior Longitudinal Ligament (OPLL), and other pathology). RESULTS/UNASSIGNED:WCS/RI after cervical spine surgery is extremely rare, being reported in only 17 cases as of 2020, and cannot be diagnosed based on "clinical judgment" alone; rather, it requires a STAT corroborate postoperative MR to demonstrate the classical "white cord". However, most likely postoperative MR studies document "iatrogenic" cord injuries, and less likely show new non-surgical and/or new surgical compressive pathology warranting reoperations to remediate the extent/severity of neurological injuries. CONCLUSION/UNASSIGNED:that requires STAT postoperative MR documentation of the classical swollen/edematous "white cord".

BACKGROUND:Post-acute sequelae of SARS-CoV-2 infection (PASC) is characterized by persistent cognitive deficits alongside anxiety and depression symptoms that adversely affect quality of life. Cognitive training (CT) programs and non-invasive neuromodulation, specifically transcranial direct current stimulation (tDCS), have each shown promise for alleviating similar deficits in non-clinical populations. However, their combined efficacy has not yet been evaluated in PASC patients. Therefore, this study aimed to determine whether the combination of CT and tDCS produces benefits for cognitive and mood-related symptoms in individuals with PASC. METHODS:We conducted a double-blind, randomized, sham-controlled clinical trial in adults aged 18-75 with confirmed SARS-CoV-2 infection within the past six months and persisting cognitive complaints. They were randomized to a 4-week in-person intervention of 20 weekday sessions of either active (2 mA anodal-left, cathodal-right prefrontal stimulation) or sham tDCS paired with an app-based CT program. Primary outcomes were six standardized neuropsychological tests assessing verbal memory, working memory, executive functioning, attention, and language, administered at baseline and immediately post-intervention. As secondary outcomes, we assessed changes in depression and anxiety symptoms over the treatment period. RESULTS:Sixty participants (mean age 43.8 ± 13.2 years, 71.7 % women) were randomized to active tDCS + CT or sham tDCS + CT groups, and 52 finished the trial. Compared to sham, tDCS + CT resulted in significantly greater improvement in tests evaluating inhibitory control (effect size [ES] = 0.07, 95 % CI 0 to 0.23, p = 0.046), processing speed (ES = 0.08, 95 % CI 0 to 0.25, p = 0.034), and divided attention (ES = 0.08, 95 % CI 0 to 0.24, p = 0.039), but not in tests evaluating other domains. Both groups improved similarly in depression and anxiety symptoms. Participant's and rater's active guess rates did not differ between groups (ps > 0.20). CONCLUSION/CONCLUSIONS:An intervention with prefrontal targeted tDCS + CT in patients with PASC with cognitive complaints might be effective in improving attention, processing speed and inhibitory control, although further studies are warranted to prospectively confirm these findings. CLINICALTRIALS/RESULTS:GOV: NCT05389592.

RATIONALE/BACKGROUND:Hemiplegic migraine (HM) is a rare subtype of migraine characterized by complex aura and transient hemiparesis. It is infrequently associated with refractory focal epilepsy, and there are no previous reports of forced normalization (FN) in this context. This case highlights a novel clinical association and the diagnostic and therapeutic challenges it presents. PATIENT CONCERNS/METHODS:A 31-year-old right-handed woman presented with episodes of cognitive impairment following seizure control, as well as recurrent episodes of HM and prolonged focal seizures. She had a history of familial HM associated with CACNA1A and PNKD mutations. DIAGNOSES/METHODS:Genetic testing confirmed the presence of CACNA1A and PNKD mutations, consistent with familial HM. The patient was also diagnosed with focal refractory epilepsy and exhibited clinical and electroencephalographic features suggestive of FN. INTERVENTIONS/METHODS:The patient received various antiseizure medications, with adjustment of dosages and regimens in response to status epilepticus and evolving cognitive symptoms. Treatment was tailored to balance seizure control while minimizing adverse neuropsychiatric effects. OUTCOMES/RESULTS:Seizure control was partially achieved with adjustment of antiseizure medications; however, episodes of cognitive dysfunction persisted during electroencephalogram normalization periods, consistent with FN. Functional status improved gradually with individualized treatment, but neurological deficits and migraine persisted intermittently. LESSONS/CONCLUSIONS:This case illustrates a rare coexistence of familial HM, focal refractory epilepsy, and FN. It emphasizes the need for heightened clinical awareness of FN in similar complex neurogenetic disorders and highlights the importance of individualized pharmacological strategies.

Brain death, or death by neurologic criteria (BD/DNC), is the permanent loss of brain function, defined by coma with loss of capacity for consciousness and complete brainstem areflexia, including the inability to breathe spontaneously. The 2023 American Academy of Neurology/American Academy of Pediatrics/Child Neurology Society (CNS)/Society for Critical Care Medicine guidelines state that pregnancy is not a contraindication for BD/DNC evaluation. Clinical evaluation of BD/DNC includes an apnea test to demonstrate the absence of spontaneous respiratory effort in response to hypercapnia and acidosis. The safety of apnea testing to the fetus in pregnant patients remains uncertain.We convened a panel of experts in BD/DNC, neurocritical care, maternal-fetal medicine, neonatology, fetal/neonatal/child neurology, and pediatric/fetal anesthesiology to perform a scoping review of apnea testing in pregnant persons. We found no studies directly assessing safety of apnea testing on the fetus. Apnea testing consists of fetal exposure to parental hyperoxia and hypercapnia; therefore, we searched for evidence related to these conditions in pregnancy. Case reports, series, and literature on physiologic changes induced during apnea testing and their potential effects on placental, fetal systemic, and fetal cerebral circulations were identified. In reported cases of BD/DNC in pregnant persons, some authors described explicitly avoiding apnea testing because of safety concerns, but whether apnea testing was performed at all was inconsistently reported. Evidence from studies evaluating hyperoxia and hypercapnia in healthy pregnant persons and in other animal models suggested possible adverse effects caused by reduced uteroplacental blood flow, fetal metabolic acidosis, and hypercapnia-induced cerebral hyperperfusion. Further possible complications of apnea testing, such as hypotension or hypoxemia in pregnant persons, could also contribute to fetal injury. These potential detrimental risks to the fetus raise the question as to whether apnea testing should be deferred if a fetus may be viable. Ancillary tests, such as radionuclide cerebral blood flow imaging or transcranial Doppler ultrasonography, can be used if the remainder of the BD/DNC evaluation and neurologic examination is otherwise consistent with BD/DNC. Further research is essential to assess the physiologic consequences of apnea testing in pregnant persons and potential risks to the fetus.