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ObjectiveTo evaluate ChatGPT‘s performance in brain glioma adjuvant therapy decision-making.MethodsWe randomly selected 10 patients with brain gliomas discussed at our institution’s central nervous system tumour board (CNS TB). Patients’ clinical status, surgical outcome, textual imaging information and immuno-pathology results were provided to ChatGPT V.3.5 and seven CNS tumour experts. The chatbot was asked to give the adjuvant treatment choice, and the regimen while considering the patient’s functional status. The experts rated the artificial intelligence-based recommendations from 0 (complete disagreement) to 10 (complete agreement). An intraclass correlation coefficient agreement (ICC) was used to measure the inter-rater agreement.ResultsEight patients (80%) met the criteria for glioblastoma and two (20%) were low-grade gliomas. The experts rated the quality of ChatGPT recommendations as poor for diagnosis (median 3, IQR 1–7.8, ICC 0.9, 95% CI 0.7 to 1.0), good for treatment recommendation (7, IQR 6–8, ICC 0.8, 95% CI 0.4 to 0.9), good for therapy regimen (7, IQR 4–8, ICC 0.8, 95% CI 0.5 to 0.9), moderate for functional status consideration (6, IQR 1–7, ICC 0.7, 95% CI 0.3 to 0.9) and moderate for overall agreement with the recommendations (5, IQR 3–7, ICC 0.7, 95% CI 0.3 to 0.9). No differences were observed between the glioblastomas and low-grade glioma ratings.ConclusionsChatGPT performed poorly in classifying glioma types but was good for adjuvant treatment recommendations as evaluated by CNS TB experts. Even though the ChatGPT lacks the precision to replace expert opinion, it may serve as a promising supplemental tool within a human-in-the-loop approach.

Introduction Syndrome of the trephined (ST) is a post-craniectomy complication. It is characterized by the appearance of new neurological symptoms following the craniectomy, which are relieved after cranioplasty. The purpose of our work was to identify radiological signs and imaging biomarkers of the ST. Methods CT images of 32 patients were retrospectively analyzed (ST = 13, controls = 19). While the shapes of craniectomy flap were qualitatively assessed, deviation of the midline structures, relative intracranial cerebrospinal fluid (CSF) volume, and the 3rd ventricle’s volume were quantitatively measured. Results We did not find between-group differences in the mean age or number of post-craniectomy days. ST was diagnosed during the second post-craniectomy month. The occurrence of a sunken skin flap sign was similar in both groups (69.23 % in ST group, 57.89 % in control group). Occurrence of paradoxical herniation and deviation of the midline structures were not significantly different between groups. Mean relative intracranial CSF volume was significantly smaller in ST patients (ST = 5.59 %, controls = 8.12 %, p  = 0.01). ST patients, compared to controls, had also significantly smaller mean 3rd ventricle volumes (ST = 1748 mm 3 , controls = 2772.97 mm 3 , p  = 0.03). Conclusions ST is an infrequent and delayed post-craniectomy complication. The most common radiological findings (paradoxical herniation, deviation of the midline structures, and sunken skin flap sign) might not be specific for ST. Significantly lower 3rd ventricle, and relative intracranial CSF volumes, suggest that altered biophysical CSF properties underlie ST pathophysiology. Therefore, volume measurements of 3rd ventricle could be useful for identification of patients who have higher probability of developing the ST.

Background: Peak width of skeletonized mean diffusivity (PSMD) is a promising diffusion tensor imaging (DTI) marker that shows consistent and strong cognitive associations in the context of different cerebral small vessel diseases (cSVD). Purpose: Investigate whether PSMD 1) is higher in patients with Cerebral Amyloid Angiopathy (CAA) than those with arteriolosclerosis; 2) can capture the anteroposterior distribution of CAA-related abnormalities; 3) shows similar neuroimaging and cognitive associations in comparison to other classical DTI markers, such as average mean diffusivity (MD) and fractional anisotropy (FA). Methods: We analyzed cross-sectional neuroimaging and neuropsychological data from 90 non-demented memory-clinic subjects from a single center. Based on MRI findings, we classified them into probable-CAA (those that fulfilled the modified Boston criteria), subjects with MRI markers of cSVD not attributable to CAA (presumed arteriolosclerosis; cSVD), and subjects without evidence of cSVD on MRI (non-cSVD). We compared total and lobe-specific (frontal and occipital) DTI metrics values across the groups. We used linear regression models to investigate how PSMD, MD, and FA correlate with conventional neuroimaging markers of cSVD and cognitive scores in CAA. Results: PSMD was comparable in probable-CAA (median 4.06 x 10-4 mm2/s) and cSVD (4.07 x 10-4 mm2/s) patients, but higher than in non-cSVD (3.30 x 10-4 mm2/s; p<0.001) subjects. Occipital-frontal PSMD gradients were higher in probable-CAA patients, and we observed a significant interaction between diagnosis and region on PSMD values (F(2, 87) = 3.887, p = .024). PSMD was mainly associated with white matter hyperintensity volume, whereas MD and FA were also associated with other markers, especially with the burden of perivascular spaces. PSMD correlated with worse executive function (=-0.581, p<0.001) and processing speed (=-0.463, p=0.003), explaining more variance than other MRI markers. MD and FA were not associated with performance in any cognitive domain. Conclusions: PSMD is a promising biomarker of cognitive impairment in CAA that outperforms other conventional and DTI-based neuroimaging markers. Although global PSMD is similarly increased in different forms of cSVD, PSMD’s spatial variations could potentially provide insights into the predominant type of underlying microvascular pathology.

Cervical artery dissection is a major cause of stroke in young people (aged <50 years). Historically, clinicians have preferred using oral anticoagulation with vitamin K antagonists for patients with cervical artery dissection, although some current guidelines—based on available evidence from mostly observational studies—suggest using aspirin. If proven to be non-inferior to vitamin K antagonists, aspirin might be preferable, due to its ease of use and lower cost. We aimed to test the non-inferiority of aspirin to vitamin K antagonists in patients with cervical artery dissection. We did a multicentre, randomised, open-label, non-inferiority trial in ten stroke centres across Switzerland, Germany, and Denmark. We randomly assigned (1:1) patients aged older than 18 years who had symptomatic, MRI-verified, cervical artery dissection within 2 weeks before enrolment, to receive either aspirin 300 mg once daily or a vitamin K antagonist (phenprocoumon, acenocoumarol, or warfarin; target international normalised ratio [INR] 2·0–3·0) for 90 days. Randomisation was computer-generated using an interactive web response system, with stratification according to participating site. Independent imaging core laboratory adjudicators were masked to treatment allocation, but investigators, patients, and clinical event adjudicators were aware of treatment allocation. The primary endpoint was a composite of clinical outcomes (stroke, major haemorrhage, or death) and MRI outcomes (new ischaemic or haemorrhagic brain lesions) in the per-protocol population, assessed at 14 days (clinical and MRI outcomes) and 90 days (clinical outcomes only) after commencing treatment. Non-inferiority of aspirin would be shown if the upper limit of the two-sided 95% CI of the absolute risk difference between groups was less than 12% (non-inferiority margin). This trial is registered with ClinicalTrials.gov, NCT02046460. Between Sept 11, 2013, and Dec 21, 2018, we enrolled 194 patients; 100 (52%) were assigned to the aspirin group and 94 (48%) were assigned to the vitamin K antagonist group. The per-protocol population included 173 patients; 91 (53%) in the aspirin group and 82 (47%) in the vitamin K antagonist group. The primary endpoint occurred in 21 (23%) of 91 patients in the aspirin group and in 12 (15%) of 82 patients in the vitamin K antagonist group (absolute difference 8% [95% CI −4 to 21], non-inferiority p=0·55). Thus, non-inferiority of aspirin was not shown. Seven patients (8%) in the aspirin group and none in the vitamin K antagonist group had ischaemic strokes. One patient (1%) in the vitamin K antagonist group and none in the aspirin group had major extracranial haemorrhage. There were no deaths. Subclinical MRI outcomes were recorded in 14 patients (15%) in the aspirin group and in 11 patients (13%) in the vitamin K antagonist group. There were 19 adverse events in the aspirin group, and 26 in the vitamin K antagonist group. Our findings did not show that aspirin was non-inferior to vitamin K antagonists in the treatment of cervical artery dissection. Swiss National Science Foundation, Swiss Heart Foundation, Stroke Funds Basel, University Hospital Basel, University of Basel, Academic Society Basel.

Background The interaction between Alzheimer's pathology and cerebral amyloid angiopathy (CAA), a common cerebral small vessel disease, plays a crucial role in cognitive impairment development in older adults. Recent studies suggest that increased blood pressure (BP) variability may affect subclinical vascular disease and cognitive decline. However, it is currently unknown whether a particular BP profile is linked to hippocampal subfield volumes, which are a significant feature of cognitive decline in neurodegenerative diseases. Therefore, we conducted a study to investigate the relationship between BP profile and hippocampal subfields in nondemented subjects with CAA. Method We investigated the relation between BP mean and variability and hippocampal neurodegeneration in a memory clinic cohort of non‐demented participants with possible and probable cerebral amyloid angiopathy (CAA), diagnosed using the modified Boston criteria v1.5. Linear regression models were used to assess the associations between BP profile and hippocampal volumes. The subfield volumes were measured using an automated method on T‐1 weighted sequence using FreeSurfer v6.0. The BP profile was defined using serial outpatient BP measurements five years prior to 3T research MRI. The BP variability was calculated using the coefficient of variation (standard deviation/mean). Result We have included 59 participants (74.3 ± 6.8 y, 9/50 F/M) who underwent a median of 12 (IQR 26) outpatient BP measurements five years prior to index MRI. We found a significant association between mean BP and all measured hippocampal subfields, notably the CA1: b=‐032, p=0.008, CA3: b = ‐0.24, p=0.049, CA4: b=‐0.34, p=0.003, and the subiculum: b=‐0.29, p=0.006), adjusted for age and brain volume normalized for total intracranial volume. However, we found no significant association with long‐term BP variability Conclusion We found significant associations between mean BP and hippocampal subfields volumes. Our results suggest that elevated BP, but not its variability, is a modifiable risk factor for preventing hippocampal degeneration in the context of CAA‐related cognitive impairment. Further pre‐planned analyses will evaluate the associationa in a subgroup of participants with mild dementia and non‐CAA participants.

Background Promoting brain health is essential for addressing the growing burden of neurological disorders, with 45% of dementia cases linked to modifiable risk factors. The McCance Brain Care Score (BCS, Figure 1) supports risk reduction by empowering patients to adopt preventive strategies that modify established risk factors. However, no validated French‐language tools currently address modifiable determinants of brain health. This prospective study aims to validate a French version of the BCS (BCS‐F, Figure 2) and evaluate its effectiveness in motivating patients to improve their brain health. Method The BCS was translated into French through a forward and back translation process conducted by two independent translators, followed by validation by an expert committee. 95 patients (mean age 70.7±13.4 years, 39% female, mean MoCA score 22.3±5.5/30 points) were recruited from the Cognitive Disorders Outpatient Clinic between March 2024 and January 2025. 43 consecutive participants were assigned to the BCS‐F group and 52 to the standard of care (SoC) group. Key outcomes included patients’ willingness to improve brain health determinants and items targeted for change, which were compared between groups. Result Both groups were comparable in age, sex and general cognitive performance. 81 % (n = 35) of participants in the BCS‐F group and 48% (n = 25) of participants in the SoC group expressed a willingness to improve their brain health determinants, with blood pressure control, aerobic activity and alcohol consumption being the most frequently targeted factors. The administration of the BCS‐F was associated with a 69% increased probability of willingness to improve brain health (Risk Ratio: 1.69, p <0.001) compared to SoC, even after accounting for age as a confounding variable. One additional participant reported willingness to improve their brain health for every 3 patients who completed the survey (Number needed to treat: 3.00). Conclusion The BCS‐F proved an effective intervention in our cohort, enhancing willingness to act on brain health determinants. This suggests that BCS‐F has the potential to address the scarcity of accessible brain health assessment tools for French‐speaking populations. Furthermore, BCS‐F may serve as a valuable resource for informing patients about their brain health and empowering them to improve modifiable risk factors for dementia, stroke, and depression.

The impact of COVID-19 lockdown on prehospital stroke care is largely unknown. We aimed to compare stroke care patterns before and during a state-wide lockdown. Thus, we analysed prospective data of stroke alerts referred to our stroke centre between 1 December 2019 and 16 June 2020, and compared them between two periods—15 weeks before and 13 weeks during the state-wide lockdown declared in Lithuania on 16 March 2020. Among 719 referrals for suspected stroke, there was a decrease in stroke alerts (rate ratio 0.61, 95% CI (0.52–0.71)), stroke admissions (0.63, 95% CI (0.52–0.76)), and decrease in prehospital stroke triage quality (positive predictive value 72.1% vs. 79.9%, p = 0.042) during the lockdown. The onset-to-door time was longer (153.0 vs. 120.5 min, p = 0.049) and seizures and intracranial tumours were more common among stroke mimics (16.9% vs. 6.7%, p = 0.012 and 9.6% vs. 3.0%, p = 0.037, respectively). We conclude that there was a decline in prehospital stroke triage quality during the lockdown despite low COVID-19 incidence in the country. Moreover, we observed an increase in hospital arrival delays and severe conditions presenting as stroke mimics. Our findings suggest that improved strategies are required to maintain optimal neurological care during public health emergencies.

Promoting brain health is essential for addressing the growing burden of neurological disorders, with 45% of dementia cases linked to modifiable risk factors. The McCance Brain Care Score (BCS, Figure 1) supports risk reduction by empowering patients to adopt preventive strategies that modify established risk factors. However, no validated French-language tools currently address modifiable determinants of brain health. This prospective study aims to validate a French version of the BCS (BCS-F, Figure 2) and evaluate its effectiveness in motivating patients to improve their brain health. The BCS was translated into French through a forward and back translation process conducted by two independent translators, followed by validation by an expert committee. 95 patients (mean age 70.7±13.4 years, 39% female, mean MoCA score 22.3±5.5/30 points) were recruited from the Cognitive Disorders Outpatient Clinic between March 2024 and January 2025. 43 consecutive participants were assigned to the BCS-F group and 52 to the standard of care (SoC) group. Key outcomes included patients' willingness to improve brain health determinants and items targeted for change, which were compared between groups. Both groups were comparable in age, sex and general cognitive performance. 81 % (n = 35) of participants in the BCS-F group and 48% (n = 25) of participants in the SoC group expressed a willingness to improve their brain health determinants, with blood pressure control, aerobic activity and alcohol consumption being the most frequently targeted factors. The administration of the BCS-F was associated with a 69% increased probability of willingness to improve brain health (Risk Ratio: 1.69, p <0.001) compared to SoC, even after accounting for age as a confounding variable. One additional participant reported willingness to improve their brain health for every 3 patients who completed the survey (Number needed to treat: 3.00). The BCS-F proved an effective intervention in our cohort, enhancing willingness to act on brain health determinants. This suggests that BCS-F has the potential to address the scarcity of accessible brain health assessment tools for French-speaking populations. Furthermore, BCS-F may serve as a valuable resource for informing patients about their brain health and empowering them to improve modifiable risk factors for dementia, stroke, and depression.