It is difficult to distinguish acute labyrinthine artery infarction from peripheral vertigo conditions, such as vestibular neuritis and labyrinthitis. Despite comprehensive neurological examinations, differentiating between these conditions remains challenging, and standard computed tomography or magnetic resonance imaging (MRI) scans may not always reveal acute labyrinthine artery infarction. This case report suggests that a thorough evaluation using susceptibility-weighted imaging on MRI may be helpful in detecting the early signs of labyrinthine infarction.

Microembolic signals (MESs), detected via transcranial Doppler ultrasonography, are essential biomarkers for assessing cerebrovascular risk, embolic events, and treatment outcomes. In this review, studies published between 2014 and 2024 were evaluated, specifically focusing on the clinical implications, associated conditions, and opportunities for advancements in MES monitoring technologies. A systematic PubMed search identified 327 articles, of which 60 were finally included in this review. MESs are associated with various conditions, including carotid/cerebral artery stenosis and atrial fibrillation. They predict adverse outcomes, including increased stroke risk, cognitive decline, and complications from procedures such as endovascular thrombectomy and unruptured aneurysm coiling. Furthermore, MESs serve as a surrogate marker for embolism, allowing for the evaluation of different procedural techniques to determine which approach minimizes embolic events. Advances in MES monitoring, including algorithms that distinguish gaseous and solid emboli and applications in pediatric cardiac surgery, have expanded its clinical utility. Moreover, emerging wearable and wireless technologies may expand the possibilities for MES monitoring.

Brainstem infarction can be a critical condition, typically due to ischemic mechanisms such as large artery atherosclerosis, small vessel disease, or cardioembolic sources. In rare instances, infectious or inflammatory etiologies may lead to brainstem infarction, posing substantial diagnostic complexities. We report the case of a 74-year-old man presenting bilateral pontine infarctions secondary to clival osteomyelitis and an adjacent abscess, which was further complicated by a basilar artery pseudoaneurysm and subsequent subarachnoid hemorrhage. This case highlights the importance of considering uncommon infectious causes of brainstem infarction, especially in patients with intricate medical backgrounds and immunosuppression.

The spinal cord is a complex and densely packed structure of nerve tissue, and magnetic resonance imaging (MRI) is an excellent imaging modality for evaluating its pathologies. Among the distinct functional zones of the spinal cord, the dorsal (or posterior) column is a crucial white matter region responsible for transmitting sensory information and is located in the posterior aspect of the spinal cord. Myelopathies of the dorsal column typically appear as high signal intensity in this region on T2-weighted images. They may arise from several pathological processes, including degenerative, metabolic, inflammatory, infectious, and traumatic conditions. Identifying the specific etiology through characteristic MRI features, along with the patient’s clinical presentation, is crucial for developing an effective treatment plan and understanding the prognosis of sensory abnormalities. This study reviews myelopathies that specifically affect the dorsal column and outlines the MRI findings that aid in the differential diagnosis of these dorsal column lesions.

Syncope, defined as the transient loss of consciousness due to reduced cerebral blood flow, is a common clinical presentation across patients of all age groups; however, it poses diagnostic challenges owing to its varied etiologies, ranging from benign reflex-mediated mechanisms to more severe cardiac or autonomic dysfunctions. Traditionally, the head-up tilt (HUT) test is applied to assess syncope by simulating orthostatic stress; however, its diagnostic yield is limited, particularly in cases lacking obvious systemic hypotension. Transcranial Doppler (TCD) ultrasonography, a noninvasive tool for measuring cerebral blood flow velocity, provides critical insights into cerebrovascular dynamics during syncope episodes and enhances diagnostic accuracy, particularly when combined with the HUT test. TCD allows for the real-time monitoring of cerebral autoregulation and blood flow changes, and can be used to identify cerebral hypoperfusion patterns in patients with neurocardiogenic syncope, orthostatic hypotension, and orthostatic cerebral hypoperfusion syndrome. Despite the diagnostic value of TCD, challenges such as technical operator dependency, interpretation variability, and the need for standardized protocols persist. Future research directions include the integration of TCD with advanced imaging modalities, leveraging artificial intelligence and machine learning for data interpretation, and refining personalized diagnostic approaches. Standardization and technological enhancements of TCD applications further hold promise for improving syncope management by providing a nuanced understanding of cerebral hemodynamics. This review explores the pathophysiology of syncope, focusing on the reflex and orthostatic forms, and highlighting the role of TCD in syncope evaluation.

Recent advances in neurointerventional strategies, including the endovascular thrombectomy (EVT) and carotid artery stenting (CAS) techniques, have revolutionized ischemic stroke management by expanding treatment options and improving patient outcomes. Conventional transcranial Doppler (TCD), a tool long used in stroke care, lacks the ability to directly visualize vessels, limiting its application. However, TCD is still valuable as a non-invasive adjunctive monitoring strategy in neurointervention, owing to its ability to provide continuous, real-time bedside hemodynamic monitoring, offering precise numerical data, high repeatability, low invasivity, and no risk of radiation or contrast agent exposure. This unique capacity for continuous monitoring is particularly useful when integrated with artificial intelligence (AI) for data interpretation. This review explored the potential of TCD as an adjunct tool in neurointervention, emphasizing its roles in EVT and CAS. In EVT, TCD aids to evaluate post-recanalization blood flow, predicting clinical outcomes by assessing cerebral autoregulation and collateral status, and identifying patients at risk of hyperperfusion syndrome. TCD can further aid in stroke risk assessment in patients with asymptomatic carotid stenosis, as well as the selection of candidates for CAS by detecting microemboli, assessing the cerebrovascular reserve, and evaluating ophthalmic artery flow reversal. It can also be used to detect cerebral hyperperfusion following CAS. The utility of TCD extends to other endovascular procedures beyond neurointerventions, where automated and AI-assisted devices enhance its real-time intraoperative neuromonitoring abilities. This review discusses the potential of TCD to refine patient selection, predict outcomes, and enhance the efficacy of neurointerventional procedures.

Background: Although ultrasound is widely used in clinical practice, educational opportunities for medical students, particularly those in neurology, remain limited. This study aimed to evaluate the impact of neurological US education on first-year medical students and provide insights for future curriculum development. Methods: A prospective, single-center study was conducted from 2022 to 2023 involving 231 first-year medical students over two years at the Chungnam National University College of Medicine. The sessions on Transcranial Doppler and carotid Doppler included a 30 minutes lecture, a 30 minutes demonstration by a neurology specialist, and optional hands-on practice, respectively. A post-session survey assessed students’ feedback, preferences, and willingness to engage in US education. For the analysis, the Likert-scale responses were dichotomized into positive and negative responses, and comparisons between years were conducted using chi-square or Fisher’s exact tests. Results: Over 80% of students found the sessions helpful in understanding anatomy and physiology. Student interest in US education significantly increases from 2022 to 2023 (80.5% vs. 92.4%, p=0.013), along with overall satisfaction (82.5% vs. 96.2%, p<0.001). Students preferred optional programs and instructions from specialists or residents. The demand for expanded US education showed an increasing trend (68.0–78.1%), although the difference was not statistically significant. Conclusion Neurological US education positively affects student learning and motivates students to use US in future practice. This study highlights the importance of neurological US education and provides insights for the development of future specialized curricula in neurology.

Background: Coronary artery calcification and carotid plaque are recognized indicators of atherosclerosis, both linked to elevated cardiovascular and cerebrovascular risks. This study investigates the association between coronary artery calcification and carotid plaque and examines key risk factors associated with carotid plaque presence. Methods: We enrolled 2,620 participants who underwent coronary artery calcium scoring via computed tomography and carotid ultrasound for health check-up from January 2017 to December 2022. Patient data, including age, sex, hypertension, diabetes mellitus, dyslipidemia, smoking history, body mass index, glucose, cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and lipoprotein(a), were collected. Logistic regression analyses were performed to explore the relationship between coronary artery calcification and carotid plaque, adjusting for major cerebrovascular risk factors. Results: Coronary artery calcification was present in 44.7% of participants, and carotid plaque was detected in 43.5%. Univariable analysis showed a significant association between coronary artery calcification and carotid plaque (unadjusted odds ratio: 4.393, p<0.001). In the multivariable model, which included age, sex, hypertension, dyslipidemia, glucose, low-density lipoprotein cholesterol, and coronary artery calcification presence, coronary artery calcification remained an independent predictor of carotid plaque (adjusted odds ratio: 2.327, p<0.001). The model’s area under the receiver operating characteristic curve was 0.768. Conclusion Our study demonstrates that coronary artery calcification is independently and significantly associated with carotid plaque in a health check-up population. Carotid imaging, such as carotid ultrasound, may be beneficial for early detection and management of carotid atherosclerosis in patients with coronary artery calcification.

Endovascular therapy (EVT) is strongly indicated for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) in the anterior and posterior circulation according to international recommendations, but the benefit is unclear for AIS patients with distal vessel occlusions (DVO) since these patients were systematically excluded from the vast majority of randomized controlled clinical trials (RCTs) establishing the safety and efficacy of EVT. Observational data from multiple registries appear promising but also highlight numerous challenges: identification of DVO is not straightforward and may necessitate advanced imaging, potential clinical benefits from the intervention are more limited than in LVOs since DVO patients present with milder deficits, recanalization of smaller caliber arteries is technically challenging and associated with greater risk for complications namely symptomatic intracranial hemorrhage and vessel perforation. There are multiple ongoing RCTs evaluating the safety and efficacy of EVT in AIS patients with DVOs in Europe, North America and Australasia. In view of the former considerations the current narrative review aims to present the different approaches to define DVO, summarize the epidemiology and natural history of DVO under best medical treatment, outline the diagnostic utility of different imaging modalities and critically address the observational data on the benefits and risks of EVT for DVO, with a special focus in M2 middle cerebral artery occlusions. Finally, we will also discuss the design and methodology of ongoing RCTs that will provide definitive data on the safety and efficacy of EVT for AIS patients with DVO.