Jason W. Allen

Objective: To quantitatively assess visual motion sensitivity in vestibular migraine (VM). Study design: Cohort study. Setting: Single institution. Patients: Prospective cohort of individuals with VM and healthy controls. Interventions: Subjects rated visually induced symptoms while watching 20 videos with varying degrees of optical flow. After each video, participants rated the intensity of their predominant symptom (headache, dizziness, nausea, or fogginess) on a 5-point Likert scale. Main outcome measures: The primary outcome was a composite symptom score (sum of ratings), which was compared with other patient-reported outcome measures, including (1) Dizziness Handicap Inventory, (2) VM-Patient Assessment Tool and Handicap Inventory, and (3) Visual Vertigo Analog Scale, among other headache, cognitive, and psychometric questionnaires. Results: The study enrolled 17 participants with VM and 19 healthy controls. The rate of visual motion sensitivity (any symptom) was significantly higher in the VM arm [71.9% vs. 13.7% in controls, X ² (4, 705)=245.6, P U =304.0, P P P P =0.01, although not significant after Bonferroni correction). Conclusions: Visual motion sensitivity is more frequent in those with VM than in healthy controls, and symptom scores correlated with other established patient-reported outcome measures, especially the Visual Vertigo Analog Scale. Visual motion sensitivity is a distinct and measurable feature of VM and can inform disease severity and treatment response.

Artificial intelligence (AI) is rapidly transforming medical imaging, yet its integration into neuroradiology remains uneven. This survey-based study assesses AI usage, tools, applications, barriers, and future expectations among U.S. neuroradiology departments. This cross-sectional survey questionnaire comprised 19 items, blending multiple-choice, multi-select, and open-ended formats. Descriptive statistics were used to identify patterns in data. Most departments (81%) reported AI use, primarily for stroke-related applications, with smaller numbers using tools for report generation, segmentation, and image quality enhancement. Most clinical tools were FDA-approved. AI had minimal perceived impact on workload, and performance was viewed as variable, with concerns about accuracy and false positives. Cost, integration challenges, and limited efficacy evidence were the main barriers to adoption. Despite these limitations, most respondents anticipated increased AI use over the next five years. Findings underscore the need for clinician-vendor collaboration to realize AI's potential in reducing workload and improving outcomes.

SUMMARY: Alzheimer disease (AD) is the leading cause of dementia, with an estimated 6.9 million Americans aged 65 and older living with Alzheimer dementia today, with this number projected to grow to 13.8 million by 2060. Amyloid and τ accumulation underpin our understanding of the pathophysiology of AD, with the abnormal accumulation of these proteins leading to neurodegeneration. With the recent approval of antiamyloid monoclonal antibody therapies for patients with early-stage Alzheimer disease by the Food and Drug Administration, there is renewed energy and focus on brain imaging for diagnosis, triage, and monitoring of patients with neurodegenerative disease. Furthermore, PET imaging of amyloid and τ has revolutionized our understanding of dementia progression and staging, and influences patient management in the clinical setting. We aim to update radiologists on the evolving role of amyloid and τ PET in clinical practice, emphasizing the need for standardized workflows and the integration of molecular imaging data with other disease biomarkers. We also discuss the clinical implications of amyloid and τ PET, including their impact on diagnosis and treatment decisions, as well as the challenges of reimbursement and workforce capacity. With recent shifts in the AD management landscape, it is crucial for radiologists to keep abreast of recent advances in clinical practice, thereby ensuring effective patient care.

BACKGROUND: Supratentorial intracerebral hemorrhage (ICH) is common and often devastating. In a randomized controlled trial, ICH evacuation with minimally invasive trans-sulcal parafascicular surgery (MIPS) improved functional outcomes at 180 days compared with medical management (MM), primarily in patients with lobar hemorrhages. The cost-effectiveness of MIPS compared with MM is explored. METHODS: A Markov model compared costs and outcomes using ENRICH trial (Early Minimally Invasive Removal of Intracerebral Hemorrhage) data for MIPS versus MM over the 6-month trial duration. Costs were 2020 US$ and effectiveness was quality-adjusted life years. Monthly model transitions between modified Rankin Scale score health states were estimated from trial data. Costs were obtained from US databases and literature. MIPS device costs were $5705/patient. Primary outcomes were total hospital costs from the hospital perspective and the incremental cost-effectiveness ratio between MIPS and MM (ie, the 6-month cost difference between strategies divided by quality-adjusted life year difference) from the healthcare perspective for patients with lobar ICH. Sensitivity analyses were performed. RESULTS: From the hospital perspective, MIPS costs were $2782 less per patient than MM ($74 252 versus $77 034), with MIPS having decreased the intensive care unit hospital length of stay, non-MIPS neurosurgery, mortality, and rehospitalization. From the healthcare perspective, including hospital and nonhospital costs, MIPS in lobar ICH cost $8850 less and gained 0.068 quality-adjusted life year per patient compared with MM; thus MIPS was dominant (less costly and more effective). Results were robust to individual parameter variation over plausible ranges and, with all parameters varied simultaneously in a probabilistic sensitivity analysis, MIPS was dominant in >93% of 10 000 model iterations and favored in >99% at $100 000/quality-adjusted life year gained (a common US benchmark). CONCLUSIONS: In the ENRICH randomized controlled trial, MIPS cost less and was more effective compared with MM from both hospital and healthcare perspectives for patients with lobar ICH. REGISTRATION: URL: https://clinicaltrials.gov/ ; Unique identifier: NCT02880878.

Case 1: A 31-year-old woman presented with secondary amenorrhea, polyuria, and polydipsia. Three years later, magnetic resonance imaging of the brain done for headaches found thickening of the pituitary infundibulum. Laboratory evaluation indicated central vasopressin deficiency, mild hyperprolactinemia, and central hypogonadism. Six months later, progression of the infundibular lesion was documented, now contacting the optic chiasm. Biopsy showed epithelioid histiocytes, chronic inflammation, and gliosis. On postoperative scan, a lesion in the parietal calvaria was identified, which was solitary on a bone scan. The patient received cytarabine for 12 months with resolution of infundibular and bone lesion on positron emission tomography-computed tomography scan 1 year later. Case 2: A 23-year-old man presented with polyuria, polydipsia, and unilateral tinnitus. Laboratory evaluation indicated vasopressin deficiency and central hypogonadism. External ear canal biopsy indicated an infiltrative lesion with eosinophils, small lymphocytes and histiocytes. Magnetic resonance of the brain revealed hypothalamic/infundibular and parietal and mastoid bone lesions; no other lesions were identified on positron emission tomography-computed tomography. Patient received cytarabine for 1 year with resolution of lesions, which was maintained during follow-up of 4 years. Although rare, Langerhans cell histiocytosis in adults should be considered in the appropriate clinical scenario. Multidisciplinary treatment is required.