Abstract: Background. Cavum septum pellucidum (CSP) and cavum vergae (CV) are anatomical variations that may persist into childhood, adolescence, or adulthood. When these cavities become abnormally large, they are classified as cysts. The mechanism leading to expansion is poorly understood. Although rare, symptomatic CSP and CV cysts can present with a wide range of clinical manifestations. Case report. A 20-year-old Caucasian male presented with progressively worsening symptoms over several months, including persistent headaches and dizziness. Neurological evaluation showed no abnormalities, with intact cranial nerve function, normal muscle strength, and no signs of paresis. Imaging identified CSP and CV cysts causing obstructive hydrocephalus. MRI findings confirmed progressive cyst enlargement and obstruction of foramen Monro. The patient underwent neuroendoscopic fenestration of the cyst with resolution of both hydrocephalus and the symptoms. A CT and MRI scan of the brain performed 12 years before revealed a developmental variant, showing no evidence of cyst formation or ventricular enlargement and without hydrocephalus at that time. This case provides a rare opportunity to observe cyst growth dynamics over time. Conclusion. This case presents the importance of recognizing symptomatic CSP and CV cysts as rare but significant causes of obstructive hydrocephalus. The progression from a developmental variant to cyst formation over time illustrates the value of long-term imaging follow-up in such cases. Neuroendoscopic fenestration provided complete resolution of symptoms, demonstrating the effectiveness of surgical intervention in such cases.

Abstract: Background/Objectives: Mild traumatic brain injury (mTBI) presents with persistent, heterogeneous symptoms requiring multifaceted care. Although interdisciplinary rehabilitation is increasingly recommended, implementation remains inconsistent. This study aimed to synthesize existing literature and clinician perspectives to construct a practice-informed conceptual framework for interprofessional mTBI rehabilitation. Methods: Structured interviews were conducted with 100 clinicians—including neurologists, neuropsychologists, optometrists, occupational and physical therapists, speech-language pathologists, neurosurgeons, and case managers—across academic, private, and community settings in the United States. Interviews followed a semi-structured format adapted for the NIH I-Corps program and were analyzed thematically alongside existing rehabilitation literature. Results: Clinicians expressed strong consensus on the value of function-oriented, patient-centered care. Key themes included the prevalence of persistent cognitive and visual symptoms, emphasis on real-world goal setting, and barriers such as fragmented communication, reimbursement restrictions, and referral delays. Disciplinary differences were noted in perceptions of symptom persistence and professional roles. Rehabilitation technologies were inconsistently adopted due to financial, training, and interoperability barriers. Equity issues included geographic and insurance-based disparities. A four-domain conceptual framework emerged: discipline-specific expertise, coordinated training, technological integration, and care infrastructure, all shaped by systemic limitations. Conclusions: Despite widespread clinician endorsement of interprofessional mTBI care, structural barriers hinder consistent implementation. Targeted reforms—such as embedding interdisciplinary models in clinical education, expanding access to integrated technology, and improving reimbursement mechanisms—may enhance care delivery. The resulting framework provides a foundation for scalable, patient-centered rehabilitation models in diverse settings.

Abstract: Background/Objectives: Intracranial macroelectrode implantation is a pivotal clinical tool in the evaluation of drug-resistant epilepsy, allowing further insights into the localization of the epileptogenic zone and the delineation of eloquent cortical regions through cortical stimulation. Additionally, it provides an avenue to study brain functions by analyzing cerebral responses during neuropsychological paradigms. By combining macroelectrodes with microelectrodes, which allow to record the activity of individual neurons or smaller neural clusters, recordings could provide deeper insights into neuronal microcircuits and the brain’s transitions in epilepsy and contribute to a better understanding of neuropsychological functions. In this study, one or two hybrid macro-micro electrodes were implanted in the anterior-inferior insular region in patients with refractory epilepsy. We report our experience and share some preliminary results; we also provide some recommendations regarding the implantation procedure of hybrid electrodes in the insular cortex. Methods: Stereoelectroencephalography was performed in 13 patients, with one or two hybrid macro-microelectrodes positioned in the insular region in each patient. Research neuropsychological paradigms could not be done in two patients for clinical reasons. In total, 23 hybrid macro-microelectrodes with 8 microcontacts each were implanted, of which 20 were recorded. Spiking activity was detected and assessed using WaveClus3. Results: No spiking neural activity was detected in the microcontacts of the first 7 patients. After iterative refinement during this process, successful recordings were obtained from 13 microcontacts in the anterior-inferior insula in the last four patients (13/64, 20.3%). Hybrid electrode implantation was uneventful with no complications. Obstacles included the absence of spiking activity signals, unsuccessful microwire dispersion, and the interference of environmental electrical noise on recordings. Conclusions: Human microelectrode recording presents a complex array of challenges; yet it holds the potential to facilitate a more comprehensive understanding of individual neuronal attributes and their specific stimulus responses.

Abstract: Postural orthostatic tachycardia syndrome (POTS), neurocardiogenic syncope, and orthostatic hypotension are the most common autonomic disorders encountered in clinical practice. Autoimmune etiology and association of these conditions with systemic autoimmune and inflammatory disorders, autonomic neuropathy and post-acute infectious syndromes, including Long COVID, suggest that immunotherapies should be considered as a therapeutic option, at least in a subset of patients. However, treatment of common autonomic disorders has traditionally included pharmacologic and non-pharmacologic symptomatic therapies as the standard approach. Unfortunately, these symptomatic therapies have been of limited or insufficient efficacy to meaningfully improve functional status or result in recovery, especially in patients with severe symptomatology. Case reports, case series, and clinical experience suggest that intravenous and subcutaneous immunoglobulin as well as other immunologic therapies, such as plasmapheresis, corticosteroids and rituximab, may be effective in some patients with severe POTS and other common autonomic disorders who are refractory to standard therapies. In this review, we summarize the literature available on the topic of immunotherapies in POTS, other common autonomic disorders, and Long COVID. We also highlight the need for large, multi-center, placebo-controlled trials of immunoglobulin, plasmapheresis, intermittent corticosteroids and other repurposed immunotherapies in patients with common autonomic disorders who have significant functional impairment.

Abstract: Alzheimer's disease (AD) is a progressive neurodegenerative disorder primarily characterized by memory loss and cognitive decline, which significantly impacts patients' quality of life and imposes substantial emotional, practical, and economic burdens on their families. As the most common cause of senile dementia, AD currently affects approximately 50 million people worldwide, with projections indicating a threefold increase by 2050 due to rising life expectancy and an aging global population. Diagnosis of AD remains challenging. Neuroimaging techniques reveal atrophy in critical brain regions, particularly in the cortex, hippocampus, and limbic system, which are essential substrates for memory, personality changes, and other cognitive functions. The hallmark molecular changes associated with AD include the accumulation of β-amyloid plaques and the formation of tau protein tangles. Several underlying mechanisms contribute to neuron loss, such as oxidative stress, neuroinflammation, microbial dysbiosis and insulin resistance. In this context, exosomes − small extracellular vesicles that facilitate cell communication − transport proteins, DNA, mRNA, and non-coding RNA (ncRNA), all of which play a significant role in the neurobiology of AD. Furthermore, emerging research indicates that exosomal ncRNAs may serve as promising biomarkers for AD, offering the possibility of improved diagnostic precision. This review explores the potential of exossomal ncRNAs as non-invasive biomarkers for AD, focusing on recent advances and future directions in translational studies.

Abstract: Background/Objectives: Deep brain stimulation (DBS) is an effective surgical treatment for Parkinson’s disease (PD) and other movement disorders. Despite its benefits, DBS explantation occurs in 5.6% of cases, with costs exceeding $22,000 USD per implant. Traditional statistical methods have struggled to identify reliable risk factors for explantation. We hypothesized that supervised machine learning could better account for complex interactions among perioperative factors, enabling the identification of novel risk factors. Methods: The Medical Informatics Operating Room Vitals and Events Repository was queried for patients with DBS, adequate clinical data, and at least two years of follow-up (n = 38). Fisher’s exact test assessed demographic and medical history variables. Data was analyzed using Python with pandas, numpy, sklearn, sklearn-extra, matlab, and seaborn. Recursive feature elimination with cross-validation (RFECV) optimized factor selection. A multivariate logistic regression model was trained and evaluated using precision, recall, F1-score, and area under the curve (AUC). Results: Fisher’s exact test identified chronic pain (p = 0.0108) and tobacco use (p = 0.0026) as risk factors. RFECV selected 24 optimal features. The logistic regression model demonstrated strong performance (precision: 0.89, recall: 0.86, F1-score: 0.86, AUC: 1.0). Significant risk factors included tobacco use (OR: 3.64; CI: 3.60 – 3.68), primary PD (OR: 2.01; CI: 1.99 – 2.02), ASA score (OR: 1.91; CI: 1.90 – 1.92), chronic pain (OR: 1.82; CI: 1.80 – 1.85), and diabetes (OR: 1.63; CI: 1.62 – 1.65). Conclusions: Our study suggests that supervised machine learning can identify risk factors for early DBS explantation. Larger studies are needed to validate our findings.

Abstract: Toxic Oil Syndrome (TOS) was a multisystemic disease that emerged in Spain in 1981 due to the ingestion of aniline-contaminated rapeseed oil. Although neurological sequelae, including cognitive deficits, have been documented in long-term survivors, it remains unclear whether TOS leads to chronic or progressive neurodegeneration. In this case-control study, we measured blood concentrations of neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), and phosphorylated tau 217 (pTau217) in 50 individuals with clinically confirmed TOS and 50 matched healthy controls. Biomarkers were quantified using ultrasensitive immunoassay platforms (Quanterix SIMOA SR-X and Fujirebio Lumipulse G600II). Group differences were evaluated using non-parametric tests, and multiple linear regression was applied to assess associations between biomarkers and clinical variables. While NfL levels were slightly higher in TOS patients, the difference was not statistically significant. Similarly, no significant group differences were observed for pTau217 or GFAP. Age was a consistent predictor of biomarker levels, particularly for GFAP and pTau217, and female sex was independently associated with higher GFAP concentrations. Lower educational attainment was linked to increased NfL levels. Clinical status (TOS vs. control) did not significantly predict biomarker concentrations in any model. These findings suggest no evidence of overt or ongoing neurodegeneration in long-term TOS survivors as detected by current blood biomarkers. However, the possibility of subtle or slowly evolving neurotoxic processes cannot be excluded. Longitudinal studies incorporating neuroimaging are warranted to clarify the long-term neurological impact of TOS and to identify potential subclinical trajectories of neurodegeneration in this population.

Abstract: Originally identified as a potential receptor for opioids, sigma-1 receptor is a class of intracellular receptors expressed in various tissues including neurons. As a resident protein in the mitochondria-associated endoplasmic reticulum (ER) membrane, sigma-1 receptor has been found involved in various biological and disease processes including stress responses, neurotransmission, and neurodegenerative diseases. Herein we discuss the history, structure, functions, and pharmacology of sigma-1 receptor and its pathological implications in neurodegenerative diseases.

Abstract: Background: Spinal arachnoid cyst development (SAC) is a rare and debilitating disease with a non-well defined treatment strategy: a series of 5 patients diagnosed with SAC, submitted to neurosurgical treatment, was retrospectively analyzed. Objectives: SACs represent 1-2% of all spinal neoplasms: they can be extradural, intradural, or intrame-dullary, with intradural arachnoid cysts (IDACs) comprising only 10% of these cases. The rarity of SACs and the lack of consensus on the best treatment strategies represent a care challenge: the aim of this study is to explore the effectiveness and outcomes of the neu-rosurgical management in patients with SACs treated at our Institution. Methods: Adult patients who underwent surgical treatment for SACs between January 2020 and De-cember 2023 were included in the study: clinical onset, imaging, surgical technique, and neurological long-term status were retrospectively analyzed. Results: Five patients (3 males, 2 females; average age 53.4 years) were included. The most common symptoms described were paresthesia, gait disturbances, and back pain. Radiological imaging in-dicated that most cysts were at the thoracic level. Surgical interventions primarily in-volved cyst resection and adhesiolysis. Postoperative outcomes showed overall im-provement or stability in Karnofsky Performance Status (KPS) and American Spinal Injury Association Impairment Scale (AIS) scores in the majority of cases, although complications and recurrences occurred. Conclusions: Surgical resection combined with adhesiolysis may prevent the worsening of neurological impairment and potentially improve pain control and clinical outcomes in patients with SACs. However, careful and tailored management is required due to the high potential of complications and recurrences.

Abstract: Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease affecting countless individuals worldwide. PD is characterized by the onset of a marked motor symptomatology in association with several nonmotor manifestations. The clinical phase of the disease is usually preceded by a long prodromal phase, devoid of overt motor symptomatology but often showing some conditions such as sleep disturbance, constipation, anosmia, and phonatory changes. To date, speech analysis appears to be a promising digital biomarker to anticipate even 10 years the onset of clinical PD, as well serving as a useful prognostic tool for patient follow-up. That is why, the voice can be nominated as the non-invasive method to detect PD from healthy subjects (HS).

Abstract: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with an unclear etiology. Emerging evidence suggests that heavy metal exposure may contribute to its development. Objective: This study aims to compare hair concentrations of heavy metals between ALS patients and healthy controls in South Korea to explore potential associations. Methods: Hair samples were collected from 66 ALS patients and 60 healthy individuals at Rodem Hospital between 2022 and 2025. Inductively coupled plasma mass spectrometry (ICP-MS) was utilized to measure levels of mercury (Hg), lead (Pb), cadmium (Cd), aluminum (Al), arsenic (As), and other potentially harmful metals including uranium (U). Results: ALS patients exhibited significantly higher mean concentrations of Hg, Pb, Cd, Al, As, and U in hair samples compared to controls (p < 0.05). Notably, 40% of ALS patients had Hg levels exceeding 50% of the reference upper limit, whereas only 10% of controls showed similar levels. Elevated levels of uranium and other rare metals were identified in specific cases. Conclusion: The findings indicate that ALS patients in South Korea have elevated hair concentrations of specific heavy metals, supporting the hypothesis that heavy metal exposure may be linked to ALS pathogenesis. Further research is warranted to elucidate the mechanisms underlying this association.

Abstract: Recent findings in physical activity epidemiology suggest that physical activity and exercise may help prevent cognitive decline and dementia. However, there is still no consensus on the causal relationship between cognitive function and physical activity or sedentary behavior, nor on the direction of this relationship. In addition to electronic sports (e-sports), which can be played without restrictions on age, sex, time, or location, recent research has examined the relationship between cognitive function and different types of sports and exercise, focusing on motor skill demands. This review explores the background and mechanisms underlying the recommendation of open-skill exercise (OSE) for preventing and mitigating cognitive decline, as well as maintaining and enhancing cognitive function. Furthermore, it discusses the role of OSE and e-sports as lifelong sports. Latent Heritable Confounder Mendelian Randomization has confirmed a causal relationship between physical activity and cognitive function in non-dementia patients, while finding no significant association between cognitive function and sedentary time. Prospective studies suggest that exercise habits, physical fitness, and performance may help inhibit cognitive decline and the onset of dementia. However, intervention studies have not reached a consensus on the effectiveness of exercise in improving cognitive function among the general elderly population or patients with mild cognitive impairment and dementia. In conclusion, aerobic OSE appears to be more effective in preventing cognitive decline and dementia associated with aging compared to closed-skill exercise. E-sports has the potential to integrate cognitive engagement with physical activity, social interaction, and stress reduction, making it a unique and holistic approach to brain health. In other words, e-sports represents a versatile intervention that simultaneously addresses multiple aspects of health.

Abstract: Background/Objectives: This study investigated the effectiveness of intraoperative ultrasonography (IOUS) combined with sodium fluorescein (SF) in evaluating tumor resection completeness in patients with glioblastoma IDH1-wildtype. By comparing SF with IOUS with postoperative magnetic resonance imaging (MRI) for detecting residual tumors, we aimed to evaluate its potential in improving surgical precision and neurosurgical outcomes. Methods: Adult patients with supratentorial IDH-wildtype grade 4 glioblastoma who underwent resection using SF or SF with IOUS during 2015–2024 were included. Results: A total of 97 patients met the inclusion criteria (49 SF group and 48 SF with IOUS group). The gross total resection (GTR) rate was higher in the SF with IOUS group (83.3%) than in the SF group (67.3%), although the difference was not statistically significant (p = 0.112). For residual tumors according to postoperative MRI findings as a result of subtotal resection due to tumor invasion of eloquent anatomical locations, 6/49 (12.2%) patients in the SF group showed a positive result (ϰ: 0.447, p = 0.001), and 4/48 (8.3%) patients in the SF with IOUS group showed a positive result (ϰ: 0.625, p < 0.001). The sensitivity, specificity, negative predictive value, and positive predictive value for predicting residual tumors peroperatively compared with postoperative MRI results were calculated for the SF and SF with IOUS groups. Comparison between the SF and SF with IOUS groups revealed a statistically significant difference in the estimated mean survival time, with 14 months (standard error: 1.236) for the SF group and 24 months (standard error: 4.103) for the SF with IOUS group (p < 0.001). In total, 11/49 (22.4%) patients in the SF group, and 10/48 (20.8%) patients in the SF with IOUS group experienced newly developed neurological deficits postoperatively (p > 0.05). In the SF with IOUS group, 26/48 (54.2%) patients, 14/48 (29.2%) patients, and 8/48 (16.7%) patients had Karnofsky Performance Status scores of 90–100, 70–80, and <70, respectively (p = 0.525), and 12 patients experienced deterioration, 24 patients were stable, and 12 patients had improved at 1 month. Conclusions: SF with IOUS provides a reliable imaging modality for achieving successful GTR and improving surgical outcomes. Nevertheless, further research is necessary to overcome its limitations and better define its intraoperative role.

Abstract: The interaction between cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) in exerting anticonvulsant effects has been scarcely studied. To improve this knowledge, we evaluated CBD and THC, combined or not, in two seizure models in mice, using an improved vehicle formula. Firstly, acute seizures were induced by intraperitoneal (i.p.) pentylenetetrazole (PTZ, 80 mg/kg), and mice received CBD or THC at 1, 3, 6, and 10 mg/kg, or a CBD/THC 1:1 combination at 1.5, 3, and 6 mg/kg, per os (p.o.), one hour before PTZ administration. Secondly, mice received p.o. CBD (10 mg/kg), CBD/THC (1.5, 3, and 6 mg/kg), valproic acid (50 mg/kg), or vehicle, one hour before PTZ (30 mg/kg, i.p.) every other day for 21 days. Behavioral, biochemical, and immunohistochemical analyses were performed to assess the response to PTZ, oxidative stress, and astroglial activation. In the acute model, CBD and THC at 3-10 mg/kg, and their combinations, significantly increased latency to generalized seizures and death, and improved survival rates. In the chronic model, similarly to valproic acid, CBD 10 mg/kg and CBD/THC at 1.5 and 3 mg/kg delayed kindling acquisition, while CBD/THC 6 mg/kg had no effect. CBD and CBD/THC treatments reduced oxidative and nitrosative stress and attenuated astrogliosis, as indicated by decreased glial fibrillary acidic protein and GABA transporter 1 expression, and increased inwardly rectifying potassium channel 4.1 expression in hippocampal regions. However, no cannabinoid treatment prevented the impairment in novel object recognition and Y maze tests. These findings support the potential role of cannabinoids in counteracting seizures, possibly by reducing oxidative stress and astrogliosis. The study also highlights the importance of nanoemulsions as a delivery vehicle to enhance cannabinoid effectiveness while considering the risks associated with direct cannabinoid receptor activation.

Abstract: Background: Postural imbalance with falls affects 80% of patients with Parkinson’s Disease (PD) at 10 years. Standard PD therapies (e.g. levodopa and/or deep brain stimulation - DBS) are poor at improving postural imbalance. Additionally, the mechanistic complexity of interpreting postural control is a major barrier to improving our understanding of treatment effects. In this paper, we review the effects of DBS on balance as measured using posturography. We also critically appraise the quantitative measures and analyses used in these studies. Methods: A literature search was performed independently by 2 researchers using PUBMED database. 38 studies are included in this review, with DBS at subthalamic nucleus (STN-) alone (n=25), globus pallidus internus (GPi-) (n=6), ventral intermediate nucleus (VIM)/thalamus (n=2) and pedunculopontine nucleus (PPN) (n=5). Results: STN- and GPi-DBS reduce static sway in PD and mitigate the increased sway from levodopa. STN-DBS impairs automatic responses to perturbations, whilst GPi-DBS has a more neutral effect. STN-DBS may promote protective strategies following external perturbations but does not improve adaptation. The evidence regarding the effects on gait initiation are less clear. Insufficient evidence exists to make conclusions regarding VIM- and PPN-DBS. Conclusions: STN- and GPi-DBS have differing effects on posturography which suggest site-specific and possibly non-dopaminergic mechanisms. Posturography tests should be utilised to answer specific questions regarding the mechanisms of and effects on postural control following DBS. We recommend standardising posturography measures and test conditions by expert consensus and greater long-term data collection, utilising ongoing DBS registries.

Abstract: Background: serious videogames have already demonstrated their positive impact on rehabilitation and of particular interest is the virtual reality (VR) technology. This immersive technology has been used in this study for a neuroaesthetic experience based on Michelangelo effect for rehabilitation of patients with spinal cord injury. The aim of this study was to test the usability of this system and its capacity to assess patients’ deficits performances. Methods: a VR headset was worn by the participants who experienced a painting simulation of famous paintings (experimental stimuli) versus colored (control stimuli). Trajectories of the hand were studied to obtained different kinematic and spectral parameters to evaluate the user performances. 13 healthy subjects and 13 patients with spinal cord injury participated to the study. Results: significative differences were obtained for most of the parameters between the two groups, except for normalized jerk and energy of the spectrum. Analysis in frequency domain showed that both groups prefer the horizontal movements to discover the canvas. NASA and USEQ scores reported a comfortable and user-friendly system according to patients’ point of view. Conclusions: the system can be a usable tool, the rehabilitative efficacy of which should be tested in patients with spinal cord injury. The kinematic and spectral parameters would allow to evaluate the performances alongside the clinical scales, distinguish pathological and physiological performances.

Abstract: Background: Electroencephalogram (EEG) is a widely used, noninvasive diagnostic tool in neurology. It is frequently employed in assessing epilepsy, altered mental status, and other neurological disorders. However, its overuse in cases where diagnostic efficacy is limited remains a concern, contributing to unnecessary healthcare costs and resource misallocation. This study examines EEG utilization patterns, diagnostic yield, and associated risk factors in a secondary hospital in Saudi Arabia. Methods: A retrospective study was conducted at Alkharj Military Industries Corporation Hospital between May and December 2024. All inpatient and outpatient EEGs performed within hospital departments were reviewed. Patient demographics, clinical indications, and EEG findings were extracted from medical records. EEG indications were categorized into epilepsy evaluation, seizure evaluation, sensory changes, motor changes, syncope, altered consciousness, dizziness, post-cardiac arrest, stroke, headache, cognitive dysfunction, and other causes. EEG outcomes were analyzed for statistical associations with patient characteristics using chi-square tests and logistic regression. Results: A total of 227 participants 59.5% male, mean age 49.4 years were included, with 53.3% being inpatients. The most common indications for EEG were seizure evaluation (31.3%), epilepsy assessment (18.0%), and dizziness (13.6%). Abnormal EEG findings were observed in 29% of cases, with generalized slowing (64%) being the most frequent abnormality. Statistical analysis revealed a significant association between EEG abnormalities and male gender (p = &lt;0.01), elderly age (p = &lt;0.01), dizziness (p = &lt;0.01), and post-cardiac arrest (p = 0.03). In contrast, female gender, young adults, and teenagers exhibited lower rates of EEG abnormalities. Conclusion: EEG is frequently used for seizure and epilepsy evaluation, though its diagnostic utility varies. Abnormal findings were more common in elderly males and patients with dizziness or altered consciousness. Refining clinical guidelines for EEG use could improve resource efficiency and diagnostic accuracy. Future research should focus on clearer criteria for its use in different patient populations.

Abstract: Background/Objectives: Action Observation Therapy (AOT) has gained attention as a re-habilitation method for motor function recovery following nerve injury. Although the total observation time and daily session duration have been studied, the effective observation duration per trial remains unclear. This study examined the effect of different observation durations on manual dexterity, mirror neuron system activity, and subjective psychomo-tor effort in healthy adults. Methods: Twenty-four healthy right-handed adults partici-pated in this crossover study under four conditions: observing ball rotations with the dominant hand for one, two, or three minutes, or geometric patterns (control) for two minutes. The outcomes included maximum rotations and errors by both hands during a ball rotation task and interpersonal motor resonance (IMR), indicating mirror neuron sys-tem activity. These measures were compared before and after intervention. Subjective rat-ings of concentration, physical fatigue, and mental fatigue were assessed post-intervention. Results: Rotation performance significantly increased for the interven-tion hand after a 2-minute observation and showed a notable effect (p = .113, r = 0.48) for the non-intervention hand after a 3-minute observation compared to the control. The IMR was significantly greater during the 2-minute observation than in the control. Compared to the 1-minute observation, the 2-minute and 3-minute observations resulted in higher mental fatigue, and the 3-minute observation showed lower concentration levels. Conclu-sions: These findings indicate that observation duration has varying effects on manual dexterity and mirror neuron system activity, with optimal effects observed at specific time intervals while also highlighting the relationship between observational learning and psychomotor effort.

Abstract: Background: Aneurysmal subarachnoid hemorrhage (aSAH) remains a life-threatening cerebrovascular event with high rates of mortality and long-term morbidity. Among its complications, delayed cerebral ischemia (DCI) is a major contributor to poor clinical outcomes. Although cerebral vasospasm has traditionally been considered the primary mechanism underlying DCI, recent studies have revealed the multifactorial nature of this condition. Objective: This review aims to provide a comprehensive overview of the pathophysiology, preventive strategies, and current treatment options for DCI following aSAH. Methods: We performed a narrative review of the literature, focusing on recent findings regarding the etiologies of DCI—including cerebral vasospasm, microvascular spasm, microthrombi, and cortical spreading depolarization—and the effectiveness of various prophylactic and therapeutic interventions. Results: Emerging evidence highlights that vasospasm alone does not account for all cases of DCI. Pharmacological approaches such as nimodipine, clazosentan, and fasudil have shown varying degrees of efficacy. Circulatory management and removal of subarachnoid hematoma via CSF drainage or thrombolytics may reduce DCI risk, although their impact on long-term neurological outcomes remains controversial. Endovascular therapy and adjunctive agents such as cilostazol or anticoagulants have demonstrated potential but require further validation through large-scale trials. Conclusions: Effective DCI prevention and treatment require a multimodal approach targeting diverse pathological mechanisms beyond vasospasm. Improved risk stratification, early detection, and individualized therapy are essential for advancing the management of patients with aSAH.

Abstract: Background and Clinical Significance: Coexistence of spinal hemangiomas and dural arteriovenous fistula (SDAVF) is uncommon. Unclear imaging and progressive neurological impairment require early surgical management. Case Presentation: A 76-year-old woman presented with progressive thoracolumbar pain and bladder dysfunction. Magnetic resonance imaging (MRI) of the thoracic spine revealed a round-shape expansive lesion at D11 with spinal cord edema and homogeneous contrast enhancement. Intraoperatively a vascular malformation resembling a dural arteriovenous fistula (SDAVF) was found in association and histological examination confirmed the diagnosis of hemangioma. Conclusions: this case underscores the importance of thorough imaging evaluation and prompt surgical management in patients presenting with neurological impairment ad a suspicion of spinal hemangioma: this case may provide awareness of potentially associated SDAVF, unrecognized at pre-operative imaging, and technical insights during surgery.