Alex Stebner MD

🤔How did the recent #MeVO #EVT trials change practice patterns worldwide??🏥🌎 Salome Bosshart, @MDStebnerAl and team will tell you in this paper!👀 journals.sagepub.com/doi/10.1177/15… @HotchkissBrain @DCNSNeuro @nishita_singh3 @draravindganesh

❓❓❓Ever wondered what do to for follow up of unruptured intracranial #aneurysms treated with #intrasaccular devices #WEB #coiling?🤔 @MDStebnerAl @PCimflova and team have you covered!💪 @DCNSNeuro ⏩journals.sagepub.com/doi/10.1177/15…

Leaky Brains, Sneaky Strokes: BBB Breakdown Associated With Penumbra Infarction In this #BloggingStroke post, @MDStebnerAl discusses #Stroke article by @fe_le_nae et al. ahajournals.org/do/10.1161/blo… @clauszsimonsen @LauranneSchelde @Fie0815 @salvasapedraza @DGNR_org @CSI_Lab

Health economic impact🧠💰 of incomplete #reperfusion in acute #LVO #stroke #EVT: check out this #ESCAPE-NA1 analysis by @MDStebnerAl, @PCimflova and team !🚨 link.springer.com/article/10.100…

🚨meeting announcement 📣#BIOSTROKE meeting (📅 Feb 23-25, 2026) in the beautiful city of Munich🥨🍻🏔️. The venue is Castle Hohenkammer 🏰 and the registration fee *includes* acommodation. @esmintsociety @ESOstroke endorsed! Pls consider joining us☺️🙏 biostroke.de/biostroke

Global Burden of Stroke: A Comprehensive Analysis of Global Trends from 1990 to 2021 In this #BloggingStroke post, @MDStebnerAl discusses #Stroke article by He et al. #AHAJournals ahajournals.org/do/10.1161/blo…

@MDStebnerAl took a close look at the association of #eTICI and #hemorrhage after #EVT in the #ESCAPE-NA1 data🧐 Poor reperfusion➕good #ASPECTS🟰⏫hemorrhage risk⚠️ BUT poor reperfusion➕poor #ASPECTS🟰⏬hemorrhage risk: jnis.bmj.com/content/early/… @mayank_G0 @mihill68

💡In this review Satoru Fujiwara is summarizing evidence📊 and outlining future directions for management of #carotid webs🕸️ @mayank_G0 @MDStebnerAl @DCNSNeuro ▶️link.springer.com/article/10.100…

The #MeVO #EVT trials were neutral😱 but that doesn't mean it's not important to diagnose MeVO stroke accurately!! Find out how to do it in this pictorial review🖼️ by @MDStebnerAl and team💡💡journals.sagepub.com/doi/10.1177/15…

To Stent or Not to Stent: That Is the Tandem Question In this #BloggingStroke post, @MDStebnerAl discusses #Stroke article by @sousajoaoandre & @MRodrigoGisbert et al., presented at #ISC25. #AHAJournals @AHAScience ahajournals.org/do/10.1161/blo…

Turning Preclinical Chaos Into Order In this #BloggingStroke post, @MDStebnerAl discusses #Stroke article by Llovera et al. #AHAJournals @ArthurLiesz ahajournals.org/do/10.1161/blo…

The January episode of the #StrokeAlert Podcast is now available. In this episode, @NAsdaghi highlights articles in the Jan. issue of #Stroke & interviews @johanna_ospel & @UPensato about “Cerebral Infarct Growth: Pathophysiology, Pragmatic Assessment, and Clinical Implications.”

Statistical principles in neurointervention part 1: basic principles, descriptive statistics and univariable analysis By @johanna_ospel et al. Via @JNIS_BMJ jnis.bmj.com/content/early/…

How has #neuroimaging for acute #stroke evolved over time? 🤔🔍 Check out this brief comment @StrokeAHA_ASA⏬⏬ @bijoymenon #neurorad #INR @neurology ahajournals.org/doi/epdf/10.11…

@teachplaygrub Great overview again, thank you Lea!

Just because it’s called SMALL vessel disease doesn’t mean it doesn’t have a BIG impact!   Small vessel disease (SVD) is a BIG contributor to vascular dementia, along w/large vessel cortical infarcts   Do YOU know all the faces of small vessel disease?   Common imaging markers of SVD include:   --White matter hyperintensities (WMHs) --Lacunes --Enlarged perivascular spaces --Microbleeds --Small subcortical infarcts --Brain atrophy   But what you see isn’t always what you get!   Even in patients w/similar degrees of SVD, clinical symptoms can be very variable.   Variability exists because of: --Perilesional penumbra --Remote effects from disruption of brain connectivity --Differing brain reserve & compensatory mechanisms   So remember, imaging findings of SMALL vessel disease are just the tip of a very BIG iceberg

@teachplaygrub @TheAJNR Nice summary, thank you!

Time to go with the flow! When you see abnormal vasculature, do you just say “vascular malformation” & hope the endovascular guy figures it out? This months @theAJNR SCANtastic has the latest on cerebrovascular malformations: ajnr.org/content/45/12/… Here’s the cheat sheet you NEED on how to differentiate vascular malformations on imaging! Cerebrovascular malformations can be divided into high & low flow: HIGH FLOW --Arteriovenous malformation (AVM): it is a true malformation so you will see a nidus of abnormal vessels—that’s the malformation --Dural arteriovenous fistula (dAVF): it is a fistula, so it’s a direct connection. You will see abnormal vessels but NO NIDUS LOW FLOW --Cavernous malformation (cav mal): has a popcorn appearance. Remember: KavMal looks like Kernel or a kernel of pop corn --Capillary telangiectasia (cap tel): has a light hazy enhancement, susceptibility signal loss & T2 signal. Remember: It truly looks like a capillary bed if you could see one! --Developmental venous anomaly (DVA): has a caput medusa appearance (looks like the snakes on Medusa’s head) Remember: DVA looks like DIVA and Medusa was a true DIVA! In this month’s @theAJNR, Itskeson et al. found that besides the risk of hemorrhage, vascular malformations, like dAVF, can also cause cognitive impairment! You can check it out for yourself: ajnr.org/content/45/12/… Now you know the basic cerebrovascular malformations. There are variations or mixed malformations, but these are the building blocks. Hopefully, now you won’t have any more consternation about vascular malformations!

#FlashbackFriday 📊ESCAPE-MeVO trial ⭕️Does acute, rapid endovascular treatment after ischaemic stroke due to medium vessel occlusion results in better clinical outcomes? ⭕️PROBE study design ⭕️ Recruitment target: 500 journals.sagepub.com/doi/full/10.11… @johanna_ospel @mayank_G0 @mihill68

@teachplaygrub 😅 great explanation!

Do you feel there’s a back-log of findings in a spine MRI report?   Everyone talks about discs & facets, but not everyone talks about the endplates.   Do you?   Do you need to talk about degenerative changes (Modic changes) of the endplates?   Here’s thread w/all you need to know!   Over 30 years ago, Modic et al. found there were 3 types of degenerative endplate changes:   (1) T2 bright changes (indicating edema, Modic 1) (2) T1 bright changes (indicating fat, Modic 2) (3) T1 & T2 dark changes (indicating sclerosis, Modic 3)   But what do they mean?   MODIC 1 --Bright on T2, indicating edema.  --Pathology shows inflammation, vascular granulation tissue, & high cellular turnover --Vascular granulation tissue means these can enhance on post contrast images—mimicking discitis!   MODIC 2 --Bright on T1, indicating fat. --Show fatty conversion of the marrow & low cellular turnover. --I think of them as the middle-aged dad bod of degenerative change—lots of fat & slow to change!   MODIC 3 --Dark on T1 & T2, indicating sclerosis --Pathology showsdense fibrous tissue & sclerosis. --Like endplates get fossilized—once you turn into rock, you are never going back.   I remember these bc the forces at work in the endplates are like the famous astrology signs—almost.    Earth (sclerosis) Wind (fatty changes, when you feel fat & full, you tend to give off wind!) Fire (inflammation, edema)   Now you can use this when you go BACK to work on reading spine MRIs!

@teachplaygrub Great summary!

Have MULTIPLE questions about MULTIPLE sclerosis?   Having trouble seeing neuromyelitis optica?   In a fog about MOG?   Here’s the cheat sheet you NEED to distinguish the demyelinating diseases!   Demyelinating diseases predominantly involve the optic nerves, brain, & spine.    The three main chronic demyelinating diseases are Multiple sclerosis (most common), neuromyelitis optica (NMO), & myelin oligodendrocyte glycoprotein (MOG) antibody associated disease or MOGAD   Each has its own features in the optic nerve, brain, & spine.  Here’s how to remember them!   MS Optic nerve: MS only has 2 letters, so MS involvement of the optic nerve tends to be short segment Brain: Letter M makes the shape of the perivascular distribution of lesions along the ventricles (Dawson’s fingers) Letter S makes the shape of the subcortical U fiber involvement Spine: MS is only 2 letters, so lesions are usually less than 2 vertebral bodies in length   NMO Optic nerve: NMO is a longer abbreviation, three letters, so longer involvement NMO can stand for Near My Occiput. Occiput is posterior, so more posterior nerve involvement Brain: NMO can stand for Near My Ocean. What is your brain’s ocean? The ventricles. NMO lesions are all periventricular Spine: NMO is 3 letters, so lesions usually more than 3 vertebral bodies in length   MOGAD Optic Nerve: Remember MO’ GAD-olinium.  So things that cause more regions of enhancement.  MOGAD lesions are commonly bilateral & long segment & enhancement can extend perineural Brain: Remember LO’ GAD.  MOGAD typically involves the lower areas of the brain Spine: Remember MO’ PLAID. MOGAD can give a plaid-like H shape in the cord from predominantly gray matter involvement   Hopefully, this cheat sheet will help you remember how to distinguish the demyelinating diseases! It ain’t lyin’ about diseases of myelin!

@Yasaman_Neuro Congratulations 🎉

Officially a board certified neurologist today! From my first book ever to my first board, grateful for the journey and the privilege to care for my patients🧠