After a dissection, almost all the recurrence happens in the first week

The edition in brief

The neurology desk opens with a multicentre Korean registry analysis of 711 patients with craniocervical artery dissection presenting within seven days. Recurrent ischaemic stroke reached 8.7% by day 1 and 17.4% by one week, against 19.9% at one year — incidence fell from 271.2 events per 1,000 person-days on day 1 to 0.1 beyond day 7. Dissection location did not predict recurrence; stenosis without dilatation and the double lumen sign did, the latter clustering between days 2 and 3. A commentary on CREST-2 argues that carotid stenting is now an evidence-based adjunct to intensive medical management in high-grade asymptomatic stenosis, with patient selection and operator skill as the determining factors. An open-label randomised trial in 62 patients with symptomatic intracranial atherosclerotic stenosis found that adding alirocumab to high-intensity statin reduced stenosis on vessel-wall MRI by a baseline-adjusted 8.9 percentage points over six months. In 85 patients with late-onset unexplained epilepsy, higher plasma p-tau217 was associated with worse cognition, with about a quarter of the association mediated by disrupted spindle-slow oscillation coupling. A pearl covers the first seizure clinic assessment. The edition closes with an appraisal of the 2024 McDonald criteria and the misdiagnosis risk of applying them outside expert centres.