Chronic subdural hematoma (CSDH) is a frequent neurosurgical issue, but ischemic cerebrovascular accidents (CVA) following surgery for CSDH are rare and present significant clinical challenges, especially in patients requiring oral anticoagulation (OAC). This case describes an 87-year-old male with atrial fibrillation who developed acute right-sided weakness and aphasia due to an M2 segment occlusion of the left middle cerebral artery (MCA), two weeks after bilateral CSDH evacuation and OAC cessation (the "Apixaban Gap"). The patient underwent successful mechanical thrombectomy with TICI 3 reperfusion, demonstrating marked clinical improvement and favourable functional recovery within three months. This case underscores the risks associated with perioperative anticoagulant interruption in high-risk patients and highlights the therapeutic dilemma in managing concurrent hemorrhagic and thrombotic complications. The technical feasibility and benefit of mechanical thrombectomy for medium vessel occlusions (MeVO) in the post-neurosurgical context are discussed. Ultimately, the case supports individualized, multidisciplinary decisions for early intervention and timely re-initiation of OAC, showing that neither advanced age nor recent neurosurgical history should be absolute contraindications to life-saving stroke interventions when stringent selection and rapid workflows are maintained.

Background: Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) although two independent clinical entities but can present in the same patient as a continuum of the same disease process. PRES can be characterized by varied neurological symptoms such as headache, impaired visual acuity or visual field deficit, confusion, impaired consciousness, seizures, and motor deficits. Ischemic infarctions in the territory of vasogenic edema post PRES is not uncommon. RCVS is typically associated with severe thunderclap headaches and reversible segmental vasoconstriction of cerebral arteries and is often complicated by ischemic or hemorrhagic stroke. More research is required to clearly delineate the link between them. Case: Here we report the case of a normotensive lady who in her post partum period developed severe holocranial headache with seizure and confusional state. A MRI Brain done showed T2 /FLAIR hyperintensities in bilateral parieto-occipital and frontal lobes suggestive of vasogenic edema and a diagnosis of PRES was made in her initial admission and she improved with conservative management. But soon after she again developed headache followed by dysarthria, left more than right sided weakness and right visual inattention and right-left disorientation. MRI Brain done now showed changes suggestive of PRES with associated infarcts. But a CT angiography done now showed evidence of intracranial vasospasm. Patient was diagnosed and managed like RCVS. However, no underlying cause of PRES/RCVS could be determined in her case except her postpartum period which could be considered as risk factor for both these conditions. Conclusion: This case highlights that PRES and RCVS although relatively uncommon neurological disorders, they share some common clinical and radiologic features and dilemma arises when clinico-radiological features suggestive of both conditions develop in same patient like seen in our case. Therefore, the two conditions can be thought of as a manifestation of same underlying disease process and further studies are required to establish this hypothesis.

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Abstract: Carotid artery stenosis (CAS) is a significant cause of stroke, with common risk factors including advanced age, diabetes, coronary artery disease, smoking, and a history of stroke or transient ischemic attack (TIA). An often underrecognized cause is radiation-induced CAS, which can lead to serious complications. While radiotherapy plays a vital role in managing head and neck cancers, it may also damage blood vessels, leading to vascular disease.We report the case of a 71-year-old male with bilateral carotid stenosis secondary to prior radiotherapy, who presented with an acute left cortical infarct. Case Details: The patient arrived with sudden onset of left facial deviation and right-sided weakness, scoring an NIHSS of 8. He had a medical history of hypertension and tongue cancer, treated with chemotherapy and radiotherapy in 2019. MRI revealed an acute infarct in the left cerebral cortex. Cerebral digital subtraction angiography (DSA) showed 70% stenosis of the right internal carotid artery (ICA) and 90% stenosis of the left ICA. As he was outside the window for thrombolysis, conservative management was initiated, followed by left ICA stenting. Post-procedure, he showed good recovery and was discharged on dual antiplatelet therapy and statins. Discussion: Radiation-induced CAS occurs in approximately 25% of patients, with a cumulative 10-year risk exceeding 25%. The incidence varies depending on cancer type, and data specific to tongue carcinoma is limited. A study by Seto K et al., reported only a 4% incidence in tongue cancer patients, underscoring the need for more research. The scarcity of data hampers early diagnosis and preventive care for radiation-associated CAS. Conclusion: Managing radiation-induced CAS is complex due to fibrosis and scarring in the neck region. This case highlights the importance of routine follow-up in patients with a history of head and neck radiotherapy. Carotid Doppler ultrasound may serve as an effective screening tool for early detection.

Mental health defined as the state of emotional, cognitive, psychological, social, and spiritual well-being of individuals. In this sense, older adults, as time goes by, experience situations related to disconnection, abandonment, loss, and, consequently, the disintegration of their social core. Therefore, the objective of this article is to define the importance of mental health in this age group, describing intervention guidelines from a Psychogerontological perspective, with the goal of promoting healthier environments. Finally, the article reflects on the importance of integrating personnel trained in mental health to address the needs of older adults and their families, and to develop strategies for prevention, promotion, and education related to mental health in old age.

Post-Stroke Incomplete Evacuation of Urinary Bladder: Are we Missing Something?