Synchronized Chaos First September Issue: The Wildness of Being

Our regular contributor Rui Carvalho invites readers and contributors to submit poetry to the next annual Nature Writing Contest.

Our contest, Nature 2025-2026, is a new opportunity that we, as organizers, create to reach the rest of the world. Every Contest is a challenge for authors participating and to people that make it happen. This year we invite all authors to write poetry about:
(i) Flowers;
(ii) Trees and wind;
(iii) Water;
(iv) Nature Conservation;
(v) Turtles;
(vi) Love for people and nature;
(vii) Hope and Happiness.

Rules and submission information here.

Image c/o Omar Sahel

Also, one of our regular contributors, Jaylan Salah, whom I’ve known for nearly 20 years, is an Egyptian national and a feminist film critic in the Arab world. She’s spoken virtually on panels at professional conferences and has a few books of poetry published.

Her father, who has been a consistent and encouraging presence in her life, has heart disease and needs a lifesaving bypass surgery. In Egypt people can get this done for $3,500 USD even without insurance, so she’s put together a GoFundMe to raise this. She’d appreciate any contributions or people resharing the fundraiser.

Fundraiser by Shadan Larki : Help My Father Receive Life-Saving Open-Heart Surgery

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The Wildness of Being: Voices Against the Beige World

Image c/o Jean Beaufort

Across these pages runs a stubborn, beautiful refusal to become beige. The writers and artists gathered here confront conformity, grief, displacement, history, education, love, work, politics, memory, and the natural world, yet again and again they discover that the deepest form of resistance is simply to remain fully alive. The Wildness of Being is their shared territory: a place where imagination challenges obedience, memory challenges erasure, and tenderness survives even when the world seems determined to make tenderness impossible.

Olive Springman opens this territory with a determination to remain rooted while staying militantly imaginative in a world demanding conformity, beige normalcy, and patriotic duplication. Her stance establishes the collection’s essential tension: belonging need not mean surrendering individuality. That tension extends into Suleiman Mansir Gado’s essay, which applies Jean Piaget’s theory of childhood development to practical observations of children, reminding us that human beings begin life as curious interpreters of their surroundings and that education must respect that developing intelligence.

Dr. Jernail Singh Anand carries the educational question further. In his reflections on improving education, he asks how schools can encourage original thought rather than manufacture students like products on a factory line. Sobirova Husniyabonu Axrorjon qizi similarly outlines effective pedagogical techniques for foreign-language learning, while Iroda Sobirova considers human capital and its relationship to broader economic growth. Together, these contributions suggest that education is not merely an economic instrument or a mechanism for producing conformity; at its best, it is an investment in human possibility.

That possibility also appears in the work of young professionals defining themselves through their own emerging identities. Alamgir Hossain Raj presents a self-portrait as an emerging Bangladeshi journalist, musician, and digital content creator, while Shinha Sarder offers a profile of himself as an aspiring Bangladeshi musician and entrepreneur. Kamolabonu Inomova presents her research as an emerging medical scientist on the use of artificial intelligence in the diagnosis of stroke. Their portraits capture lives still being assembled—careers, ambitions, identities, and futures that resist the idea that a person must fit neatly into one predetermined role.

Photo c/o Mick Lissone

Dr. Jernail Singh’s career journey, discussed in his interview with writer Rupa Rao, reinforces this spirit. He argues that there is no secret formula for success, only honest work, dedication, and creativity. Alan Catlin offers a grittier version of the same struggle: his poetic speaker is worn down by grunt work but cannot quit, partly because he needs the money and partly because continuing to work is proof that he still exists. Between Anand’s faith in purposeful labor and Catlin’s exhausted persistence lies a fundamental question: how do we preserve a sense of self inside systems that can make people feel interchangeable?

For some contributors, authenticity is inseparable from resistance. Bill Tope’s short story imagines love and the courage to be one’s true self transcending age, gender, and even conventional definitions of what it means to be human. Young-eun Kang’s pieces explore the complexity of personhood and the many facets we contain and radiate to our worlds. Christopher Bernard’s latest installment of Otherwise explores choice under impossible conditions and the struggle to keep the idea of alternatives to oppressive regimes alive. Stephen Betts’ ekphrastic poems continue Marcel Duchamp’s wit and playful satire through another medium. Ismatullayeva Maxliyo discusses a study looking into a protocol weaning toddlers off of excessive screen use and helping them learn to think for themselves and engage with others. Yaqubjonova Madinabonu To’lqinbek qizi urges us to moderate our screen time and maintain our attention by reading paper books. Bobomurodova Gulzina Fazliddin qizi discusses how, while social media and artificial intelligence may be useful tools, we should not let them replace our humanity. These pieces insist that freedom begins in imagination—the ability to conceive that another way of living might exist.

Duane Vorhees discovers a similar freedom in the ordinary, suggesting that the fantastical may be present directly inside mundane life if we learn to look at familiar things with a slant. Mark Young takes that principle onto the page, playing with maps and opening new possibilities through text, line, and color. Adam Fieled’s prose poems turn toward the complicated lives and roles of creative artists, examining what it means to make art while inhabiting the many identities, expectations, and pressures attached to being an artist. Together, these works turn perception itself into an act of rebellion.

Jerome Berglund takes a darker route. His dense, free-associative poems weave images of conspiracy and corruption into a critique of society’s normalization of evil. Adjekpagbon Blessed Mudiaga, meanwhile, speaks truth and vision from within the specific realities, struggles, and beauty of his own time and place. J.J. Campbell writes from a specific posture: middle-aged, weathered, romantic under a crust of cynicism, aware of death’s proximity. Ahmed Miqdad mourns the ongoing violence in Gaza. These works demonstrate that resistance need not have a single voice or aesthetic. It may emerge as surrealism, social criticism, local testimony, fragmented association, or uncompromising witness.

Image c/o Mohamed Mahmoud Hassan

History becomes another battleground against erasure. Charos Ismoilova honors the strength and perseverance of her Uzbek homeland across 35 years of modern-day independence. Shokhida Nazirova’s essay declares that Uzbekistan’s reforms have succeeded in creating a generation that is educated, globally confident, and deeply patriotic, while Sabrina Ravshanova encourages modern Uzbek youth not to become obsessed with the vapid aspects of global consumer culture but instead to live up to the dreams of their ancestors. Zarnigor Salayeva Bekmamad qizi stresses the importance of preserving the ancient Uzbek fortress and city of Katkala. Eshniyozova Sevinch Jumanazar qizi discusses how to understand various cultures’ contributions to syncretic literature, teasing out the long and varied cultural history that has inspired many works. These contributions place modern identity in conversation with history, asking how a culture can enter the future without abandoning the memory that made the future possible.

Shokhida Nazirova’s gratitude for her mother’s consistent care and Berdinazarova Jasmina Mirshod qizi’s celebration of her mother’s steady, devoted love bring history down to the intimate scale of family. Their tributes are echoed by To‘raqulova Dilso‘z Anvar qizi, who resolves to mourn the loss of love while continuing to live, and by Yongbo Ma, whose poems ask how one lives after love ends: by memorializing, ritualizing, and honoring what has been lost.

Love throughout these pages is rarely simple. John Dorsey’s poetry traces the tender outlines of romantic longing and unrequited love. Perwaiz Shaharyar mourns a dead love while remaining suspended in grief and still wondering whether a future might be possible. Mykyta Ryzhykh presents love as a slow, beautiful, ultimately fatal suffocation. Faleeha Hassan’s essay and poem, translated into English by Hussein Nasser Jabr, embrace love in all its contradictions: whatever human beings make of it, whether exalted or ridiculous, sacred or sweaty. These writers refuse the polished mythology of romance and instead explore its tenderness, absurdity, danger, persistence, and aftermath.

Randi Rohde approaches love through an especially painful maternal memory. She reflects on the baby teeth of her child that she saved but never shared, realizing that what was intended as a treasured relic of childhood innocence would have been cruelly overshadowed by the adult teeth violently taken by cancer treatment. The keepsake becomes a meditation on how memory can preserve both love and unbearable pain.

Image c/o Linnaea Mallette

Other contributors examine suffering without allowing it to have the final word. Steven Croft’s literary review of William Walsh’s Haircuts for the Dead describes a protagonist who confronts trauma but refuses to let trauma define her. Jacques Fleury’s “Hills and Valleys” follows a painful yet transformative inner journey through life’s external hardships and internal contradictions toward the discovery and embrace of an authentic self. Claire Photini Karamouzis Chalkias meditates on living with depression as a continual balancing act between despair and defiance, frozen numbness and the dangerous courage of confronting what lies beneath. Philip Butera’s poem is a sustained meditation on existential acedia: the specific kind of sadness that doesn’t come from any single loss but from the gap between what life promises and what living delivers. Isaac Dominion Aju speaks to the responsibility and ability of writers and artists to empathize with, hold, and transmute pain. Nedaa Al-Durubi’s two poems trace an equally painful arc, from a young soul wishing for death rather than endurance to one who has fought countless battles and still wonders whether anything has truly changed.

Yet survival repeatedly becomes a form of creation. Eva Petropoulou Lianou’s poetic cycle moves from disillusionment toward faith in the resilience of the human spirit. Abigail George transforms continual unfulfilled cravings into a guide and a path for helping others. Kushi Nanayakkara insists that peace is not merely the exhaustion of angry words or the emptying of bullets but an active choice that must be planned, written, and released into the world. Thi Lan Anh Tran and Musharraf Hussain make that commitment collective, offering a unified call for the world to choose and learn peace. Stephen Jarrell Williams’ poetry shows the Earth itself healing after a human-caused apocalypse, coming back not exactly as before but something new and different. Mahbub Alam’s piece laments a homeland remembered as beautiful but irrecoverably lost.

Bahtiyar Hidayet’s dark humor provides a devastating counterpoint, showing how, for many displaced and impoverished refugees, happiness can seem possible only in death. His poem exposes the terrible distance between abstract ideals of happiness and the realities of people denied security, home, and dignity. Joshua W. J. Brown similarly turns memory into a form of mourning in his elegy for the burning of Zanzibar Tavern, the historic Toronto strip club at 359 Yonge Street. For him, the fire destroyed more than a building: it erased a working-class, unpolished piece of the city’s memory, a place that had housed decades of lives, labor, loneliness, and desire atop an old morgue. Both works ask what happens when places and people deemed marginal are allowed to disappear without witnesses.

Ri Hossain’s satire attacks another form of social disappearance: the male intellectual who imagines himself exceptionally important while objectifying women and his poetic subjects and fearing humility and genuine intimacy. Anna Zanidaki’s poem explores the ethics of seeing, and the refusal to be seen on any terms but one’s own. Saeed Koushan confronts the inculcation of shame in children for natural joy and exploration. In different registers, both writers challenge systems that teach people to distrust their own humanity.

Image c/o Omar Sahel

The natural world offers an alternative vocabulary. Dr. Muhammad Ishaq Abbasi, in a piece translated from Urdu by Neelum Waqar, paints a quiet summer evening in which the speaker climbs a hill, eats wild jambolan fruits, watches monkeys and a peacock, hears a cuckoo, and feels a light rain. Brian Barbeito finds joy in ordinary days in his garden among deer, cardinals, raccoons, basil, and raspberries. Christina Chin’s haibun celebrates a moment of pure, adorable happiness with a soft puppy. Jerrice Baptiste’s art blossoms into another colorful, joyful flower.

Ravshanova Shakhina Rustamovna celebrates Uzbekistan’s seasons and changing weather. Egor Cherkasov reflects on how meteorologist Luke Howard’s naming and categorizing ethereal clouds opens the door for a quieter kind of reverence — the little god of an afternoon, a birdhouse, a piece of bread, a truth that fits in your palm. In poet Alan Patrick Traynor’s new release The Silence of the Desert, the quiet of the Sahara and the Atlas Mountains becomes not an absence but a place for listening, the space between notes where love and truth become audible. Ali Hasnain echoes this theme with his short story where a speaker rediscovers the value of seemingly “unproductive” moments. Ike Boat celebrates the work and seeks partners for a youth outdoor soccer program in Ghana. These works remind us that wonder need not be spectacular. Sometimes resistance to despair begins with noticing what is alive.

Yeon Myung-Ji gives that natural resilience a more precarious form: cows and sheep huddle together, creatures confronting indifference and uncertainty with something resembling grace. Sayani Mukherjee likewise turns toward the earth, finding solace not as an escape from ruin but as an active contrast to it—something that lives and sings despite destruction.

Sheila Murphy’s poetic response to David Chorlton’s painting occupies a quieter border between nature and consciousness. The painting offers a serene, painterly landscape populated by birds, a mountain, a palm, a hawk, a pear, and a pitcher, while gently wondering whether this stillness possesses its own interior life at night. Against that imagined wholeness stands the speaker’s fractured, restless inner world. The landscape becomes a mirror: apparently still outside, tumultuous within.

Patrick Sweeney’s monostich poems create another kind of landscape. Taken together, they seem to form a lyric sequence or poem in fragments, circling transience, inheritance, and the collision between the natural world and human-made structures of meaning. Mark Young’s maps, meanwhile, transform geography into possibility. Both poets show that landscape is never merely scenery. It is memory, structure, history, inheritance, and imagination.

Image c/o Linnaea Mallette

Susie Gharib expands the sense of loss into an encompassing elegy. Her poetry collection reads as one multilayered lament for a world losing its substance to surveillance, noise, and decay. Against this erosion, the collection repeatedly proposes acts of attention: remembering, observing, imagining, preserving, creating, loving, and refusing to accept the given world as the only possible world.

Even humor becomes part of that resistance. Noah Berlatsky lightens the atmosphere with a brief, amusing observation about perennial skin problems, while Duane Vorhees finds the fantastic lurking in everyday existence. Humor does not cancel suffering; rather, it gives the imagination room to breathe inside it.

The same mixture of gravity and play appears in Mesfakus Salahin’s portrait of the human mind, whose stubbornness can be simultaneously heroic and tragic. We cling to beliefs because persistence can help us survive, yet that same persistence can prevent transformation. This paradox runs throughout the collection. To remain rooted can be courageous, but roots can also become chains. To preserve memory can honor the past, but memory can also imprison us. To mourn can be necessary, but mourning must sometimes become the road back into life.

That is why To‘raqulova Dilso‘z Anvar qizi’s resolve to mourn and continue living matters so deeply beside Yongbo Ma’s rituals of remembrance. Grief does not require forgetting. It requires learning how to carry what cannot be changed. Faleeha Hassan’s expansive vision of love, John Dorsey’s longing, Perwaiz Shaharyar’s suspended grief, and Mykyta Ryzhykh’s suffocating romance all become variations on the same question: what do we do with what has transformed us?

Image c/o Linnaea Mallette

The collection’s answer is not uniform, but it is persistent: we make something from it.

We teach. We write. We paint. We remember. We preserve old cities. We profile ourselves into existence. We question oppressive systems. We challenge shame. We garden. We listen to birds. We laugh about our skin. We honor mothers. We mourn lost children and lost lovers. We imagine alternatives. We choose peace. We keep creating.

Olive Springman’s determination to stay imaginatively rooted therefore becomes an apt emblem for the entire gathering. These contributors do not deny the pressures of conformity, grief, violence, economic hardship, displacement, decay, or historical erasure. Instead, they answer those pressures with multiplicity.

Image c/o Linnaea Mallette

Their worlds contain Piaget and Katkala, mothers and refugees, maps and mountains, musicians and journalists, factory-like classrooms and stubborn brains, baby teeth and adult wounds, puppies and sheep, gardens and strip clubs, dead lovers and living possibilities. They contain ethereal melodies and guttural growls, as Alex S. Johnson’s interview with musician Leila Abdul-Rauf makes especially vivid: her music enacts an internal conflict between ethereal melody and guttural growl, between psychoanalytic self-examination and geopolitical rage. That contradiction is not a flaw. It is the sound of a complex human being refusing to simplify herself for anyone.

In the end, The Wildness of Being is not about escaping the world. It is about looking at the world more intensely and refusing to accept its first definition of us. The fantastical may hide inside the mundane. Peace may begin as a sentence. A map may become an opening. A garden may become a sanctuary. A ruined building may become a memory. A mother’s care may become an inheritance. A dead love may become a ritual. A painful past may become a source of compassion. A classroom may become a place where original minds are liberated rather than standardized.

And a world determined to make us beige may discover, despite itself, that we remain gloriously, stubbornly, irreducibly alive.

Essay from Yaqubjonova Madinabonu To’lqinbek qizi

ELECTRONIC AND PAPER BOOKS

In our modern daily life, there are two main ways to read books: reading through electronic books or paper books. In past times, people could only use printed books, but nowadays, as technology develops day by day, we can also make use of e-books. This article discusses in detail the positive and negative aspects of both traditional and electronic books.


Nowadays, we can read e-books in almost any situation because they are located on our electronic devices, such as phones and tablets. We cannot only read them ourselves, but in situations when we might not be able to, we also have the opportunity to listen to their ready-made audio versions.


Just as online books have a number of useful aspects, they are not without harmful sides. For instance, if we read them for a long time, we may encounter eye disorders, meaning a decrease in visual acuity. Another aspect is that mobile books can easily disrupt readers’ reading routines. Because nowadays phones and other devices feature short-form videos and various entertaining games, they distract people quickly. As a result, the habits and routines of reading books can be disrupted, and interest in reading gradually declines.


Traditional books also have their own unique advantages. Taking them in hand, turning the pages, marking important parts, and keeping them on bookshelves as souvenirs give people a special feeling. Furthermore, printed books help us greatly to concentrate our attention. Printed books also have their respective negative aspects. For example, over time they can deteriorate, their colors can fade, and they can fall apart. Moreover, we face several challenges in
finding newly released literary works because finding new books in remote villages causes difficulties.


In conclusion, both traditional books and electronic books are equally useful. Nevertheless, taking the above thoughts into account, I consider printed books to be more preferable. The reason is that they
help us focus our attention. In my opinion, the advantages of paper books surpass those of e-books.

Essay from Bobomurodova Gulzina Fazliddin qizi


Preserving Humanity in the Age of Technology


AN ESSAY ON CONNECTION, CONSCIOUSNESS, AND MODERN LIFE


As we realize in our daily lives, technology is occupying every single field day by day. Manual labor, various services, and even the education sector that we have performed since ancient times are almost entirely being handled by artificial intelligence (AI). On the one
hand, modern technologies save our time, make our work easier, and help us learn what we do not know in a short period. However, the fundamental question that should make us think is this: while modern technologies are developing and becoming smarter, to what
extent are our own intellectual potential and humanity changing?


True, algorithms create all kinds of conveniences for human beings. In particular, they offer advice by telling us which music we like or which food is healthy or harmful for our bodies. They may even seem like a sympathetic listener, but they cannot truly feel like a human. We converse with artificial intelligence and take advice, but this communication can never replace genuine human emotions and sincerity. Even knowing this, we sometimes run away
from real life and rush towards them.


We spend most of our day in front of phones and other technologies. We strive to gain hundreds of “likes” and subscribers on social networks. In reality, however, we do not make time to sit face-to-face with our relatives and friends and enjoy each other’s company live.
We cannot simply wave our hands and dismiss the time we waste trading such precious moments for the virtual world. Our greatest strength, and the main difference that separates us from artificial intelligence, is the fact that we are human and capable of
understanding the feelings of others.


Using technology is certainly good, but we must not become overly dependent on it; rather, we must not lose our identity. Our future will be built not only by computers and social networks, but by people with sincere emotions and deep thinking. Sometimes, let us put our
phones aside and make time for our loved ones and ourselves. After all, the most important thing in life is to remain a simple and sincere human being.

Essay from Kamolabonu Inomova

THE ROLE OF ARTIFICIAL INTELLIGENCE IN THE EARLY DETECTION OF STROKE

Kamolabonu R. Inomova

Andijan State Medical Institute, Andijan, Uzbekistan

E-mail: inamovak17@gmail.com

ORCID: 0009-0005-4285-4578

Abstract

Stroke is a leading cause of death and long-term disability worldwide. In acute ischemic stroke, timely diagnosis and treatment are critical because the probability of tissue salvage decreases as cerebral ischemia progresses. The principle of “time is brain” therefore underlies modern acute stroke management, particularly when reperfusion therapy is being considered. Recent advances in artificial intelligence (AI), machine learning, and deep learning have created new opportunities to support rapid and standardized interpretation of neuroimaging data.

This review examines the role of AI in the early detection and triage of acute stroke, with particular emphasis on neuroimaging. Current applications include the automated detection of intracranial hemorrhage and ischemic abnormalities on non-contrast computed tomography (NCCT), identification of large-vessel occlusion (LVO) on computed tomography angiography (CTA), automated assessment of the Alberta Stroke Program Early CT Score (ASPECTS), and quantitative analysis of perfusion and magnetic resonance imaging (MRI) data. The potential advantages of AI include rapid image processing, automated alerts, standardized assessment, and support for time-sensitive clinical workflows. However, important limitations remain, including variability in algorithm performance, dataset bias, technical artifacts, false-positive and false-negative results, limited external validation, and uncertainty regarding the effect of AI implementation on patient-centered outcomes.

Current evidence indicates that AI is most appropriately considered a clinical decision-support technology rather than an autonomous diagnostic system. In particular, AI-assisted detection of LVO may improve communication and workflow efficiency and may reduce delays to treatment, although evidence that AI itself improves functional outcomes remains limited. Appropriate external validation, transparency, data protection, and continued physician oversight are therefore essential for safe clinical implementation.

Keywords: stroke; acute ischemic stroke; artificial intelligence; machine learning; deep learning; neuroimaging; computed tomography; CT angiography; CT perfusion; magnetic resonance imaging; large-vessel occlusion; early diagnosis.

Introduction

Stroke is an acute neurological disorder caused by disruption of cerebral blood flow and is broadly classified as ischemic or hemorrhagic. Ischemic stroke occurs when cerebral arterial blood flow is interrupted, most commonly because of thrombotic or embolic occlusion, whereas hemorrhagic stroke results from rupture of a blood vessel and subsequent bleeding within or around the brain.

Acute ischemic stroke is a time-sensitive medical emergency. The extent of irreversible brain injury generally increases with prolonged cerebral ischemia, making rapid recognition, neuroimaging, and selection of appropriate reperfusion therapy fundamental components of acute stroke care [1,2].

Neuroimaging plays a central role in determining the nature and extent of cerebral injury. Non-contrast computed tomography (NCCT) is widely used in the initial assessment because it can rapidly identify intracranial hemorrhage and provide information about early ischemic changes. CT angiography (CTA) is used to evaluate intracranial and extracranial vessels and identify large-vessel occlusion, while CT perfusion (CTP) and MRI can provide additional information regarding tissue viability and the extent of ischemic injury.

Despite major advances in stroke imaging, interpretation remains subject to time constraints, workload, differences in expertise, and the complexity of multimodal imaging datasets. These challenges have stimulated interest in AI-based technologies capable of rapidly analyzing large volumes of imaging data and providing standardized decision-support information [3,4].

Artificial Intelligence in Neurology

Artificial intelligence refers to computational methods designed to perform tasks that typically require human cognitive abilities, including pattern recognition, classification, prediction, and decision support.

Machine learning is a major branch of AI in which algorithms learn statistical patterns from datasets. Deep learning, particularly convolutional neural networks (CNNs), uses multiple layers of artificial neural networks to extract increasingly complex features from data. These approaches are particularly suitable for medical imaging because they can analyze high-dimensional image datasets without requiring every relevant feature to be manually defined.

In acute stroke care, AI has been investigated for several applications, including:

  • detection of intracranial hemorrhage;
  • detection and quantification of ischemic lesions;
  • identification of large-vessel occlusion;
  • automated or assisted ASPECTS assessment;
  • estimation of infarct-core volume;
  • analysis of perfusion imaging;
  • segmentation of abnormal brain tissue;
  • workflow and stroke-team notification;
  • clinical and functional outcome prediction [3–5].

The strongest current clinical application is in imaging-based triage, particularly the rapid detection of LVO and other time-critical abnormalities.

Neuroimaging and Early Stroke Detection

The primary objectives of acute stroke imaging are to distinguish ischemic from hemorrhagic stroke, identify the extent of established brain injury, detect vascular occlusion, and determine whether advanced imaging findings support reperfusion treatment.

Non-contrast CT

NCCT is commonly the first-line imaging examination in patients with suspected acute stroke. Its rapid acquisition and widespread availability make it particularly useful in emergency settings. Intracranial hemorrhage can often be identified rapidly, which is essential because hemorrhage and ischemia require fundamentally different treatment strategies.

AI algorithms can analyze NCCT scans and flag findings suspicious for intracranial hemorrhage or early ischemic change. Such systems may assist radiologists and stroke physicians by prioritizing examinations requiring urgent review [3].

However, AI should not be interpreted as a replacement for expert image assessment. Subtle lesions, motion artifacts, atypical presentations, and technical differences between scanners may affect algorithmic performance.

CT Angiography and Large-Vessel Occlusion

LVO is an important cause of severe acute ischemic stroke and is particularly relevant because eligible patients may benefit from mechanical thrombectomy. Rapid identification of LVO is therefore a major component of modern stroke triage [2,5].

AI-based CTA analysis can assist in detecting occlusion of major intracranial arteries. Earlier systematic reviews demonstrated the feasibility of machine-learning approaches for automated LVO detection, while more recent evidence has continued to support their diagnostic potential [4,5].

AI systems may also generate automated notifications to stroke teams when an LVO is suspected. This can reduce communication delays and facilitate transfer or activation of endovascular treatment pathways.

Nevertheless, diagnostic performance varies according to the vascular territory and algorithm. Detection of distal occlusions, smaller-vessel lesions, and posterior circulation occlusions may remain challenging [6]. Therefore, an AI alert should prompt expert review rather than automatically determine treatment.

Automated Assessment of ASPECTS

The Alberta Stroke Program Early CT Score (ASPECTS) is a standardized scoring system used to estimate the extent of early ischemic change in the middle cerebral artery territory on NCCT.

AI-based systems can assist in the automated identification of regions affected by early ischemic change and provide an estimated ASPECTS. This may reduce interobserver variability and provide standardized quantitative information during time-critical assessment [3,4].

However, automated ASPECTS estimation may be affected by image quality, anatomical variation, pre-existing abnormalities, and segmentation errors. Consequently, AI-derived ASPECTS should be considered supportive information and interpreted in conjunction with the clinical examination and expert neuroimaging assessment.

CT Perfusion and Estimation of the Infarct Core

CT perfusion provides quantitative information about cerebral hemodynamics and may help distinguish established infarcted tissue from hypoperfused tissue that may remain potentially salvageable.

AI can facilitate automated processing of perfusion datasets, calculation of perfusion parameters, and segmentation of regions of abnormal perfusion. These capabilities may be particularly useful when symptom onset is unknown or when patients present beyond conventional early treatment windows and advanced imaging is used for treatment selection [2,3].

However, automated perfusion maps can be affected by motion, poor contrast bolus, incorrect arterial or venous input selection, and other technical factors. Automated estimates should therefore be reviewed for plausibility and interpreted within the clinical context rather than treated as definitive measurements.

MRI and Artificial Intelligence

MRI provides highly sensitive imaging of acute ischemic injury. Diffusion-weighted imaging (DWI), particularly when interpreted together with apparent diffusion coefficient (ADC) maps, is highly useful for identifying acute ischemic lesions.

AI techniques have been investigated for automated lesion detection, segmentation, volume estimation, and quantitative analysis of DWI and perfusion-weighted imaging data [7].

Despite these advantages, MRI may be less suitable than CT as the initial emergency imaging modality in some settings because of longer acquisition times, limited availability, contraindications, and the need for appropriate patient monitoring.

AI-Assisted Clinical Decision-Making

The principal clinical value of AI in acute stroke is its ability to support—not replace—clinical decision-making.

A simplified AI-assisted workflow can be represented as:

Patient presentation → clinical assessment → neuroimaging → AI-assisted analysis → identification of suspected pathology → automated notification → expert review → treatment decision.

This approach is particularly relevant to LVO stroke, where delays in recognition and communication can affect the speed of endovascular treatment.

Evidence from systematic reviews indicates that AI-supported LVO detection can improve workflow efficiency and reduce certain treatment delays. However, recent evidence suggests that improved workflow does not necessarily translate into improved functional outcomes or reduced mortality [8,9]. Therefore, the clinical benefit of AI should be evaluated not only by diagnostic accuracy but also by its effect on meaningful patient outcomes.

Advantages of Artificial Intelligence in Acute Stroke Care

The potential advantages of AI include:

  1. Rapid image analysis: large imaging datasets can be processed within seconds or minutes.
  2. Automated notification: suspected LVO or intracranial hemorrhage can trigger rapid alerts.
  3. Standardization: algorithmic analysis may reduce some forms of interobserver variability.
  4. Workflow optimization: automated triage may reduce delays between imaging, communication, and treatment.
  5. Decision support: quantitative imaging information may complement clinical assessment.
  6. Scalability: AI-based tools may assist healthcare systems with limited access to specialist neuroradiology expertise.

Limitations and Challenges

Despite substantial progress, several limitations restrict the widespread implementation of AI in acute stroke care.

Dataset Bias and Generalizability

AI algorithms depend on the quality and representativeness of the datasets used for development and validation. Differences in patient populations, imaging protocols, scanner manufacturers, disease prevalence, and clinical workflows may affect performance when an algorithm is transferred to a new healthcare environment.

False-Positive and False-Negative Results

No AI system is perfectly accurate. False-positive results can generate unnecessary alerts and increase workload, whereas false-negative results may potentially delay recognition of a treatable lesion.

Explainability

Some deep-learning models provide highly accurate predictions without clearly explaining how a particular conclusion was reached. Limited interpretability may reduce clinician confidence and complicate regulatory and medico-legal considerations.

External Validation

High performance in a development dataset does not necessarily guarantee equivalent performance in routine clinical practice. Independent external validation across multiple institutions and populations is therefore essential.

Clinical Outcomes

One of the most important limitations is the distinction between diagnostic performance and patient benefit. AI may accurately detect LVO or improve workflow metrics without necessarily improving functional independence or survival. Recent meta-analytic evidence supports this distinction: AI-assisted LVO detection has been associated with faster treatment workflows, but improvement in clinical outcomes has not been consistently demonstrated [8,9].

Data Protection and Cybersecurity

The use of AI requires processing potentially sensitive medical information. Patient confidentiality, secure data storage, cybersecurity, and appropriate governance are therefore essential components of responsible implementation.

Future Perspectives

The future of AI in stroke care is likely to involve multimodal systems that integrate imaging, clinical findings, laboratory data, and electronic health-record information.

Such systems may eventually support individualized treatment selection, prediction of functional recovery, identification of patients at high risk of recurrent stroke, and optimization of rehabilitation strategies.

Integration with telemedicine may be particularly valuable in regions where specialist stroke and neuroradiology services are limited. AI could assist remote clinicians in prioritizing patients who require urgent specialist evaluation or transfer.

However, future development should focus not only on improving algorithmic accuracy but also on clinical validation, transparency, interoperability, fairness, cybersecurity, and demonstrable improvements in patient-centered outcomes.

Conclusion

Artificial intelligence has become an important emerging technology in acute stroke imaging and triage. Current applications include automated detection of intracranial hemorrhage, identification of early ischemic abnormalities, LVO detection on CTA, assisted ASPECTS assessment, and quantitative analysis of perfusion and MRI data [3–5].

The greatest current clinical potential of AI lies in accelerating image interpretation, facilitating communication, and optimizing time-sensitive stroke workflows. In particular, AI-assisted LVO detection may reduce delays between imaging and endovascular treatment. Nevertheless, improved workflow or diagnostic accuracy should not automatically be interpreted as proof of improved patient outcomes.

AI should therefore be implemented as a clinical decision-support technology, with final diagnostic and therapeutic decisions remaining under the responsibility of appropriately trained healthcare professionals.

The most promising model for the future of AI-assisted stroke care is not replacement of physicians, but human–AI collaboration. Properly validated and responsibly implemented AI systems may improve the speed, consistency, and efficiency of stroke diagnosis while allowing clinicians to retain responsibility for individualized patient care.

References

1. Campbell B.C.V., De Silva D.A., Macleod M.R., et al. Ischaemic stroke. Nature Reviews Disease Primers. 2019;5:70. doi:10.1038/s41572-019-0118-8.

2. Powers W.J., Rabinstein A.A., Ackerson T., et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines. Stroke. 2019;50(12):e344–e418. doi:10.1161/STR.0000000000000211.

3. Soun J.E., Chow D.S., Nagamine M., Takhtawala R.S., Filippi C.G., Yu W., Chang P.D. Artificial Intelligence and Acute Stroke Imaging. American Journal of Neuroradiology. 2021;42(1):2–11. doi:10.3174/ajnr.A6883. (PubMed)

4. Murray N.M., Unberath M., Hager G.D., Hui F.K. Artificial intelligence to diagnose ischemic stroke and identify large-vessel occlusions: a systematic review. Journal of NeuroInterventional Surgery. 2020;12(2):156–164. doi:10.1136/neurintsurg-2019-015135. (PubMed)

5. Shlobin N.A., Baig A.A., Waqas M., et al. Artificial Intelligence for Large-Vessel Occlusion Stroke: A Systematic Review. World Neurosurgery. 2022;159:207–220.e1. doi:10.1016/j.wneu.2021.12.004. (PubMed)

6. Luijten S.P.R., Wolff L., van der Lugt A. The True Potential of Artificial Intelligence for Detection of Large-Vessel Occlusion: The Role of M2 Occlusions. American Journal of Neuroradiology. 2021;42(7):E46. doi:10.3174/ajnr.A7111.

7. Ben Salem D., et al. Applications of artificial intelligence for DWI and PWI data processing in acute ischemic stroke: Current practices and future directions. Clinical Imaging. 2022. doi:10.1016/j.clinimag.2021.09.015. (PubMed)

8. Detection of large vessel occlusion using artificial intelligence tools: a systematic review and meta-analysis. American Journal of Neuroradiology. 2025. (PubMed)

9. Susanti L., Cuandra K.N., Tristan C.D., et al. Diagnostic Test Accuracy of Artificial Intelligence in Large Vessel Occlusion: A Systematic Review and Meta-Analysis. Neurology Research International. 2026;2026:5709868. doi:10.1155/nri/5709868. (PubMed)

10. Yedavalli V.S., Tong E., Martin D., Yeom K.W., Forkert N.D. Artificial intelligence in stroke imaging: Current and future perspectives. Clinical Imaging. 2021;69:246–254. doi:10.1016/j.clinimag.2020.09.005. (PubMed)

11. Nogueira R.G., Jadhav A.P., Haussen D.C., et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. New England Journal of Medicine. 2018;378(1):11–21. doi:10.1056/NEJMoa1706442.

12. Albers G.W., Marks M.P., Kemp S., et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. New England Journal of Medicine. 2018;378(8):708–718. doi:10.1056/NEJMoa1713973.

Poetry by Young-eun Kang

Relativity

Like grapes held in a glass,

a face

easy to take out.

Like grapes reflected in a glass,

a face

impossible to take out.

Like sunrise in the morning

and sunset in the evening,

a face

with a different mood.

Who raised so many versions of me?

Though I fall in love with countless selves,

though I part from countless selves,

a face

of the same temperature.

Like the seeds I spit out

and the fruit I swallow,

a face

governed by the same law.

Like morning when a bird sings

and evening when it returns,

a face

at the same coordinates.

Was it you,

keeper of the vineyard,

who raised them?

Faces

in the small palm of my hand,

met yesterday,

parting today.

A Note on Tuché*

        by Young-eun Kang

With a banana in my mouth,

I climb the stairs.

Climbing stairs is good for the body—

it straightens the back.

I lick with my tongue

a thought that has swum its way here,

and into my mouth disappears—

ah, banana.

Chewing a banana

without tension or rapture,

I arrive at the banana.

As though parting from something like sorrow,

the banana lets itself be chewed.

Thinking of the arrogance of a fruit

with neither juice nor seeds,

I arrive at the loneliness

of one that has wandered far from its kind—

like a newly born grave.

Ah, banana.

Like a philosopher,

the banana peel, having parted

from days of ravenous appetite,

is good for the teeth.

It polishes white

the stains upon them.

The banana says nothing

of what remains after death.

I climb the stairs

where only the peel remains.

There it was, by chance,

lying on the table—

ah, banana.

* Tuché: chance as an encounter with the Real.

Author Bio – Young-eun Kang

Young-eun Kang is a Korean poet born in Jeju. She made her literary debut in 2000 and holds an M.A. in Literature from Dongguk University. She has published nine poetry collections and serves on the Board of the Korean Poets Association. Her work has received literary awards and international recognition.

Poetry from Ahmed Miqdad

They Lied to You

They lied to you

When they said

They had stopped the genocide.

They lied to you.

I still hear the buzzing of nasty drones

Hovering over the grey sky,

Like hungry birds searching for another home.

They lied to you.

I witnessed my home collapse

Under the weight of heavy bombs,

Its walls falling like broken memories,

Its rooms swallowing the laughter

That once lived inside them.

They lied to you.

I hear the screams of widows

And orphaned toddlers,

Their trembling voices rising

From beneath the dust and rubble.

They lied to you

While they razed our homes,

One after another,

Until familiar streets

Became fields of concrete and ash.

They lied to you

As the horizon of destruction

Grows wider and wider,

While the grey sky carries

The smell of smoke and fear.

They lied to you

While they are killing us quietly,

While our names disappear beneath the rubble,

While our stories are buried with us,

And the world is told

That the killing has stopped.

Ahmed Miqdad is a poet from Gaza.

Poetry from Mahbub Alam

The Green House of Dead Sunlight

The cats are yawning. 

A faded dawn, a long, soundless light.

In the refugee tale of sunlight,

a wrong journey along a road of dust.

Rain falls in the classic dawn of jasmine flowers.

Beloved words are birds taking flight.

Beneath a fire-red night,

a long sigh torn from dreams.

The darkness of a red day—

no light comes to walk beside the river.

A plundered village of trees, the heart of clouds,

the light of the eyes.

The noons weep naked in a bath of fire.

Darkness grows wet— love-burned, destitute, 

a scorching thirst, thorns of water.

The cats leap into the Padma and the Meghna,

in the scent of light torn from its roots.

With other eyes they dream another dream,

in the green house of dead sunlight

that has fallen asleep.