What Work Is

They routinely ask you, what else you have to do with your life?

What’s your other job?

As if working split shifts, doubles, red-eyed with raging hangovers, running on depleted adrenaline levels, days and nights. Seeing The Future in a cracked shot glass, the amber liquid inside all the hours and minutes of those days and nights forming a hard, small viscous puddle in the middle of a cratered bar surface that looks like no man’s land in some nightmare film version of The Waste Land. 

So I say, “I’m independently wealthy.  Actually, I do this for fun, getting paid is just a bonus.”

And, if I’m in a real foul mood, I tell them something like the truth, “I’m doing in depth field research for a human science experiment.

My thesis is set for review and possible publication like in the next few days, keep asking questions and there might be a whole section devoted to you.”

And they laugh and laugh and laugh as if I were some kind of quick witted, one liner artiste, instead of a small piece in god’s plan for the human comedy that always has a tragic ending no matter what part you play.

Sometimes I even tell them the title of the Work in Progress, although it’s rarely the same one or the real one.

Somehow today sort of feels like, Show Me the Way to the Next Whiskey Bar

Last week it was Quiet Flow the John

Next week?

Who knows?

Face Down on the Barroom Floor Ramada Inn/Silo 1974

She pushes open the swinging kitchen doors,

eyes wide, hands shaking she said,”You’ve got

to do something, they’re tearing the place

apart.” 

In the rathskeller, below, it sounds

to the staff as if the dancing has gotten out

of hand as if all of the feet are in the

wrong part of the room and that there is no

music but a new kind of nerve ending

sound of glass meeting brick.  

Now, on the floor of the lounge, five brothers 

are putting the finishing touches to a twelve-hour 

day of solemn marriage rites and shots of 7 Crown 

with beer chasers along the bar, holding 

the night manager’s head inert, free form kicking 

his face in the darkness as a waitress weeps, 

they run overturning tables and chairs as they go

spinning table candles spread a thin hot sealing

wax over blood on the wash and wear carpet.

This year on the job training qualifies you for a merit badge in plastic surgery and seven days with a white batman mask, as the stitches heal. It’s a mask you won’t show off in public because Halloween isn’t for another eight months and you’re in no mood to answer questions.

Actually, there are some hidden benefits in a life threatening beating; a week off, no questions asked ,and the scars, later, to prove you’d done Mugging 101 and passed with three scars workman’s comp will fork over cash for.

Upper Management show their gratitude for blood and time loss with a spontaneous, in-depth criticism for all the things you did wrong in a crisis beginning with, “You should have nuked them with the fire extinguisher.”

Or, “call the cops first, ask questions, later.”

As if there was an operating telephone nearby to use.

As if one foam fire extinguisher could quell an indoor, no rules Australian football game involving all the players from several teams, their next of kin And their fans, a congregation of Assholes that gave new meaning to the word, Chaos

Walk On

He was up against

the side bar

and he’d been there

all of his life

touching him was

risking contracting

a fatal disease

but I had to do it,

“The bar is closing

down, you have to leave.”

His eyes focused

on a point no one

else could see.

“Leave?” He said.

“I have weapons

sanctioned by the Lord.”

“I hope they’re

registered in Albany

County or else you’re

in big trouble.”

“I have transmitters

locked into invisible

orbiting satellites.”

“I’ll pass up my best FCC

line, would you like

me to call a cab

back to CDPC or would

you rather walk?”

“I have no money.”

“You’ll have to walk then,

it’s not that far. Besides,

I’ll bet you could use

the fresh air and exercise.”

It was late November

and he didn’t have a coat.

That was his problem.

He should have thought

of that when he left

the Loony Bin with

his spare change.

I was being hard on

lunatics that week, and they

were being hard on me.

After this last assault, you file that claim with Workman’s Compensation despite strict prohibition of any such claims by management no matter what the cause or nature of the injury.

Compensation Board claims raise the Company’s premiums.

But after a complete, comprehensive late-night tour of all the Emergency Rooms in the Greater Capital District Area, for a wide variety of on-the-job related injuries and nothing to show for them but permanent damage and lost wages, you really don’t give a flying fuck about their higher premiums.

And Management says, “You’re developing an attitude.

A Bad Attitude.

But when you tender your resignation a couple of months later, they change their tune.

Offer you a modest raise.

After all they can’t afford to lose you.

Who else will do all the dirty work?

Working Stiff

They like

to work

you day

and night

until your

eyes start

to bleed

they don’t

care about

how you

might feel

unless they

think you

might not

make it

So you show up for work.

For now. They aren’t the only club in a tri-state area no matter what they would like you to believe.

You don’t like the job but it’s the work you do and despite all the heat, the stuff and nonsense, you take a certain pride in being able to do something no else can do as well as you can.

Like walking out on a ledge and staying there, daring what will happen to happen

But you can’t shake the labels or the rap

The Attitude

You’ve got a Bad Attitude

Why bother, it’s true, you do: it comes with the job

It’s what distinguishes you from the rest of the crowd, the amateurs.

Mind Games

“Do you know

Mary Beth?” he asks

“Everyone knows

Mary Beth.” I sd.

“Why she was 

here just last

week.

We talked for

over an hour.”

“How’s she doing?”

“Fine.  Real 

fine.

Still working

in the same

place

Still hates

it too.

She was asking

about Joe.”

“Yeah, she would.

Do you know

Joe?”

“Not really,

I’ve seen him

though.”

“He’s a real

pisser, Joe is.

Did Mary Beth

tell you about

the time

Joe dropped trou?”

“Oh, no really?”

“Yeah, it was at

the New Year’s Eve bash

over at the Son’s Hall

Freaked everyone

right out in a hurry.

You should get to

know Joe, he’s a real

pisser.”

“I can tell.”

“Hey, man, when you

see Mary Beth tell

her I was by.”

“Sure will, dude.”

As if I knew

who any of these

people were.

You’ve cultivated this on the job trained self-image of a night time warrior in the trenches for so long you actually believe it.

Think that there’s a war being fought with liquor bottles, beer steins, insults and drunken tirades instead of hand grenades, horseshoes and atomic bombs.

When asked how you do it, the answer is always the same, “If everyone were doing it would be easy and then what would become of us?”

A line from a movie about a bomb disposal expert.

And what you are doing is a kind of bomb disposal; all those human atomic bombs you always ready and waiting to go off.

And they’re always at your disposal to deal with as you wish

Because you’re the head mad doctor,

The scientist with the rocket fuel

The magic cure

The liquid medicine

Cripples

They looked 

as if they’d

copped

their last

dimes out

of a blind

man’s cup

As if they

rolled old

ladies and 

infirm old

men for their

meals

There was

nothing wrong

with them

drinking

in my place

that a

couple of 

years

behind bars

couldn’t cure

You’re no better than they are

And you probably feel worse

But you can never show it

After all the show must go on

And you have your professional pride

Reference Question

“You see this guy?

when he came to

work for us

he had to look

Bud up in a

book-didn’t know

the difference

between a bottle

of beer and a

bottle of booze

and just look

at him now.”

I didn’t hear that

I guess it’s because

I know the boss man has

to score points with

the money men too

Just ‘cause he hasn’t any

thing better to do than

build himself up by knocking

someone else down has nothing

to do with me, I’m better

than that.  I mean I can

take a joke as well as

anyone, I’ve been laughed

at too many times not

to know a joke when I

hear one. So later, when 

the Boss Man asks me

for a Dewar’s on

the rocks I have to laugh

What’s he talking about?

He must be kidding me.

I might even have to look

it up in a book.

I don’t let the door hit me in the ass on the way out when I leave either

Or turn out any of the lights

I just make sure everything stops working the next day in a timed sequence like some kind of Alfred Hitchcock restaurant horror movie with those who remain as the unwilling characters.

I make sure all of my messages are put on Call waiting indefinitely or are misdirected to the back room of Rummy’s Bat Cave where the derelict who answers the phone has been on a non-stop binge since 1937 and will forget what he is doing with the phone in his hand, mid-conversation and leave the line open forever, phone dangling against the wall like the useless appendage that it is.

What the hell, it was only a job.

There’s always more work once you’ve summitted the plateau.

After all bartending is just something you learn to do with your head while your body is making drink, is watching what’s coming down in your world as it happens and surviving long enough to talk about it.

I guess that’s what writing is all about,as well.

But what would I know about that, man, I’m just the bartender.

A Pro-fessional with an Attitude

Or a character in a story

Or maybe even one who creates characters

Which one is it?

That would be telling and a bartender never tells

That’s against all the unwritten laws,

The Code of Ethics

Everyone Wants to Be a Bartender

It must be a

great life-

I’ll bet

all the girls

proposition you-

You must

overhear some

wild conversations-

I’ll bet all

the waitresses

are really wild

and all of that

free booze-

All that easy

money-

You must make

great tips

here

huh?-

You must be

a gambler-

Who do you

like in the-

You know

where I

can find

some easy-

I’m a little

short-

I know you

guys always

have bread

can I bum-

it’s a great

life

real great

and I’ve

been beat up

in some of

the best

joints

in town

too

Every word of this is true.

Everything I say is true.

Come to the Tavern where I work now and sample one of the cocktails from my bar book of recipes with a personality called Killer Cocktails.

Better be nice; remember who’s making those drinks you’re going to put into your body.

Better yet, just read the book

And see who gets the last laugh.

Or wait for the sequel, The Hair of the Dog That Bit Me.

That’s me on the cover, not Lon Chaney Jr. dressed to kill as the Wolfman.

It happens to all us professionals after a while, The Metamorphosis

That’s what work is.

The War Inside the Voice: Leila Abdul‑Rauf Between Calls from a Seething Edge and Andros Insidium

by Alex S Johnson

Leila Abdul‑Rauf has long occupied a singular position in the experimental music landscape, moving fluently through noise, ambient, metal, thrash‑adjacent hybrids, folk‑metal permutations, and avant‑garde vocal architecture. Her recent work unfolds across two closely linked records: Calls from a Seething Edge, released on Cyclic Law in 2024, and the newer Andros Insidium, whose title she describes as a partly invented Latin construction—“andros meaning… the masculine,” while “insidium… I don’t even know if that’s real… sometimes you just got to make something up just to keep it interesting.”

Calls from a Seething Edge is the record that contains “Crimes of the Soul,” a song whose emotional and visual architecture anchors much of the conversation.

Abdul‑Rauf explains that the video was shot by her partner, Gregory Hagen, who “does make an appearance on both that record… Calls from a seating edge, which came out on cyclic law in 2024, and then… he also does a vocal appearance on Andros Insidium.”

The video’s pastoral core was filmed at “a local rose garden here in Oakland… such a hidden gem… a great place to just go and relax… watch the water fountains and all the birds… whatever’s lurking around there.”

That serenity is violently interrupted by war footage edited in by their friend Dave Brenner, who “kind of gave it the grit that… was true to the song.”

Abdul‑Rauf isn’t certain of the exact source of the footage—“you’ll have to talk to him about that”—but suspects “probably Gaza or Lebanon or a combination, Syria… all the recent bombings and things like that.”

The backdrop for Calls from a Seething Edge is explicitly geopolitical. Abdul‑Rauf describes 2024 as “sort of, like, the D‑day for all the… genocides going on,” a time when she began to feel “really… angry and vulnerable in a way that I hadn’t felt quite to that point,” especially in “this… hyper‑surveillance world that we’re living in.”

She became “really anxious… very on edge,” and war moved “to the forefront” of her thinking. Her day job at a psychoanalytic institute—“I do administration, but I’m around psychoanalysts all the time”—inflected the record’s conceptual frame.

For over a decade she has been immersed in a culture that insists, “don’t take everything at face value… really distill it… don’t make these flipped judgments… explore… the most horrible parts of ourselves.”

War, she notes, is “one of the most despicable things about humanity,” yet “going back to early humans, there’s always been war and violence of some kind.”

The record asks, without pretending to answer, whether war is something humanity can ever transcend: “Is war even something that we… can ever be above?… I like to think yes… but…”

One of the songs on Calls from a Seething Edge, “Failure to Fire,” draws on research from the Vietnam War. Abdul‑Rauf recounts studies suggesting that soldiers “weren’t… killing each other… enough,” which led to the use of gas to “incite more violence.”

She connects this to the premise of the film Jacob’s Ladder: “That was the whole premise for the movie Jacob’s Ladder, too… people don’t really want to kill each other… so they had to drug them.”

The song becomes a meditation on the gap between human reluctance and systemic coercion.

Sonically, “Crimes of the Soul” is built from deceptively simple materials. “The structure’s pretty simple,” she says. “I did very simple drum programming… some… deep growly synths… and lots of these lofty kind of vocals.” The second half introduces what sound like “high stringy synths,” but they are in fact trumpet parts “really stretched out… and playing back at different speeds.”

She took a treated horn part from “Summon,” the first track on Calls from a Seething Edge—“there’s another treated horn part at the beginning… that’s drop‑pitched”—and “put it in ‘Crimes of the Soul’ and sped it up… probably 3 or 4 different speeds.”

The result is a harmonic mesh that feels electronic but is “honestly just… acoustic horn, just trumpet… through a microphone… some reverb and some pitch shifting.”

Her approach to gear is deliberately minimal. “You’re very self‑sufficient as far as your gear,” I say.

“Not at all,” she replies. “I feel like I’m the antithesis of techie.” She insists on keeping “the gear as minimal as possible,” explaining, “I can’t wrap my head around these complicated setups with all these pedals… wires everywhere, I get nauseous when I see… I’m impressed when other people do it, but if I had to do it, I would just… freeze.”

The simplicity is in service of performance: she wants to “really get into the vocal performance, the horn performance… interact with the crowd,” especially now that there is “a lot more… challenging singing and… a lot more growling in the sets… a lot more visceral and immediate” than her earlier, more “down tempo” work.

If Calls from a Seething Edge is the war‑haunted, psychoanalytic record, Andros Insidium is the newer, parallel project where Abdul‑Rauf continues to push her voice and compositional strategies.

She notes that many listeners think she “now is going solo,” but clarifies that these projects have been running in parallel for years: “I’ve been doing my solo projects since 2012… Vastum started right before I joined Hammers… and then I started my solo project not much longer after that.”

On Andros Insidium, tracks like “Eros Anima” and “Fractured Body” carry some of her most overtly metal‑inflected and Halford‑inspired vocal lines. “There are a couple moments on… ‘Eros Anima’… where I just get my inner Halford out,” she says. “No one’s gonna say that when they listen to it, but… there’s some vocal melodies where that’s straight up the case.”

“Fractured Body” on Andros Insidium is repurposed from a Vastum song, “Corpus Fractum.” “I just… translated into English ‘Fractured Body’,” she explains. “Instead of the… guitar lead as the vocal lead… the rhythm guitars is the synth… did different drum part… shortened it… took, like, the intro of the Vastum song and made it its own song.”

The ending, built from “sound bites of glass breaking,” is a direct homage to Einstürzende Neubauten’s “Haster Luger”: “At the end of ‘Haster Luger’… there’s just, like, this endless… stream of broken glass. I was like, well, that’s… gotta… give my love to them there as well.”

Her influences form a dense, unconscious archive: “There’s… all kinds. There’s… Einsturzende Neubauten… a little Dead Can Dance, little Skinny Puppy… it’s all there back in… deep in the unconscious.”

One of her most important inspirations is Rob Halford: “I’m a huge Rob Halford fan. Anyone who knows me… knows that.” She has read “both of Rob’s memoirs” and K.K. Downing’s, calling them “all fantastic,” and still describes Judas Priest as “the best heavy metal band in the world.”

Abdul‑Rauf’s personal history adds further layers to her work. She grew up between two religious traditions: an Egyptian Muslim father, an imam, and an Irish Roman Catholic mother from New York.

She spent childhood weekends in a Sufi mosque in Soho, sitting through sermons, listening to the call to prayer, participating in dhikr: “You repeat God’s name… whirling around… almost passing out from these recitations.”

She recalls “all the call to prayer… it just kind of works its way in,” and notes that these sounds later resurfaced in her solo work.

Her band history is equally rich. Amber Asylum, Hammers of Misfortune, Vastum, Saros—each marks a different phase.

She describes joining Hammers after playing with Sigrid in Amber Asylum: “We had had a couple of years already… touring together… and then she invited me to join Hammers… I said, oh, okay, well, it’s Sigrid, I love playing with Sigrid.”

Hammers, she notes, is “John’s… basically his solo project brought to life in a band,” and her role was to “support… his ideas… guitar‑wise and vocal‑wise.”

Vastum, formed with Dan and others, continues: “At this point, it’s just me and Dan… we’ve been writing another record.” Her long partnership with Sam Foster—“the drummer of… Saros… who used to be in Weakling”—extends across projects: “He’s all over my last two solo albums… hand percussion… he’s done videos… all the photography… that’s all… he did all of that… that’s like an almost 25‑year relationship… he’s been such a big part of my life creatively.”

Touring has become increasingly strategic. Abdul‑Rauf outlines an upcoming East Coast solo tour with dungeon‑synth artist Vela Straz, describing the genre’s cosplay, masks, swords, chainmail, and 1980s keyboards: “It’s a whole thing.” The aesthetic appeals to her, and the economics make sense: “Touring with a band now is a total racket… too expensive… solo is more worth your while.”

Her sets now feature “a lot more growling… a lot more visceral and immediate” energy, even as she maintains dynamic range.

Her perspective on heavy music’s evolution is grounded in experience. She notes shifts in production—“hyper‑compressed guitar tones,” “drum triggers,” “homogenized growls”—and the explosion of global diversity in metal scenes, from blackgaze and shoegaze‑metal hybrids to internationalized extreme music.

She also gestures toward the intellectual currents behind punk and metal, mentioning Marxism, socialism, and situationism, and referencing a friend who “wrote a whole book on situationism in punk rock.”

When asked about advice for women in extreme music, Abdul‑Rauf answers with warmth and pragmatism: “Play with good people… collaborate with true friends… diversify creatively… avoid burnout.” She emphasizes the importance of long‑term artistic relationships: “If you play with good people, they’re gonna be in your life for a long time.”

Across Calls from a Seething Edge and Andros Insidium, Abdul‑Rauf’s work reveals an artist who moves fluidly between genres, cultures, histories, and emotional registers, creating music that is as intellectually rigorous as it is sonically visceral.

Her records are not simply fusions of influence; they are the lived expression of a life shaped by war, ritual, rebellion, psychoanalytic inquiry, and relentless creative curiosity.

Unmoving creatures

Is famous to bosom 

As poet is to illiterate 

Opposite and therefore unimportant? 

Tethered and territorial 

Unwavering appendages 

Unmoving creatures

Are we these bright dead things? 

You can find us among these bright dead things.

You can find me under the shade of a weeping willow contemplating the radical nature of life 

And floating through a checkerboard wormhole 

You can find me in surrealist wonderland 

Reading these melting clocks and floating apples

You can find me where the wild things are 

I am militant 

I am militantly insane 

I am responsible in preserving the insanity and not letting it slip into deadbeat normalcy 

Even when I can feel myself 

Inching closer

To that not so distant beige and fluorescent world 

Made in the USA 

Oh say can you see 

Me 

Surrendering myself to the wrath of the media 

The land of the 

Control 

Alt 

Delete 

The mind 

Copy paste 

Duplicate 

Patriotic clones

And the home of the free

From the burden of having a vibrant imagination 

God bless America

God bless poets

We are these unmoving creatures 

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.

The Poem of Peace and Love

Fumes of grey drew ghosts on the sky,

Once a sapphire canvas now painted with cries.

A lone pearly dove flew above the ruins.

A wandering poet saw peace among the chaos. 

The rubbles and echoes felt unseen for a while. 

As the poet followed the dove with a forgotten smile. 

Line by line a poem weaved on the way.

A hopeful light, a bridge over where night lay.

The dove descended on to a hanging block.

Pointed its beak towards the rubbles below. 

The poet gazed, seeing a crumpled  up book,

Took out a pen, the poet treasured through high and low.

Sat down on the stones, the marks of the violence. 

weaved the poem of peace in scared silence.

The poet slowly tied the poem on the dove.

And watched it carried the poem of peace and love.

Loveless Humanity

Widowed ‘Humanity’ walked on the road.

Witnessing people breezed right pass through.

Unseen, Unheard, Unfelt, Unmoved.

She was bewildered, Had she became a ghost?

‘Empathy’ and ‘Sympathy’ joined later on,

Still no one noticed their pearly glow.

The world carried on, soulessly happy, 

Chasing the mist of greed and money, 

‘Kindness’ laid on the road, long gone.

Her stench drew no trails of tears.

‘Honesty’ bled, her dress was stained. 

‘Empathy’ and ‘Sympathy’ lost it and fell.

‘Humanity’ unwillingly moved on the road.

Another pearl dress splayed on the floor.

People stood around, singing “Peace lives on”.

While ‘Peace’ laid there distorted and crushed.

At last ‘Humanity’ stumbled and dropped.

Only the nature witnessed this mournful crime.

People walked by laughing hallow croaks.

As six corpses decayed, Unseen, Unmoved. 

Wishes of the Children

A child watching other children play,

Laughing, running, in a joyous day.

The child looks at his hands in dismay,

Carrying bags of trash every day.

He looks at the clothes of the others.

Bright colours fashioned with animals. 

While his shows, his bones through tatters, 

Worn and torn, never whole only holes.

He gazes at the parents watching their kids,

Twinkles in their eyes, glowing golden skins.

He wonders where his own, on or under the grass?

Yet he smiles instead, A hope is all he needs.

The playing kids saw him with all the bags,

Wondering of his strange bags and clothes.

Yet ‘come, let’s play’ waves the angelic kids,

Their hearts so pure, Yet the boy hesitates.

One mother got up, coming towards his way,

He prepares to run, but her smile stops his day.

‘Hey, wanna join them?’ She asks lovingly,

The boy slowly nods, Wondering is it a dream or reality?

In life, every child deserves a peaceful life.

It shouldn’t be a dream or a case in the courts. 

Only love and care, every child wishes in life. 

And nothing should ever, deny that from their lives.

Kushi Nanayakkara is a Sri Lankan born poetess who brings nature, human experiences, and creativity together through poetry. She studied Graphic Design/Information Technology before finding her way into poetry in 2020.

Her work often revolves around themes such as nature, art, life, love, mind, death, philosophy, and social themes such as justice and humanity. Her poetry was featured in literature websites in USA and India and newspapers in Sri Lanka and Bangladesh. Her poetry was also published in poetry anthologies and magazines in India, Iraq, USA and the Philippines. Her sincere wish is to inspire hearts to stay creatively conscious and continue refining her craft. 

Written by Dr Muhammad Ishaq Abbasi 

PAKISTAN 

Translated from Urdu by Neelum Waqar

PAKISTAN 

A Summer Evening In The Nature 

One summer evening, warm and bright,

I climbed a hill at fading light.

The day was hot, the air was dry,

And dust had settled near my eye.

Around me stood the forest trees,

They danced and swayed in gentle breeze.

The jambolan fruits hung dark and sweet,

A lovely gift for me to eat.

I picked the fruits with happy care,

And tasted nature’s goodness there.

Their juicy flavor, cool and fine,

Brought strength and joy to heart of mine.

A cuckoo sang upon a tree,

Its pleasant song delighted me.

The monkeys jumped from limb to limb,

While evening light was growing dim.

A peacock spread its feathers wide,

And walked with beauty, grace, and pride.

Then clouds appeared across the sky,

And little raindrops floated by.

The rain refreshed the thirsty land,

Like magic from the Maker’s hand.

My thoughts became so calm and clear,

And every worry disappeared.

Nature teaches us every day,

To love, be thankful, and obey.

Its beauty fills each heart with cheer,

And makes our world more bright and dear.

Translated 

عنوان ۔فطرت کی ایک گرم شام

ایک گرم اور روشن شام تھی،

میں ڈھلتی ہوئی روشنی میں ایک پہاڑی پر چڑھا۔

دن بہت گرم تھا، ہوا خشک تھی،

اور گرد نے میری آنکھوں کے قریب ڈیرہ ڈال رکھا تھا۔

میرے چاروں طرف جنگل کے درخت کھڑے تھے،

جو نرم و خنک ہوا میں جھوم رہے تھے۔

جامن کے پھل گہرے سیاہ اور میٹھے تھے۔

قدرت کی طرف سے میرے لیے ایک خوب صورت تحفہ تھے۔

میں نے خوشی خوشی پھل توڑے

اور وہیں قدرت کی نعمت کا ذائقہ چکھا۔

ان کا رس بھرا، ٹھنڈا اور عمدہ ذائقہ

میرے دل میں طاقت اور خوشی بھر گیا۔

ایک درخت پر کوئل گنگنا رہی تھی،

اس کی دلکش آواز نے مجھے بہت خوش کیا۔

بندر ایک شاخ سے دوسری شاخ پر اچھل رہے تھے،

جبکہ شام کی روشنی آہستہ آہستہ مدھم ہو رہی تھی۔

ایک مور نے اپنے خوب صورت پر پھیلا دیے،

اور حسن، وقار اور شان سے چلنے لگا۔

پھر آسمان پر بادل چھا گئے،

اور ننھی ننھی بوندیں برسنے لگیں۔

بارش نے پیاسی زمین کو تازگی بخش دی،

جیسے خالق کے ہاتھ سے کوئی جادو برس رہا ہو۔

میرے خیالات پرسکون اور صاف ہو گئے،

اور میری ہر پریشانی جیسے کہیں کھو گئی۔

قدرت ہمیں ہر روز یہ سبق سکھاتی ہے

کہ محبت کریں، شکر گزار رہیں اور فرمانبرداری اختیار کریں۔

اس کی خوب صورتی ہر دل کو خوشی سے بھر دیتی ہے،

اور ہماری دنیا کو مزید روشن اور پیارا بنا دیتی ہے۔

The Ark

Maori warriors flattened the lands won through bloodshed

and named it the South Island.

When the giant bustard flapped its wings,

the roots of the grassland trembled even in the wind.

On New Zealand’s earthquake island, isolated at 00:02,

three white-faced cows.

This tiny island of earth, where everything collapsed leaving only just enough,

is it God’s planned ark?

Counting toward infinity, then snap, short by the number 3.

Into that very plan, God drags the three cows.

The crumbling and cracking vast land is no longer a pasture for the cattle.

Like those times, excluded from the game of hopscotch at dusk,

the abandoned herd of cows.

The cows, puzzled by the suddenly narrowed field, comfort one another.

The cows can no longer go up

nor go down; nibbling on grass, they are peaceful for now.

The cows do not know God,

yet calmly, they rub their flanks together and graze.

That silent endurance of the cows.

Every crack in the world is a tear shed by God.

Seventeen-Year-Old Miss Marco Polo Sheep

By Yeon Myung-ji

Miss Marco Polo Sheep of the Pamir Mountains loved almond blossoms

and was an aspiring singer

who sang along to K-POP.

An aspirant,

what a beautiful occupation.

Riding the rhythm on the breath of the wind,

an aspirant walking the grassland.

She loves the wild goat

that endured the winter, tightly chewing on festuca grass.

The beasts of winter

must be winter aspirants.

The ghost of the snow mountains, the snow leopard,

must be a snow aspirant.

When you lie face down on the grassland, the grass sways,

and when you flip over the back of a stone, fish swim—

the aspirants of nature.

Only when a river flows from the belly

does the voice break through, says Miss Marco Polo Sheep.

Even if bitten on the nape and blood flows,

the song of the idol goat cannot be given up.

The pop song, which claimed that when the snow melts,

the leopard would melt too,

was plagiarism anyway.

The moonlight darkens,

and the snow leopard of Pamir, a high and desolate land,

drags its long tail across the ridge—

the ghost of the alpine.

The aspirant of a fairy tale,

caught off guard by the seventeen-year-old Miss Marco Polo Sheep.

Profile
Poet Yeon Myung-ji began her literary career in 2013 with the poetry collection 『Gashibi』, published in the Minerva Poetry Series.

Her published works include the poetry collections 『Sitting Like an Apple』 and 『Where would the House of the Sorry’ be? 』 the e-poetry collection 『Seventeen Marco Polos,』 and the travel essay 『Step by Step, Walking the Camino.』She has received the Tolstoy Literary Award, the Homi Literary Award, the Cheongsong Gaekju Literary Award, and the Aviation Literary Award. In 2025, she was awarded the Bronze Prize in Poetry at the Literature Asia Awards, Grand Prize Winner,9th Kim Myung-bae Literary Award.

Her poems have been translated and published in local languages in India, Pakistan, Kosovo, Italy, Egypt, the United States, and Belgium, Greece, UK, and Germany.