const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ─── Fetch MRI images as base64 ─────────────────────────────────────────────
const imageUrls = [
  "https://radiologyassistant.nl/assets/cerebral-venous-thrombosis/a509797a5f0311_direct-thrombus-mr2.jpg",       // 0 T1 hypersignal SSS
  "https://radiologyassistant.nl/img/containers/main/cerebral-venous-thrombosis/a509797a615ba2_pseudodense-.jpg/65ff9ee1b4c8df725b142757139712c2.jpg", // 1 pseudodense
  "https://www.ajnr.org/content/ajnr/30/2/344/F3.large.jpg",   // 2 AJNR MRV
  "https://www.ajnr.org/content/ajnr/30/2/344/F1.large.jpg",   // 3 AJNR T1/T2
  "https://cdn.agilitycms.com/applied-radiology/publishhub/AR-D-24-0016/F002.jpeg",  // 4 applied radiology CSVT
  "https://www.mdpi.com/life/life-12-01215/article_deploy/html/images/life-12-01215-g001-550.jpg",  // 5 MDPI CSVT
  "https://media.springernature.com/m685/springer-static/image/art%3A10.1007%2Fs11547-016-0630-9/MediaObjects/11547_2016_630_Fig1_HTML.jpg", // 6 springer T1
  "https://media.springernature.com/full/springer-static/image/art%3A10.1038%2Fs41598-020-57867-1/MediaObjects/41598_2020_57867_Fig1_HTML.png", // 7 springer full
  "https://pubs.rsna.org/cms/10.1148/rg.26si055174/asset/images/g06oc03c01x.jpeg",  // 8 RSNA
];

let imgs = [];
try {
  const result = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`,
    { maxBuffer: 50 * 1024 * 1024 }
  );
  imgs = JSON.parse(result.toString());
  console.log("Images fetched:", imgs.map((i, idx) => `[${idx}] ${i.error ? "ERR: "+i.error : "OK"}`).join(", "));
} catch (e) {
  console.error("Image fetch failed:", e.message);
  imgs = imageUrls.map(() => ({ base64: null, error: "fetch failed" }));
}

function getImg(idx) {
  return (imgs[idx] && !imgs[idx].error && imgs[idx].base64) ? imgs[idx].base64 : null;
}

// ─── Color Palette ─────────────────────────────────────────────────────────
const C = {
  white:     "FFFFFF",
  offwhite:  "F7F9FC",
  darknavy:  "0D1B2A",
  navy:      "1A3A5C",
  blue:      "1E6FBF",
  lightblue: "4A9FD5",
  accent:    "E63946",   // red accent for emphasis
  gray:      "5A6A7A",
  lightgray: "D8E3ED",
  midgray:   "8FA3B1",
};

// ─── Helper: slide header bar ───────────────────────────────────────────────
function addHeader(slide, title, subtitle) {
  // Navy top bar
  slide.addShape("rect", { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.navy }, line: { color: C.navy } });
  // Slide title in bar
  slide.addText(title.toUpperCase(), {
    x: 0.18, y: 0, w: 9.5, h: 0.55,
    fontSize: 13, bold: true, color: C.white,
    fontFace: "Calibri", valign: "middle", charSpacing: 1.2, margin: 0
  });
  // Accent left strip
  slide.addShape("rect", { x: 0, y: 0, w: 0.06, h: 0.55, fill: { color: C.accent }, line: { color: C.accent } });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.18, y: 0.62, w: 9.5, h: 0.3,
      fontSize: 9.5, italic: true, color: C.lightblue,
      fontFace: "Calibri", margin: 0
    });
  }
}

// ─── Helper: footer ──────────────────────────────────────────────────────────
function addFooter(slide, num) {
  slide.addShape("rect", { x: 0, y: 5.38, w: 10, h: 0.245, fill: { color: C.lightgray }, line: { color: C.lightgray } });
  slide.addText("CSVT — Neuroradiology | Cerebral Sinus Venous Thrombosis", {
    x: 0.18, y: 5.38, w: 8.5, h: 0.245,
    fontSize: 7.5, color: C.gray, fontFace: "Calibri", valign: "middle", margin: 0
  });
  slide.addText(`${num} / 30`, {
    x: 9, y: 5.38, w: 0.8, h: 0.245,
    fontSize: 7.5, color: C.gray, fontFace: "Calibri", align: "right", valign: "middle", margin: 0
  });
}

// ─── Helper: section divider slide ──────────────────────────────────────────
function addSectionSlide(pres, num, section, subtitle, color) {
  const s = pres.addSlide();
  s.background = { color: color || C.navy };
  s.addShape("rect", { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.accent }, line: { color: C.accent } });
  s.addText(section, {
    x: 0.5, y: 1.7, w: 9, h: 1.4,
    fontSize: 36, bold: true, color: C.white,
    fontFace: "Calibri", align: "left"
  });
  if (subtitle) {
    s.addText(subtitle, {
      x: 0.5, y: 3.2, w: 9, h: 0.8,
      fontSize: 16, color: C.lightblue,
      fontFace: "Calibri", align: "left", italic: true
    });
  }
  s.addText(`${num} / 30`, {
    x: 9, y: 5.2, w: 0.8, h: 0.3,
    fontSize: 8, color: C.midgray, fontFace: "Calibri", align: "right"
  });
  return s;
}

// ─── Helper: two-column text+image ──────────────────────────────────────────
function addTwoCol(slide, bullets, imgBase64, imgCaption, yStart) {
  const y = yStart || 0.95;
  const textH = 4.0;
  slide.addText(bullets, {
    x: 0.22, y: y, w: 4.9, h: textH,
    fontSize: 11, color: C.darknavy,
    fontFace: "Calibri", valign: "top"
  });
  if (imgBase64) {
    slide.addImage({ data: imgBase64, x: 5.3, y: y, w: 4.4, h: 3.4 });
    if (imgCaption) {
      slide.addText(imgCaption, {
        x: 5.3, y: y + 3.42, w: 4.4, h: 0.4,
        fontSize: 7.5, color: C.gray, italic: true, fontFace: "Calibri", align: "center", margin: 0
      });
    }
  }
}

// ─── Helper: full-image slide ────────────────────────────────────────────────
function addImageSlide(slide, imgBase64, caption, yStart) {
  const y = yStart || 0.95;
  if (imgBase64) {
    slide.addImage({ data: imgBase64, x: 0.5, y: y, w: 9, h: 3.8 });
  } else {
    slide.addShape("rect", { x: 0.5, y: y, w: 9, h: 3.8, fill: { color: C.lightgray }, line: { color: C.midgray } });
    slide.addText("[MRI image — see radiology reference]", {
      x: 0.5, y: y + 1.5, w: 9, h: 0.8,
      fontSize: 12, color: C.midgray, fontFace: "Calibri", align: "center"
    });
  }
  if (caption) {
    slide.addText(caption, {
      x: 0.5, y: y + 3.85, w: 9, h: 0.45,
      fontSize: 9, color: C.gray, italic: true, fontFace: "Calibri", align: "center", margin: 0
    });
  }
}

// ─── Helper: bullet list ─────────────────────────────────────────────────────
function makeBullets(items, bold, fontSize) {
  return items.map((item, i) => ({
    text: item,
    options: {
      bullet: { type: "bullet", code: "2022" },
      fontSize: fontSize || 11,
      bold: bold || false,
      color: C.darknavy,
      breakLine: i < items.length - 1
    }
  }));
}

// ─── Helper: table ───────────────────────────────────────────────────────────
function addStyledTable(slide, rows, colW, y) {
  slide.addTable(rows, {
    x: 0.22, y: y || 1.0, w: 9.55,
    colW: colW,
    fontSize: 10, fontFace: "Calibri",
    border: { pt: 0.5, color: C.lightgray },
    autoPage: false
  });
}

// ════════════════════════════════════════════════════════════════════════════
// BUILD PRESENTATION
// ════════════════════════════════════════════════════════════════════════════
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "CSVT - Cerebral Sinus Venous Thrombosis: A Neuroradiology Approach";
pres.subject = "Neuroradiology";
pres.author = "Neuroradiology Department";

// ══════════════════════════════════════════════════
// SLIDE 1 — TITLE SLIDE
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  // Full-width top strip
  s.addShape("rect", { x: 0, y: 0, w: 10, h: 1.5, fill: { color: C.darknavy }, line: { color: C.darknavy } });
  s.addShape("rect", { x: 0, y: 0, w: 0.18, h: 1.5, fill: { color: C.accent }, line: { color: C.accent } });
  // Bottom strip
  s.addShape("rect", { x: 0, y: 5.1, w: 10, h: 0.525, fill: { color: C.lightgray }, line: { color: C.lightgray } });
  // Acronym
  s.addText("CSVT", {
    x: 0.35, y: 0.1, w: 9, h: 1.0,
    fontSize: 54, bold: true, color: C.white,
    fontFace: "Calibri", valign: "middle", charSpacing: 5
  });
  // Full title
  s.addText("Cerebral Sinus Venous Thrombosis", {
    x: 0.35, y: 1.55, w: 9.3, h: 0.75,
    fontSize: 24, bold: true, color: C.navy,
    fontFace: "Calibri"
  });
  s.addText("A Comprehensive Neuroradiology Approach", {
    x: 0.35, y: 2.3, w: 9, h: 0.45,
    fontSize: 16, color: C.blue, fontFace: "Calibri", italic: true
  });
  // Decorative line
  s.addShape("rect", { x: 0.35, y: 2.85, w: 5.5, h: 0.04, fill: { color: C.lightblue }, line: { color: C.lightblue } });
  // Topics overview
  s.addText([
    { text: "MRI Protocols  •  Direct & Indirect Signs  •  Thrombus Evolution  •  Differential Diagnosis  •  Management", options: { fontSize: 10, color: C.gray, fontFace: "Calibri" } }
  ], { x: 0.35, y: 2.95, w: 9, h: 0.4 });
  // Dept
  s.addText("Neuroradiology Department  |  June 2026", {
    x: 0.35, y: 5.1, w: 9, h: 0.525,
    fontSize: 9, color: C.gray, fontFace: "Calibri", valign: "middle"
  });
}

// ══════════════════════════════════════════════════
// SLIDE 2 — AGENDA / OUTLINE
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Presentation Outline");
  addFooter(s, 2);

  const sections = [
    ["01", "Introduction & Epidemiology", "Definition, incidence, demographics"],
    ["02", "Anatomy of Cerebral Venous System", "Dural sinuses, cortical veins, deep veins"],
    ["03", "Pathophysiology", "Virchow's triad, thrombosis mechanism"],
    ["04", "Clinical Presentation", "Signs, symptoms, risk factors"],
    ["05", "Imaging Protocols", "MRI sequences, CT venography"],
    ["06", "Direct MRI Signs", "T1, T2, DWI, SWI, FLAIR findings"],
    ["07", "Indirect MRI Signs", "Edema, hemorrhage, venous infarct"],
    ["08", "MR Venography", "TOF, PC, CE-MRV techniques"],
    ["09", "Site-specific Findings", "SSS, transverse, sigmoid, cavernous sinus"],
    ["10", "Differential Diagnosis & Pitfalls", "Mimics and false positives"],
    ["11", "Management & Treatment", "Anticoagulation, endovascular, monitoring"],
    ["12", "Prognosis & Follow-up", "Outcomes, recanalization, recurrence"],
  ];

  const leftY = 1.05;
  const rowH = 0.3;
  sections.slice(0, 6).forEach((r, i) => {
    s.addShape("rect", { x: 0.22, y: leftY + i * rowH, w: 0.35, h: 0.24, fill: { color: C.blue }, line: { color: C.blue }, rounding: true });
    s.addText(r[0], { x: 0.22, y: leftY + i * rowH, w: 0.35, h: 0.24, fontSize: 8.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    s.addText(`${r[1]}  `, { x: 0.65, y: leftY + i * rowH, w: 4.3, h: 0.24, fontSize: 10, bold: true, color: C.darknavy, fontFace: "Calibri", valign: "middle", margin: 0 });
    s.addText(r[2], { x: 0.65, y: leftY + i * rowH + 0.13, w: 4.3, h: 0.18, fontSize: 8, color: C.midgray, fontFace: "Calibri", italic: true, valign: "top", margin: 0 });
  });
  sections.slice(6).forEach((r, i) => {
    s.addShape("rect", { x: 5.22, y: leftY + i * rowH, w: 0.35, h: 0.24, fill: { color: C.lightblue }, line: { color: C.lightblue }, rounding: true });
    s.addText(r[0], { x: 5.22, y: leftY + i * rowH, w: 0.35, h: 0.24, fontSize: 8.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    s.addText(`${r[1]}  `, { x: 5.65, y: leftY + i * rowH, w: 4.1, h: 0.24, fontSize: 10, bold: true, color: C.darknavy, fontFace: "Calibri", valign: "middle", margin: 0 });
    s.addText(r[2], { x: 5.65, y: leftY + i * rowH + 0.13, w: 4.1, h: 0.18, fontSize: 8, color: C.midgray, fontFace: "Calibri", italic: true, valign: "top", margin: 0 });
  });
}

// ══════════════════════════════════════════════════
// SLIDE 3 — SECTION DIVIDER: INTRODUCTION
// ══════════════════════════════════════════════════
addSectionSlide(pres, 3, "Introduction & Epidemiology", "Understanding the scope of CSVT", C.navy);

// ══════════════════════════════════════════════════
// SLIDE 4 — DEFINITION & EPIDEMIOLOGY
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Definition & Epidemiology");
  addFooter(s, 4);

  s.addText("What is CSVT?", { x: 0.22, y: 0.65, w: 9.5, h: 0.3, fontSize: 14, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Cerebral Sinus Venous Thrombosis (CSVT) — thrombotic occlusion of the dural venous sinuses and/or cerebral veins",
    "Accounts for 0.5–1% of all strokes; incidence ~5 per million per year",
    "More common in women (75%) due to pregnancy, puerperium, oral contraceptives",
    "Bimodal age distribution: neonates and young adults (20–35 years)",
    "Mortality has declined to <5% with modern anticoagulation therapy",
    "Highly treatable if recognized early — imaging is key to diagnosis",
  ]), { x: 0.22, y: 1.0, w: 9.55, h: 3.2, fontFace: "Calibri" });

  // Stats boxes
  const stats = [
    ["5/million/yr", "Incidence"],
    ["75%", "Female predominance"],
    ["<5%", "Modern mortality"],
    ["80%", "Good outcome with Rx"],
  ];
  stats.forEach((st, i) => {
    const xPos = 0.22 + i * 2.4;
    s.addShape("rect", { x: xPos, y: 4.35, w: 2.2, h: 0.7, fill: { color: C.offwhite }, line: { color: C.lightblue, pt: 1.5 } });
    s.addText(st[0], { x: xPos, y: 4.38, w: 2.2, h: 0.36, fontSize: 16, bold: true, color: C.blue, fontFace: "Calibri", align: "center", margin: 0 });
    s.addText(st[1], { x: xPos, y: 4.74, w: 2.2, h: 0.25, fontSize: 8, color: C.gray, fontFace: "Calibri", align: "center", margin: 0 });
  });
}

// ══════════════════════════════════════════════════
// SLIDE 5 — ANATOMY OF CEREBRAL VENOUS SYSTEM
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Anatomy: Cerebral Venous System", "Dural sinuses, cortical & deep veins");
  addFooter(s, 5);

  s.addText("Dural Venous Sinuses", { x: 0.22, y: 0.65, w: 4.8, h: 0.3, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Superior sagittal sinus (SSS) — most common CSVT site",
    "Inferior sagittal sinus",
    "Transverse sinuses (bilateral)",
    "Sigmoid sinuses",
    "Straight sinus — receives deep venous drainage",
    "Cavernous sinuses — anterior skull base",
    "Torcular Herophili — confluence of sinuses",
  ]), { x: 0.22, y: 1.0, w: 4.8, h: 2.8, fontFace: "Calibri" });

  s.addText("Cerebral Veins", { x: 0.22, y: 3.9, w: 4.8, h: 0.3, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Superficial cortical veins — drain into SSS",
    "Vein of Labbe — temporal lobe drainage",
    "Vein of Trolard — large anastomotic vein",
    "Deep veins: internal cerebral veins, vein of Galen, basal vein of Rosenthal",
  ]), { x: 0.22, y: 4.25, w: 4.8, h: 1.0, fontFace: "Calibri" });

  // Anatomy placeholder / decorative
  s.addShape("rect", { x: 5.3, y: 0.95, w: 4.4, h: 4.0, fill: { color: C.offwhite }, line: { color: C.lightgray, pt: 1 } });
  s.addText("Cerebral Venous Anatomy", { x: 5.3, y: 1.8, w: 4.4, h: 0.4, fontSize: 12, bold: true, color: C.midgray, fontFace: "Calibri", align: "center" });
  s.addText([
    { text: "SSS", options: { fontSize: 10, bold: true, color: C.accent } }, { text: " → Torcular → Transverse → Sigmoid → IJV\n", options: { fontSize: 10, color: C.darknavy } },
    { text: "Straight Sinus", options: { fontSize: 10, bold: true, color: C.blue } }, { text: " → Torcular\n", options: { fontSize: 10, color: C.darknavy } },
    { text: "Deep veins", options: { fontSize: 10, bold: true, color: C.lightblue } }, { text: " → Vein of Galen → Straight Sinus\n", options: { fontSize: 10, color: C.darknavy } },
    { text: "Cortical veins", options: { fontSize: 10, bold: true, color: C.gray } }, { text: " → SSS or transverse sinuses", options: { fontSize: 10, color: C.darknavy } },
  ], { x: 5.4, y: 2.3, w: 4.2, h: 1.8, fontFace: "Calibri" });
}

// ══════════════════════════════════════════════════
// SLIDE 6 — PATHOPHYSIOLOGY
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Pathophysiology", "Virchow's Triad applied to CSVT");
  addFooter(s, 6);

  // Three boxes for Virchow's triad
  const triad = [
    { label: "Hypercoagulability", color: C.blue, items: ["Thrombophilia (Factor V Leiden, protein C/S deficiency)", "Pregnancy & puerperium", "Oral contraceptives", "Malignancy", "Antiphospholipid syndrome"] },
    { label: "Stasis", color: C.lightblue, items: ["Dehydration", "Cardiac failure", "Dural AVM", "Obesity (increased venous pressure)", "Immobility"] },
    { label: "Endothelial Injury", color: C.accent, items: ["Trauma / neurosurgery", "Lumbar puncture", "Infection (meningitis, sinusitis, mastoiditis)", "Inflammatory disease (Behcet's, IBD)", "Dural sinus invasion by tumor"] },
  ];
  triad.forEach((t, i) => {
    const xPos = 0.22 + i * 3.25;
    s.addShape("rect", { x: xPos, y: 0.7, w: 3.0, h: 0.42, fill: { color: t.color }, line: { color: t.color } });
    s.addText(t.label, { x: xPos, y: 0.7, w: 3.0, h: 0.42, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    const bullets = t.items.map((item, ii) => ({ text: item, options: { bullet: { type: "bullet" }, fontSize: 10, color: C.darknavy, breakLine: ii < t.items.length - 1 } }));
    s.addText(bullets, { x: xPos, y: 1.15, w: 3.0, h: 2.8, fontFace: "Calibri", valign: "top" });
  });

  // Consequence
  s.addShape("rect", { x: 0.22, y: 4.1, w: 9.55, h: 0.04, fill: { color: C.lightgray }, line: { color: C.lightgray } });
  s.addText("Consequence:", { x: 0.22, y: 4.22, w: 1.4, h: 0.3, fontSize: 10, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText("Thrombus → venous outflow obstruction → raised venous pressure → vasogenic edema → cytotoxic edema → hemorrhagic venous infarction", {
    x: 1.65, y: 4.22, w: 8.1, h: 0.55, fontSize: 10, color: C.darknavy, fontFace: "Calibri", margin: 0
  });
}

// ══════════════════════════════════════════════════
// SLIDE 7 — CLINICAL PRESENTATION
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Clinical Presentation");
  addFooter(s, 7);

  s.addText("Symptoms", { x: 0.22, y: 0.65, w: 4.5, h: 0.3, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Headache — most common (90%); progressive, often bilateral",
    "Focal neurological deficits — weakness, sensory loss, aphasia",
    "Seizures — focal or generalized (30–40%)",
    "Papilledema — raised intracranial pressure",
    "Visual disturbances — diplopia, blurred vision",
    "Altered consciousness — encephalopathy",
    "Cavernous sinus triad: proptosis, chemosis, ophthalmoplegia",
  ]), { x: 0.22, y: 1.0, w: 4.7, h: 3.0, fontFace: "Calibri" });

  s.addText("Risk Factors", { x: 5.1, y: 0.65, w: 4.5, h: 0.3, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  const rfTable = [
    [{ text: "Prothrombotic Conditions", options: { bold: true, color: C.white, fill: C.blue } }, { text: "Situational", options: { bold: true, color: C.white, fill: C.blue } }],
    [{ text: "Factor V Leiden", options: { color: C.darknavy } }, { text: "OCP use", options: { color: C.darknavy } }],
    [{ text: "Prothrombin mutation", options: { color: C.darknavy } }, { text: "Pregnancy/puerperium", options: { color: C.darknavy } }],
    [{ text: "Protein C/S deficiency", options: { color: C.darknavy } }, { text: "Dehydration", options: { color: C.darknavy } }],
    [{ text: "Antiphospholipid Ab", options: { color: C.darknavy } }, { text: "Trauma/surgery", options: { color: C.darknavy } }],
    [{ text: "Homocysteinemia", options: { color: C.darknavy } }, { text: "Infection/inflammation", options: { color: C.darknavy } }],
    [{ text: "Malignancy", options: { color: C.darknavy } }, { text: "Drugs (steroids, androgens)", options: { color: C.darknavy } }],
  ];
  s.addTable(rfTable, { x: 5.1, y: 1.0, w: 4.7, colW: [2.35, 2.35], fontSize: 10, fontFace: "Calibri", border: { pt: 0.5, color: C.lightgray } });

  s.addText("Subacute onset in 50% of cases. Symptom duration ranges from hours to weeks. High clinical suspicion required — mimics many conditions.", {
    x: 0.22, y: 4.15, w: 9.55, h: 0.55, fontSize: 9.5, italic: true, color: C.gray, fontFace: "Calibri"
  });
}

// ══════════════════════════════════════════════════
// SLIDE 8 — SECTION DIVIDER: IMAGING
// ══════════════════════════════════════════════════
addSectionSlide(pres, 8, "Imaging Protocols", "CT, MRI, and Venography", C.navy);

// ══════════════════════════════════════════════════
// SLIDE 9 — IMAGING PROTOCOLS OVERVIEW
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Imaging Protocols", "Which modality and when?");
  addFooter(s, 9);

  const protocolRows = [
    [{ text: "Modality", options: { bold: true, color: C.white, fill: C.navy } }, { text: "Indication", options: { bold: true, color: C.white, fill: C.navy } }, { text: "Key Sequences / Findings", options: { bold: true, color: C.white, fill: C.navy } }],
    [{ text: "NECT (Non-contrast CT)", options: { color: C.darknavy } }, { text: "Initial screening; rapid triage", options: { color: C.darknavy } }, { text: "Dense sinus sign, cord sign, empty delta sign", options: { color: C.darknavy } }],
    [{ text: "CT Venography (CTV)", options: { color: C.darknavy } }, { text: "Rapid, widely available, good for sinuses", options: { color: C.darknavy } }, { text: "Filling defect in venous sinus", options: { color: C.darknavy } }],
    [{ text: "MRI Brain", options: { bold: true, color: C.blue } }, { text: "Gold standard; superior for parenchyma", options: { color: C.darknavy } }, { text: "T1, T2, FLAIR, DWI, SWI/GRE sequences", options: { bold: true, color: C.blue } }],
    [{ text: "MR Venography (MRV)", options: { bold: true, color: C.blue } }, { text: "Combined with MRI — gold standard pair", options: { color: C.darknavy } }, { text: "TOF, PC, or CE-MRV; absent flow in sinus", options: { bold: true, color: C.blue } }],
    [{ text: "DSA (Conventional Angio)", options: { color: C.darknavy } }, { text: "Reserved for equivocal cases / intervention", options: { color: C.darknavy } }, { text: "Direct visualization, pressure gradients", options: { color: C.darknavy } }],
  ];
  s.addTable(protocolRows, {
    x: 0.22, y: 0.7, w: 9.55,
    colW: [2.4, 2.9, 4.25],
    fontSize: 10, fontFace: "Calibri",
    border: { pt: 0.5, color: C.lightgray },
    rowH: 0.38
  });

  s.addText("MRI Protocol Recommendation:", { x: 0.22, y: 4.25, w: 2.6, h: 0.3, fontSize: 10, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText("T1W + T2W + FLAIR + DWI + SWI/GRE + MRV (TOF or CE). Post-gadolinium T1 adds value for equivocal cases and cortical vein thrombosis.", {
    x: 2.85, y: 4.25, w: 7.0, h: 0.45, fontSize: 9.5, color: C.darknavy, fontFace: "Calibri", margin: 0
  });
}

// ══════════════════════════════════════════════════
// SLIDE 10 — SECTION DIVIDER: DIRECT MRI SIGNS
// ══════════════════════════════════════════════════
addSectionSlide(pres, 10, "Direct MRI Signs", "Signal changes within the thrombus", C.navy);

// ══════════════════════════════════════════════════
// SLIDE 11 — THROMBUS EVOLUTION ON MRI
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Thrombus Signal Evolution on MRI", "Stage-dependent appearance");
  addFooter(s, 11);

  const thrombus = [
    [{ text: "Stage", options: { bold: true, color: C.white, fill: C.navy } }, { text: "Time", options: { bold: true, color: C.white, fill: C.navy } }, { text: "Hgb Form", options: { bold: true, color: C.white, fill: C.navy } }, { text: "T1W", options: { bold: true, color: C.white, fill: C.navy } }, { text: "T2W", options: { bold: true, color: C.white, fill: C.navy } }, { text: "SWI/GRE", options: { bold: true, color: C.white, fill: C.navy } }],
    [{ text: "Hyperacute", options: { color: C.darknavy } }, { text: "<24 hrs", options: { color: C.darknavy } }, { text: "Oxyhemoglobin", options: { color: C.darknavy } }, { text: "Iso", options: { color: C.darknavy } }, { text: "Hyperintense", options: { color: C.darknavy } }, { text: "Hypointense (↓)", options: { color: C.darknavy } }],
    [{ text: "Acute", options: { bold: true, color: C.accent } }, { text: "1–7 days", options: { bold: true, color: C.accent } }, { text: "Deoxyhemoglobin", options: { color: C.darknavy } }, { text: "Iso (difficult)", options: { color: C.darknavy } }, { text: "Hypointense (↓)", options: { bold: true, color: C.accent } }, { text: "Hypointense ↓↓ (blooming)", options: { bold: true, color: C.accent } }],
    [{ text: "Subacute", options: { bold: true, color: C.blue } }, { text: "1–2 weeks", options: { bold: true, color: C.blue } }, { text: "Methemoglobin", options: { color: C.darknavy } }, { text: "Hyperintense ↑↑", options: { bold: true, color: C.blue } }, { text: "Hyperintense ↑", options: { color: C.darknavy } }, { text: "Iso to hypointense", options: { color: C.darknavy } }],
    [{ text: "Chronic", options: { color: C.darknavy } }, { text: ">2 weeks", options: { color: C.darknavy } }, { text: "Hemosiderin", options: { color: C.darknavy } }, { text: "Variable/low", options: { color: C.darknavy } }, { text: "Hypointense", options: { color: C.darknavy } }, { text: "Hypointense ↓↓", options: { color: C.darknavy } }],
    [{ text: "Recanalized", options: { color: C.gray } }, { text: "Weeks–months", options: { color: C.gray } }, { text: "—", options: { color: C.gray } }, { text: "Flow void returns", options: { color: C.gray } }, { text: "Flow void returns", options: { color: C.gray } }, { text: "Variable", options: { color: C.gray } }],
  ];
  s.addTable(thrombus, {
    x: 0.22, y: 0.7, w: 9.55,
    colW: [1.4, 1.35, 1.75, 1.45, 1.7, 1.9],
    fontSize: 9.5, fontFace: "Calibri",
    border: { pt: 0.5, color: C.lightgray },
    rowH: 0.4
  });

  s.addText("Clinical Pearl: Acute CSVT may be the most difficult to detect on standard MRI sequences due to isointense T1 signal. SWI/GRE blooming effect is the most sensitive sequence in the acute phase.", {
    x: 0.22, y: 4.0, w: 9.55, h: 0.6, fontSize: 9.5, italic: true, color: C.gray, fontFace: "Calibri"
  });
}

// ══════════════════════════════════════════════════
// SLIDE 12 — T1 SIGNAL: HYPERSIGNAL IN SSS
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "T1-Weighted Imaging: Direct Thrombus Sign", "T1 hypersignal in subacute thrombus");
  addFooter(s, 12);

  s.addText(makeBullets([
    "Normal dural sinuses show low signal (flow void) on T1W images",
    "Subacute thrombus (methemoglobin phase, days 7–14): T1 HYPERINTENSE signal replacing flow void",
    "Sagittal T1 is the best plane for evaluating the SSS and straight sinus",
    "Sensitivity of T1 hyperintensity: ~71% for DVST",
    "Can be confused with: slow flow (especially on 3T), fat saturation artifacts",
    "Always correlate with MRV for confirmation",
  ]), { x: 0.22, y: 0.72, w: 4.8, h: 3.4, fontFace: "Calibri" });

  const img0 = getImg(0);
  if (img0) {
    s.addImage({ data: img0, x: 5.3, y: 0.72, w: 4.4, h: 3.5 });
    s.addText("T1W sagittal: hyperintense thrombus in superior sagittal sinus (subacute phase)", {
      x: 5.3, y: 4.25, w: 4.4, h: 0.45, fontSize: 7.5, italic: true, color: C.gray, fontFace: "Calibri", align: "center", margin: 0
    });
  } else {
    s.addShape("rect", { x: 5.3, y: 0.72, w: 4.4, h: 3.5, fill: { color: C.offwhite }, line: { color: C.lightgray } });
    s.addText("T1W: Hyperintense signal in thrombosed sinus\n(subacute methemoglobin phase)", {
      x: 5.3, y: 1.8, w: 4.4, h: 1.0, fontSize: 11, color: C.midgray, fontFace: "Calibri", align: "center" });
  }

  s.addShape("rect", { x: 0.22, y: 4.25, w: 4.8, h: 0.6, fill: { color: C.offwhite }, line: { color: C.lightblue, pt: 1 } });
  s.addText("Key Finding: T1 hypersignal in a venous sinus = strong evidence of subacute CSVT. Combined T1+T2 abnormality increases specificity.", {
    x: 0.28, y: 4.28, w: 4.68, h: 0.54, fontSize: 9, color: C.navy, fontFace: "Calibri", margin: 0 });
}

// ══════════════════════════════════════════════════
// SLIDE 13 — T2/FLAIR SIGNS
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "T2W & FLAIR: Flow Void Loss and Edema", "Direct and indirect parenchymal changes");
  addFooter(s, 13);

  s.addText("T2W Direct Signs:", { x: 0.22, y: 0.65, w: 9.5, h: 0.28, fontSize: 11, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Loss of normal T2 FLOW VOID in the affected sinus — the earliest and most reliable sign",
    "Acute phase (deoxyhemoglobin): T2 HYPOINTENSE signal within the sinus",
    "Subacute phase: T2 hyperintense thrombus (methemoglobin)",
    "Asymmetric sinus signals should always raise suspicion",
  ]), { x: 0.22, y: 0.95, w: 4.8, h: 1.6, fontFace: "Calibri" });

  s.addText("FLAIR Sequence:", { x: 0.22, y: 2.65, w: 9.5, h: 0.28, fontSize: 11, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "FLAIR: Hyperintense signal in the thrombosed sinus (sensitivity ~50–60%)",
    "CSF suppression makes FLAIR excellent for cortical vein thrombosis detection",
    "FLAIR may show parenchymal edema before DWI changes",
    "Sulcal FLAIR hyperintensity suggests cortical vein thrombosis",
  ]), { x: 0.22, y: 2.95, w: 4.8, h: 1.6, fontFace: "Calibri" });

  const img3 = getImg(3);
  if (img3) {
    s.addImage({ data: img3, x: 5.3, y: 0.72, w: 4.4, h: 3.5 });
    s.addText("T1/T2 showing thrombus signal changes in SSS (AJNR)", {
      x: 5.3, y: 4.25, w: 4.4, h: 0.38, fontSize: 7.5, italic: true, color: C.gray, fontFace: "Calibri", align: "center", margin: 0 });
  } else {
    s.addShape("rect", { x: 5.3, y: 0.72, w: 4.4, h: 3.5, fill: { color: C.offwhite }, line: { color: C.lightgray } });
    s.addText("T2/FLAIR: Loss of flow void, parenchymal edema", {
      x: 5.3, y: 2.1, w: 4.4, h: 0.8, fontSize: 11, color: C.midgray, fontFace: "Calibri", align: "center" });
  }
}

// ══════════════════════════════════════════════════
// SLIDE 14 — DWI / ADC
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Diffusion-Weighted Imaging (DWI/ADC)", "Distinguishing vasogenic from cytotoxic edema");
  addFooter(s, 14);

  s.addText(makeBullets([
    "DWI in CSVT — two distinct patterns:",
    "  (1) Thrombus itself: DWI hyperintense, ADC variable/restricted (especially subacute)",
    "  (2) Parenchymal changes: vasogenic vs cytotoxic edema",
    "",
    "Vasogenic edema: DWI mildly ↑, ADC ↑ (reversible if treated early)",
    "Cytotoxic edema: DWI ↑↑, ADC ↓ (true infarction — irreversible)",
    "Mixed patterns common in hemorrhagic venous infarction",
    "ADC normalization on follow-up = favorable prognostic sign",
    "DWI-based diagnosis: sensitivity ~50–70%, specificity >90% for thrombus",
    "DWI combined with T1+T2 improves overall CSVT detection",
  ]), { x: 0.22, y: 0.72, w: 9.55, h: 3.6, fontFace: "Calibri" });

  // Summary box
  s.addShape("rect", { x: 0.22, y: 4.3, w: 9.55, h: 0.55, fill: { color: C.offwhite }, line: { color: C.lightblue, pt: 1.2 } });
  s.addText([
    { text: "DWI Pattern Rule: ", options: { bold: true, color: C.navy, fontSize: 10 } },
    { text: "ADC ↑ = vasogenic (potentially reversible) | ADC ↓ = cytotoxic infarction (irreversible). Determines prognosis and guides treatment urgency.", options: { color: C.darknavy, fontSize: 10 } },
  ], { x: 0.28, y: 4.33, w: 9.4, h: 0.48, fontFace: "Calibri", margin: 0 });
}

// ══════════════════════════════════════════════════
// SLIDE 15 — SWI / GRE
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "SWI & GRE: The Blooming Effect", "Most sensitive for acute and cortical vein thrombosis");
  addFooter(s, 15);

  s.addText(makeBullets([
    "SWI (Susceptibility-Weighted Imaging) — most sensitive sequence for acute CSVT",
    "Deoxyhemoglobin in acute thrombus: pronounced T2* signal loss = BLOOMING effect",
    "Blooming exceeds actual size of thrombus on GRE — pathognomonic sign",
    "SWI superior to GRE: detects cortical vein thrombosis with sensitivity >90%",
    "SWI cord sign: hypointense thrombosed cortical vein visible on SWI",
    "Venous stasis and slow collateral flow also appear hypointense on SWI",
    "Chronic CSVT: hemosiderin deposition maintains SWI hypointensity",
    "SWI helps detect hemorrhagic venous infarction — petechial bleeds visible",
    "Always include SWI or GRE in routine CSVT MRI protocol",
  ]), { x: 0.22, y: 0.72, w: 5.0, h: 3.8, fontFace: "Calibri" });

  const img4 = getImg(4);
  if (img4) {
    s.addImage({ data: img4, x: 5.4, y: 0.72, w: 4.3, h: 3.3 });
    s.addText("SWI/GRE: Blooming effect — hypointense thrombus exceeds vessel size", {
      x: 5.4, y: 4.05, w: 4.3, h: 0.42, fontSize: 7.5, italic: true, color: C.gray, fontFace: "Calibri", align: "center", margin: 0 });
  } else {
    s.addShape("rect", { x: 5.4, y: 0.72, w: 4.3, h: 3.3, fill: { color: C.offwhite }, line: { color: C.lightgray } });
    s.addText("SWI: Blooming hypointensity\nin thrombosed sinus/cortical vein", {
      x: 5.4, y: 1.95, w: 4.3, h: 1.0, fontSize: 11, color: C.midgray, fontFace: "Calibri", align: "center" });
  }
}

// ══════════════════════════════════════════════════
// SLIDE 16 — MR VENOGRAPHY
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "MR Venography (MRV)", "TOF, Phase-Contrast, and CE-MRV");
  addFooter(s, 16);

  const mrvTable = [
    [{ text: "Technique", options: { bold: true, color: C.white, fill: C.navy } }, { text: "Principle", options: { bold: true, color: C.white, fill: C.navy } }, { text: "Advantages", options: { bold: true, color: C.white, fill: C.navy } }, { text: "Limitations", options: { bold: true, color: C.white, fill: C.navy } }],
    [{ text: "2D TOF MRV", options: { color: C.darknavy } }, { text: "Flow-related enhancement", options: { color: C.darknavy } }, { text: "No contrast, widely available, sensitive", options: { color: C.darknavy } }, { text: "Artifacts from slow flow, saturation effects", options: { color: C.darknavy } }],
    [{ text: "Phase-Contrast MRV", options: { color: C.darknavy } }, { text: "Phase shifts of moving spins", options: { color: C.darknavy } }, { text: "Quantifies flow, no background suppression issues", options: { color: C.darknavy } }, { text: "Long acquisition, velocity-dependent", options: { color: C.darknavy } }],
    [{ text: "CE-MRV", options: { bold: true, color: C.blue } }, { text: "Gadolinium-enhanced T1 fat sat", options: { color: C.darknavy } }, { text: "Comparable to CTV, least artifact-prone, best for sinuses", options: { bold: true, color: C.blue } }, { text: "Requires IV contrast, timing critical", options: { color: C.darknavy } }],
    [{ text: "DSA", options: { color: C.gray } }, { text: "Digital subtraction catheter angio", options: { color: C.gray } }, { text: "Gold standard; interventional capability", options: { color: C.gray } }, { text: "Invasive, radiation, rarely needed diagnostically", options: { color: C.gray } }],
  ];
  s.addTable(mrvTable, {
    x: 0.22, y: 0.7, w: 9.55,
    colW: [1.6, 2.2, 3.3, 2.45],
    fontSize: 9.5, fontFace: "Calibri",
    border: { pt: 0.5, color: C.lightgray },
    rowH: 0.45
  });

  s.addText(makeBullets([
    "MRV finding in CSVT: ABSENT FLOW signal (filling defect) in affected sinus",
    "CE-MRV: thrombus appears as filling defect surrounded by enhancing collaterals",
    "TOF pitfall: slow flow mimics absent flow (check jugular foramen size for hypoplastic TS)",
    "Recommended: MRI brain + MRV as first-line combined imaging — sensitivity >95%",
  ]), { x: 0.22, y: 3.6, w: 9.55, h: 1.4, fontFace: "Calibri", fontSize: 10 });
}

// ══════════════════════════════════════════════════
// SLIDE 17 — MRV IMAGE SLIDE
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "MR Venography — Imaging Examples", "Absent flow in thrombosed sinuses");
  addFooter(s, 17);

  const img2 = getImg(2);
  const img5 = getImg(5);

  if (img2) {
    s.addImage({ data: img2, x: 0.22, y: 0.72, w: 4.65, h: 3.5 });
    s.addText("TOF MRV: Absent flow in SSS and transverse sinus (AJNR)", {
      x: 0.22, y: 4.25, w: 4.65, h: 0.4, fontSize: 7.5, italic: true, color: C.gray, fontFace: "Calibri", align: "center", margin: 0 });
  } else {
    s.addShape("rect", { x: 0.22, y: 0.72, w: 4.65, h: 3.5, fill: { color: C.offwhite }, line: { color: C.lightgray } });
    s.addText("TOF MRV: Absent flow in SSS", { x: 0.22, y: 2.2, w: 4.65, h: 0.8, fontSize: 12, color: C.midgray, fontFace: "Calibri", align: "center" });
  }

  if (img5) {
    s.addImage({ data: img5, x: 5.13, y: 0.72, w: 4.65, h: 3.5 });
    s.addText("MRV: Deep venous system thrombosis — absent internal cerebral vein flow", {
      x: 5.13, y: 4.25, w: 4.65, h: 0.4, fontSize: 7.5, italic: true, color: C.gray, fontFace: "Calibri", align: "center", margin: 0 });
  } else {
    s.addShape("rect", { x: 5.13, y: 0.72, w: 4.65, h: 3.5, fill: { color: C.offwhite }, line: { color: C.lightgray } });
    s.addText("CE-MRV: Filling defect in transverse sinus", { x: 5.13, y: 2.2, w: 4.65, h: 0.8, fontSize: 12, color: C.midgray, fontFace: "Calibri", align: "center" });
  }
}

// ══════════════════════════════════════════════════
// SLIDE 18 — SECTION DIVIDER: INDIRECT SIGNS
// ══════════════════════════════════════════════════
addSectionSlide(pres, 18, "Indirect MRI Signs", "Parenchymal consequences of CSVT", C.navy);

// ══════════════════════════════════════════════════
// SLIDE 19 — VENOUS INFARCTION
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Venous Infarction", "Non-arterial distribution, often hemorrhagic");
  addFooter(s, 19);

  s.addText(makeBullets([
    "Occurs in 30–40% of CSVT cases — due to venous outflow obstruction",
    "Distribution: does NOT follow an arterial territory — crosses vascular boundaries",
    "Often BILATERAL and PARASAGITTAL in SSS thrombosis",
    "Frequently HEMORRHAGIC (40–60%): mix of vasogenic and cytotoxic edema",
    "Common locations by sinus involved:",
    "  - SSS: bilateral parasagittal cortex",
    "  - Transverse/sigmoid: ipsilateral temporal-occipital lobe, cerebellum",
    "  - Deep veins (ICVs): bilateral thalami, basal ganglia",
    "  - Straight sinus: bilateral thalamic edema",
    "  - Vein of Labbe: temporal lobe (unilateral)",
  ]), { x: 0.22, y: 0.72, w: 5.0, h: 4.0, fontFace: "Calibri" });

  const img6 = getImg(6);
  if (img6) {
    s.addImage({ data: img6, x: 5.3, y: 0.72, w: 4.4, h: 3.5 });
    s.addText("Hemorrhagic venous infarction — bilateral parasagittal distribution", {
      x: 5.3, y: 4.25, w: 4.4, h: 0.4, fontSize: 7.5, italic: true, color: C.gray, fontFace: "Calibri", align: "center", margin: 0 });
  } else {
    s.addShape("rect", { x: 5.3, y: 0.72, w: 4.4, h: 3.5, fill: { color: C.offwhite }, line: { color: C.lightgray } });
    s.addText("Hemorrhagic venous infarct\n(bilateral parasagittal — SSS thrombosis)", {
      x: 5.3, y: 1.9, w: 4.4, h: 1.1, fontSize: 11, color: C.midgray, fontFace: "Calibri", align: "center" });
  }
}

// ══════════════════════════════════════════════════
// SLIDE 20 — DEEP VENOUS THROMBOSIS
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Deep Cerebral Venous Thrombosis", "Bilateral thalamic involvement — a diagnostic challenge");
  addFooter(s, 20);

  s.addText(makeBullets([
    "DVT of deep cerebral veins: internal cerebral veins, vein of Galen, straight sinus",
    "Characteristic finding: BILATERAL THALAMIC edema/infarction",
    "Often mimics other conditions: encephalitis, metabolic disease, bilateral thalamic glioma",
    "Basal vein of Rosenthal thrombosis: medial temporal lobe edema",
    "DWI: bilateral thalamic restricted diffusion (cytotoxic edema)",
    "T1W: hyperintense ICVs on sagittal view is diagnostic",
    "MRV: absent vein of Galen and straight sinus flow",
    "Poor prognosis due to involvement of diencephalic structures",
    "Clinical: rapid onset coma, memory deficits, gaze abnormalities",
  ]), { x: 0.22, y: 0.72, w: 9.55, h: 3.8, fontFace: "Calibri" });

  s.addShape("rect", { x: 0.22, y: 4.6, w: 9.55, h: 0.5, fill: { color: C.offwhite }, line: { color: C.accent, pt: 1.5 } });
  s.addText("Red Flag: Bilateral thalamic signal abnormality on MRI — always consider deep CSVT before encephalitis or metabolic etiology.", {
    x: 0.28, y: 4.63, w: 9.4, h: 0.44, fontSize: 9.5, bold: true, color: C.accent, fontFace: "Calibri", margin: 0 });
}

// ══════════════════════════════════════════════════
// SLIDE 21 — CORTICAL VEIN THROMBOSIS
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Isolated Cortical Vein Thrombosis (CoVT)", "Focal, challenging to detect — SWI is key");
  addFooter(s, 21);

  s.addText(makeBullets([
    "CoVT: thrombosis of cortical veins without dural sinus involvement",
    "Isolated CoVT accounts for ~6% of CSVT — underdiagnosed",
    "Clinical: focal neurological deficits, focal seizures, localized headache",
    "MRI Direct Signs:",
    "  - SWI/GRE: hypointense cord sign — the most sensitive finding",
    "  - T1W: focal hyperintense cortical vein (subacute)",
    "  - FLAIR: sulcal hyperintensity in affected region",
    "  - Post-Gd T1: vein enhancement or delta sign analog",
    "MRI Indirect Signs:",
    "  - Focal cortical/subcortical edema or infarction",
    "  - Hemorrhagic cortical contusion appearance",
    "  - Focal sulcal effacement",
    "Standard MRV (TOF): often NORMAL — CoVT not visible on conventional MRV",
    "CE-MRV or source images needed for cortical vein visualization",
  ]), { x: 0.22, y: 0.72, w: 9.55, h: 4.4, fontFace: "Calibri" });
}

// ══════════════════════════════════════════════════
// SLIDE 22 — SECTION DIVIDER: SITE-SPECIFIC
// ══════════════════════════════════════════════════
addSectionSlide(pres, 22, "Site-Specific Findings", "SSS, Transverse, Sigmoid, Cavernous Sinus", C.navy);

// ══════════════════════════════════════════════════
// SLIDE 23 — SSS AND TRANSVERSE SINUS THROMBOSIS
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "SSS & Transverse Sinus Thrombosis", "Most common CSVT locations");
  addFooter(s, 23);

  s.addText("Superior Sagittal Sinus (SSS)", { x: 0.22, y: 0.65, w: 4.75, h: 0.3, fontSize: 11, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Most common site (~70–80% of CSVT)",
    "Bilateral parasagittal cortical infarcts",
    "CT: dense triangle sign / cord sign along SSS",
    "MRI sagittal T1: loss of flow void, T1 hypersignal",
    "MRV: absent SSS flow on coronal MIP images",
    "Raised ICP: papilledema, empty sella, distended optic sheaths",
  ]), { x: 0.22, y: 0.98, w: 4.75, h: 2.0, fontFace: "Calibri" });

  s.addText("Transverse Sinus", { x: 0.22, y: 3.1, w: 4.75, h: 0.3, fontSize: 11, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Second most common site (~40–60% of CSVT)",
    "Often associated with otitis media/mastoiditis",
    "Right > left (usually dominant right TS)",
    "Ipsilateral temporal-occipital and cerebellar infarct",
    "Key pitfall: hypoplastic left TS — compare jugular foramina size",
  ]), { x: 0.22, y: 3.43, w: 4.75, h: 1.6, fontFace: "Calibri" });

  const img7 = getImg(7);
  if (img7) {
    s.addImage({ data: img7, x: 5.3, y: 0.72, w: 4.4, h: 3.9 });
    s.addText("SSS + transverse sinus CSVT — T1/T2/MRV correlation", {
      x: 5.3, y: 4.65, w: 4.4, h: 0.38, fontSize: 7.5, italic: true, color: C.gray, fontFace: "Calibri", align: "center", margin: 0 });
  } else {
    s.addShape("rect", { x: 5.3, y: 0.72, w: 4.4, h: 3.9, fill: { color: C.offwhite }, line: { color: C.lightgray } });
    s.addText("MRI multisequence:\nSSS and transverse sinus thrombosis", {
      x: 5.3, y: 2.2, w: 4.4, h: 1.1, fontSize: 11, color: C.midgray, fontFace: "Calibri", align: "center" });
  }
}

// ══════════════════════════════════════════════════
// SLIDE 24 — CAVERNOUS SINUS THROMBOSIS
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Cavernous Sinus Thrombosis", "Septic vs aseptic — a dangerous entity");
  addFooter(s, 24);

  s.addText(makeBullets([
    "Cavernous sinus (CS): located at the anterior skull base — bilaterally",
    "Contains CN III, IV, V1, V2, VI and the internal carotid artery",
    "",
    "Etiology: Septic (most common) — facial/nasal infection spreading via facial veins",
    "  Causal organisms: S. aureus (most common), S. pneumoniae, gram-negatives",
    "  Aseptic: trauma, OCP, dehydration, hypercoagulable state",
    "",
    "Classic Clinical Triad: Proptosis + Chemosis + Ophthalmoplegia (CN VI most affected)",
    "  Plus: periorbital edema, fever (septic), vision loss",
    "",
    "MRI Findings:",
    "  - Enlargement and bulging of cavernous sinus",
    "  - Loss of normal flow void / heterogeneous signal",
    "  - Post-Gd: peripheral enhancement with central filling defect",
    "  - Orbital proptosis, periorbital fat stranding on T1/T2",
    "  - May show internal carotid artery narrowing",
    "  - Possible spread: meningitis, brain abscess, septic emboli",
    "",
    "CT/MRI both needed: CT for bony destruction/sinusitis, MRI for parenchymal involvement",
  ]), { x: 0.22, y: 0.72, w: 9.55, h: 4.5, fontFace: "Calibri", fontSize: 10.5 });
}

// ══════════════════════════════════════════════════
// SLIDE 25 — SECTION DIVIDER: DIFFERENTIAL DIAGNOSIS
// ══════════════════════════════════════════════════
addSectionSlide(pres, 25, "Differential Diagnosis & Pitfalls", "Mimics and false positives", C.navy);

// ══════════════════════════════════════════════════
// SLIDE 26 — DIFFERENTIALS & PITFALLS
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Differential Diagnosis & Imaging Pitfalls");
  addFooter(s, 26);

  const ddRows = [
    [{ text: "Mimic / Pitfall", options: { bold: true, color: C.white, fill: C.navy } }, { text: "How it Mimics CSVT", options: { bold: true, color: C.white, fill: C.navy } }, { text: "How to Distinguish", options: { bold: true, color: C.white, fill: C.navy } }],
    [{ text: "Hypoplastic Transverse Sinus", options: { color: C.darknavy } }, { text: "Absent TOF flow mimics occlusion", options: { color: C.darknavy } }, { text: "Compare jugular foramen size; CE-MRV shows normal small but patent sinus", options: { color: C.darknavy } }],
    [{ text: "Slow Flow / High Riding SSS", options: { color: C.darknavy } }, { text: "T1 hyperintensity without thrombosis", options: { color: C.darknavy } }, { text: "CE-MRV normal enhancement; no parenchymal changes", options: { color: C.darknavy } }],
    [{ text: "Arachnoid Granulations", options: { color: C.darknavy } }, { text: "Filling defect in sinus on CE-MRV/CTV", options: { color: C.darknavy } }, { text: "Smooth rounded margins, CSF density on CT, T2 hyperintense", options: { color: C.darknavy } }],
    [{ text: "Subdural Hematoma", options: { color: C.darknavy } }, { text: "Hyperdense TS can simulate SDH", options: { color: C.darknavy } }, { text: "Tubular shape of sinus thrombus vs crescent SDH; MRI confirms", options: { color: C.darknavy } }],
    [{ text: "Meningioma / Tumor", options: { color: C.darknavy } }, { text: "Dural sinus invasion", options: { color: C.darknavy } }, { text: "Enhancing mass with dural tail; CE-MRV demonstrates sinus patency vs occlusion", options: { color: C.darknavy } }],
    [{ text: "Arterial Infarct", options: { color: C.darknavy } }, { text: "Parenchymal edema/infarction", options: { color: C.darknavy } }, { text: "Arterial distribution vs non-arterial, non-gyral; check MRA for arterial occlusion", options: { color: C.darknavy } }],
    [{ text: "Encephalitis / Metabolic", options: { color: C.darknavy } }, { text: "Bilateral thalamic edema (DVT mimic)", options: { color: C.darknavy } }, { text: "MRV: absent deep venous flow; clinical context, CSF analysis", options: { color: C.darknavy } }],
  ];
  s.addTable(ddRows, {
    x: 0.22, y: 0.68, w: 9.55,
    colW: [2.25, 2.8, 4.5],
    fontSize: 9, fontFace: "Calibri",
    border: { pt: 0.5, color: C.lightgray },
    rowH: 0.36
  });
}

// ══════════════════════════════════════════════════
// SLIDE 27 — SECTION DIVIDER: MANAGEMENT
// ══════════════════════════════════════════════════
addSectionSlide(pres, 27, "Management & Treatment", "Anticoagulation, endovascular, monitoring", C.navy);

// ══════════════════════════════════════════════════
// SLIDE 28 — TREATMENT
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Treatment of CSVT", "Anticoagulation is the cornerstone — even with hemorrhage");
  addFooter(s, 28);

  s.addText("First-Line Therapy:", { x: 0.22, y: 0.65, w: 9.5, h: 0.3, fontSize: 11, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "ANTICOAGULATION — first-line in ALL patients, even with hemorrhagic venous infarction",
    "Acute phase: IV unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH)",
    "UFH preferred if high risk of deterioration (allows rapid reversal)",
    "Transition to oral anticoagulants: warfarin (INR 2–3) OR direct oral anticoagulants (DOACs)",
    "DOACs (dabigatran, rivaroxaban): non-inferior to warfarin per ISCVT-2 & RE-SPECT trials (2023–2024)",
    "Duration: 3–6 months for provoked; 6–12 months for unprovoked; indefinite if underlying thrombophilia",
  ]), { x: 0.22, y: 0.98, w: 9.55, h: 1.9, fontFace: "Calibri" });

  s.addText("Symptomatic Treatment:", { x: 0.22, y: 2.95, w: 9.5, h: 0.28, fontSize: 11, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Seizures: antiepileptic drugs (AED) — levetiracetam first-line",
    "Elevated ICP: acetazolamide, serial LP, CSF diversion (shunt) for refractory cases",
    "Septic CSVT (cavernous): IV antibiotics + anticoagulation + surgical drainage if abscess",
  ]), { x: 0.22, y: 3.26, w: 9.55, h: 1.0, fontFace: "Calibri" });

  s.addText("Endovascular (reserved for severe cases):", { x: 0.22, y: 4.3, w: 9.55, h: 0.28, fontSize: 11, bold: true, color: C.accent, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Catheter-directed thrombolysis (tPA) or mechanical thrombectomy in deteriorating patients despite anticoagulation",
    "Decompressive craniectomy if large hemorrhagic infarct with herniation risk",
  ]), { x: 0.22, y: 4.6, w: 9.55, h: 0.65, fontFace: "Calibri" });
}

// ══════════════════════════════════════════════════
// SLIDE 29 — PROGNOSIS & FOLLOW-UP IMAGING
// ══════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addHeader(s, "Prognosis & Follow-Up Imaging", "Outcomes and recanalization monitoring");
  addFooter(s, 29);

  s.addText("Outcomes:", { x: 0.22, y: 0.65, w: 9.5, h: 0.28, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Overall good outcome (mRS 0–2) in ~75–85% with appropriate treatment",
    "Mortality <5% in modern series",
    "Poor prognostic factors: altered consciousness, coma, deep CSVT, hemorrhagic infarct, malignancy, age >65",
    "Recanalization occurs in 80%+ of patients within 3–6 months",
    "Complete recanalization associated with better neurological outcomes",
    "Recurrence rate ~2–4% per year; higher in underlying thrombophilia",
  ]), { x: 0.22, y: 0.97, w: 4.8, h: 2.3, fontFace: "Calibri" });

  s.addText("Follow-Up Imaging Protocol:", { x: 0.22, y: 3.35, w: 9.5, h: 0.28, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "MRI + MRV at 3–6 months to assess recanalization",
    "ADC normalization on DWI confirms edema resolution",
    "Persistent sinus occlusion despite 6 months anticoagulation: reassess duration",
    "Papilledema follow-up: ophthalmology and repeat MRI in IH cases",
    "If no recanalization at 12 months: unlikely to occur — chronic thrombosis",
  ]), { x: 0.22, y: 3.67, w: 4.8, h: 1.55, fontFace: "Calibri" });

  // Progress indicators
  const outcomes = [["75–85%", "Good outcome (mRS 0–2)"], ["80%+", "Recanalization by 6 mo"], ["<5%", "Mortality"], ["3–4%/yr", "Recurrence rate"]];
  outcomes.forEach((o, i) => {
    const xPos = 5.3 + (i % 2) * 2.3;
    const yPos = 0.95 + Math.floor(i / 2) * 1.45;
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}

// ══════════════════════════════════════════════════
// SLIDE 30 — SUMMARY & KEY TAKEAWAYS
// ══════════════════════════════════════════════════
{
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  s.addShape("rect", { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.accent }, line: { color: C.accent } });

  s.addText("Key Takeaways", {
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  s.addShape("rect", { x: 0.4, y: 0.8, w: 6, h: 0.04, fill: { color: C.lightblue }, line: { color: C.lightblue } });

  const takeaways = [
    ["01", "MRI + MRV", "Gold standard imaging — sensitivity >95%. Include T1W, T2W, FLAIR, DWI, SWI, and MRV in every suspected CSVT protocol."],
    ["02", "Stage-dependent signal", "Acute CSVT hardest to detect (isointense T1). SWI blooming is most sensitive in acute phase."],
    ["03", "Non-arterial pattern", "Venous infarction crosses vascular boundaries, often bilateral, frequently hemorrhagic — distinct from arterial stroke."],
    ["04", "Bilateral thalami", "Bilateral thalamic edema = deep CSVT until proven otherwise. Don't diagnose encephalitis first."],
    ["05", "Anticoagulate", "Treat with heparin/LMWH even with hemorrhage — this is the cornerstone of management."],
    ["06", "Pitfalls matter", "Hypoplastic TS, slow flow, arachnoid granulations — always verify with CE-MRV before diagnosing CSVT."],
  ];

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  s.addText("Cerebral Sinus Venous Thrombosis  |  Neuroradiology  |  June 2026", {
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// ─── Write file ─────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/csvt-ppt/CSVT_Neuroradiology.pptx" })
  .then(() => console.log("DONE: CSVT_Neuroradiology.pptx written successfully"))
  .catch(e => console.error("ERROR:", e));