1,721,285 research outputs found
Is Parkinson's Disease a Very Rare Pathology in Centenarians? A Clinical Study in a Cohort of Subjects.
Full text linkThe number of people reaching old age is growing dramatically and centenarians are among the fastest growing age groups. Since no epidemiological study on Parkinson's disease (PD) in this age class is present in the medical literature, we estimated PD prevalence in the Centenari a Trieste (CaT) study. Participating centenarians were examined by a neurologist, who also retrieved their remote and pharmacological anamnesis. Ninety centenarians received a neurological examination. No subject had PD clinical signs. Moreover, none had a previous diagnosis of PD or had taken or was taking anti-Parkinson treatment. This simple but consistent clinical observation permits some physio-pathological hypothese
Trattamento dello stroke nell’adulto e nel bambino: due mondi paralleli e differenti, sulla via di incontrarsi...
No full textN/
The prevention of deep venous thrombosis in neurosurgery: An update from our institution
Full text linkProphylactic low weight molecular subcutaneous heparin combined with mechanical devices and elastic stockings has already been correlated to a low incidence of deep venous thrombosis. However, there is still concern with the use of heparin in the neurosurgical field due to the potential hemorrhagic risks. We would like to update this topic with new data coming from a larger cohort of patients operated on at our Department in the last 8 years both for cranial and spinal procedures. We collected information on 5347 patients: 1497 were cranial and 3850 were spinal cases. We recorded 35 clinically symptomatic DVTs (0.6%) and 18 cases (0.3%) of hemorrhagic complications and no cases of pulmonary embolus. It is our opinion that the protocol we have implemented in our Unit for the prevention of deep venous thrombosis and pulmonary embolus is safe and effective and does not seem to increase the incidence of hemorrhagic complications
Avoiding misdiagnosis: Cystic calcified brain metastases of uterine cervical cancer mimicking neurocysticercosis
No full textThe radiological finding of multiple calcified brain lesions is atypical for brain metastases and in absence of a clear evidence of disseminated neoplastic disease the differential diagnosis may be difficult. Calcified brain metastases (CBM) are rarely encountered in clinical practice and they mostly arise from lung, breast and gastrointestinal primitive tumours. Only one case of uterine cervical carcinoma (UCC) with CBM has been reported so far. We describe the case of a 41-year-old Caucasian woman with a history of hysterectomy and bilateral salpingo-oophorectomy for UCC 3 years prior to observation and no evidence of neoplastic recurrence that developed cystic CBM. Owing to their peculiar radiological appearance, lesions were initially misidentified as neurocysticercosis, the most common parasitic infection of the central nervous system. We offer the reader some important teaching points for the differential diagnosis and discuss the rarity of our case
How far away from having an effective treatment option for progressive multiple sclerosis are we?
No full textN/
Increased risk of stroke and myocardial infarction in patients with epilepsy: A systematic review of population-based cohort studies
No full textOBJECTIVE: The objective of the study was to review the current epidemiological evidence about the relationship between epilepsy and increased risk of cardio- and cerebrovascular events. METHODS: We systematically searched MEDLINE (from inception to 19th October 2018) to identify population-based cohort studies evaluating the risk of subsequent stroke or myocardial infarction (MI) in patients with epilepsy without history of prior cerebrovascular disease in comparison with subjects without epilepsy. RESULTS: A total of 16,641 records were screened, and 6 studies were included. Data on the risk of subsequent stroke and MI were provided by five and two studies, respectively. The adjusted hazard ratios (adjHRs) of subsequent ischemic stroke for patients with epilepsy ranged from 1.09 (95% confidence interval (CI): 1.00-1.19) to 2.85 (95% CI: 2.49-3.26). Two studies assessing the incidence of hemorrhagic stroke showed an increased risk in patients with epilepsy (adjHR: 3.30; 95% CI: 2.46-4.43 and adjHR: 2.27; 95% CI: 1.80-2.85). The adjHRs of subsequent MI ranged between 1.09 (95% CI: 1.00 to 1.19) and 1.48 (95% CI: 1.31-1.67). Age, hypertension, MI, diabetes, hyperlipidemia, and arteriosclerosis were significantly associated with the increase in stroke risk. A gradient between the antiepileptic drug (AED) dose and risk of subsequent stroke was found. In comparison with carbamazepine (CBZ), oxcarbazepine (OXC) was associated with an increased risk of stroke and valproate (VPA) with a reduction in risk of stroke and MI, whereas no significant associations with vascular disease were found for phenobarbital (PB), lamotrigine (LMT), phenytoin (PHT), clonazepam (CLZ), and clobazam (CLB). CONCLUSIONS: Patients with epilepsy are at higher risk of subsequent stroke and MI in comparison with subjects without epilepsy. Although individual AEDs may carry different risks of cardio- and cerebrovascular disease, the clinical relevance of the metabolic effects of the enzyme-inducing AEDs is still uncertain. This article is part of the Special Issue "Seizures & Stroke
Comment on “Anti-NMDA receptor encephalitis presenting as new onset refractory status epilepticus in COVID-19”
No full textN/
Epilepsia partialis continua following a Western variant tick-borne encephalitis
No full textEpilepsia partialis continua (EPC) is a rare entity, first described in 1894 by Koževnikov, as a variant of simple focal motor status epilepticus. EPC is most frequently characterized by motor symptoms, but as recently described, non-motor manifestations may occur, such as somatosensory symptoms or aura continua. EPC in adults has been attributed to various etiologies: infectious, vascular, neoplastic, and metabolic. According to the recent definition, we reported a case of EPC with behavioral symptoms, following a tick-borne encephalitis (TBE) contracted in an endemic area (North Eastern Italy). Patient's symptom was a poorly localized "whole body sensation", which is reported as a condition occurring only in frontal lobe epilepsy. Patient's EEG showed a left frontal predominance of epileptiform discharges. Literature highlighted the importance of the Far-eastern TBE variant as a cause of EPC, since no Western variant TBE cases are reported. In contrast to what was claimed so far, our case demonstrates that not only the Far-eastern TBE variant, but also Western variant TBE is a cause of EPC. Prognosis of EPC depends largely on the underlying etiology, and it is frequently drug-resistant. Our patient was treated with intravenous levetiracetam, with a subsequent clinical recovery and a disappearance of epileptiform discharges. The rapid clinic and electroencephalographic response to levetiracetam confirm that it can be a promising therapeutic option for treatment of EPC
Contralesional Cathodal versus Dual Transcranial Direct Current Stimulation for Decreasing Upper Limb Spasticity in Chronic Stroke Individuals: A Clinical and Neurophysiological Study
Full text linkBackground Different transcranial direct current stimulation (tDCS) paradigms have been implemented to treat poststroke spasticity, but discordant results have been reported. Objective This study aimed to determine the efficacy and persistence of dual tDCS (anode over affected motor cortex [M1] and cathode over contralateral M1) compared with cathodal tDCS (cathode over contralateral M1) on upper limb (UL) functional, behavioral, and neurophysiological measures in chronic poststroke individuals. Subjects and Methods Ten subjects with UL spasticity (7 men; mean 62 years; 8 ischemic stroke; years from event: 2.3 years) were enrolled in a cross-over, double-blinded study. Cathodal and dual tDCS, both preceded by 1 week of sham stimulation 1 month before real stimulation, were applied with 3 months interval. Stimulating paradigm was 20 minutes for five consecutive days in each block. Evaluations were performed before (T1), after real or sham treatment (T2), and after 1 (T3), 4 (T4), and 8 weeks (T5). Functional, behavioral, and neurophysiological tests were performed at each time. Results Both tDCS paradigms decreased spasticity, increased strength, and ameliorated behavioral scales. Cathodal tDCS was superior to dual tDCS in reducing UL distal spasticity immediately after treatment (T2: cathodal > dual: P = .023) and provided a higher and longer lasting reduction at proximal districts (T3: cathodal > dual: P = .042; T4: cathodal > dual: P = .028; T5: cathodal > dual: P = .05). These findings are supported by an H-reflex modulation (overall time effect P > .002). Conclusions Cathodal tDCS is slightly more effective than dual tDCS in reducing distal UL spasticity in chronic poststroke subjects. A modulation of spinal inhibitory mechanisms, demonstrated by H-reflex modifications, supports this finding
- …
