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Visual acuity loss can be due to eye ball diseases or to lesions of the optic nerves, visual pathway or cortical projection of vision. The differential diagnosis can be challenging and though patients go first to the ophthalmologist, there is not always the ophthalmologist who can diagnose and treat the patient. For a great number of causes/diseases, a neurologist should also see the patient, even if there is a transient or persistent monocular or binocular visual acuity loss a disturbance of the visual field or of the perception of colours. Visual acuity loss can be more than this. It can be a symptom or a sign of a neurological or systemic disease and a rapid diagnosis and specific treatment are mandatory in order to treat the symptoms and improve the patient’s quality of life.

Acute encephalopathy is frequently seen in Neurology and Internal Medicine Departments, it makes for a wide spectrum of neuropsychiatric abnormalities, but its brain magnetic resonance imaging appearance in the adult population is not well recognised. We present the case of an acute hyperammonemic encephalopathy in the setting of ischemic hepatitis secondary to global heart failure and its MRI findings with a review of the literature.

Chronic subdural hematoma is a common type of intracranial hemorrhage with higher incidence and unpredictable evolution among elderly people. We present the case of a 73 years old male patient, diagnosed in October 2013 with subacute bilateral subdural hematomas who was admitted in our clinic for worsening of motor function in his left limbs. The cerebral CT performed revealed a right massive chronic subdural hematoma which met the criteria for neurosurgical approach requiring a large craniotomy for complete removal. In this article we review the risk factors associated with an unpredictable evolution and postoperative subdural hematoma recurrence in the elderly.

Cavernomas are frequent low-flow vascular malformations with a characteristic MRI aspect due to their specific morphology. We present the case of a 64-year old male diagnosed in 2008 with multiple cerebral cavernomas and symptomatic epilepsy, who developed left face, arm and leg paresthesias during the last 6 days. The MRI examination performed in our clinic showed increased number of infracentimetic lesions with no signs of hemorrhage or growth of the previous documented ones. Considering MRI findings and the patient being seizure free for the last three years there is no current indication for invasive treatment. The presence of multiple lesions along with their aspect on T2* MRI sequences suggest a hereditary form in absence of familial history of cerebral cavernous malformations.

We present the case of T.F., a 28 year-old woman diagnosed with corpus callosum dysgenesis and colpocephaly. The diagnosis is based on cerebral imaging – magnetic resonance imaging (MRI) and computerised tomography (CT).

We present the case of a 60 year-old woman diagnosed with meningiomatosis (multiple sporadic meningiomas), in the absence of neurofibromatosis type 2. The cerebral computerized axial tomography (CT scan) revealed six expansive lesions (one isodense and five spontaneously hyperdense partially or completely calcified), which at the cerebral magnetic resonance imaging (MRI) examination showed typical features of meningiomas. Case particularity: the very low incidence of sporadic multiple meningiomas and a rare cause of secondary epilepsy.

Traditionally, multiple sclerosis (MS) has been considered a white matter disease, but MS lesions are known to occur in grey matter. Recent immunohistochemical studies have demonstrated extensive grey matter demyelination in chronic MS, grossly underestimated by standard hystochemical myelin staining methods. Extensive cortical demyelination is associated with the progressive phases of disease, as less cortical demyelination has been detected in relapsing-remitting MS. The pathology of grey matter lesions differs from that of white matter lesions. Significant axonal transection and neuronal loss have been demonstrated in grey matter MS lesions. Current magnetic resonance imaging (MRI) methods are not sensitive for purely cortical MS lesions. Special MRI techniques permit the visualization of grey matter lesions, and in the future more sensitive MRI methods will help to characterize their clinical significance.

The possibility of myasthenia gravis must be considered in patients persistently complaining of weakness and fatigue. There may be many difficulties and pitfalls in differentiating myasthenia gravis from other disorders in which muscular weakness is a common complaint. Myasthenia gravis is an autoimmune disease caused by a defect of neuromuscular transmission due to antibodymediated attack. Dysphagia and dysarthria are two of the common symptoms and are due to oropharyngeal muscles involvement. They can be the first symptoms of the disease and sometimes can be mistaken for manifestations of emotional problems, usually anxiety or depression. The disease may be underappreciated as a cause of bulbar weakness. If clinical findings and history are highly suggestive, complementary tests should be performed (and sometimes maybe repeated) in order to confirm the diagnosis before psychasthenia or another psychiatric diagnosis is considered. We report the case of a 42-year-old woman who was admitted in our clinic for swallowing difficulties leading at the end of the day to total dysphagia, dysarthria, fluctuating limb muscle weakness and bilateral eyelids ptosis with incomplete occlusion.

Multiple sclerosis (MS) is a chronic inflammatory and degenerative disease of young people, which affects life quality, with social and psychological effects. The new era of treatments in MS, with drugs influencing immunomodulatory systems made possible a new approach of these patients, in efforts to make them capable to perform their activities as much as possible. Physical rehabilitation is an important mean for making patients with MS to accept their disease and to favourise their independence longer time. Patients should be encouraged to perform daily, or at least 2-3 times a week, a programme of physical exercises under the supervision of a specialist. Performing exercises in MS leads to a lot of benefits, not only physical ones, but also psychological ones and for overall health and finally to quality of life improvement. Physical therapy should be combined with psychological support, for limitation of negative impact of a chronic disease in young people. We must not forget that depression, anxiety, and in late stages of the disease, cognitive decline can interfere with life quality, so it is necessary to manage in a correct way all these aspects.