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Background/Objectives: This study investigated the frequency and timing of optic neuritis (ON) episodes in relation to the onset of multiple sclerosis (MS) and examined the occurrence of Uhthoff's phenomenon and Lhermitte's sign to understand their roles in early diagnosis and disease progression. Methods: A longitudinal study was conducted with 127 MS patients. Clinical data, including ophthalmological examinations for ON, were collected and questionnaires assessed the presence of Uhthoff's phenomenon and Lhermitte's sign. Results: Results showed that 37% of patients experienced demyelinating retrobulbar ON, with 25.53% having ON as the initial symptom of MS. Residual visual acuity impairment (below 20/40) and dyschromatopsia were reported by 25.53% and 17.02% of patients, respectively. Uhthoff's phenomenon and Lhermitte's sign were present in 26.77% and 36.22% of patients, respectively. The findings underscore the importance of early ophthalmological assessments in diagnosing MS, as ON can be an initial indicator of the disease. Conclusions: The study highlights the need for precise diagnostic tools and personalized therapeutic strategies focused on specific biomarkers and pathways involved in neuroinflammation and demyelination. Early diagnosis through vigilant ophthalmologic evaluation can lead to interventions that significantly alter disease progression, improving patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Objectives: Carotid artery dissection represents a common cause of stroke among people aged 30-45. We present two clinical cases and a review of the literature concerning the management of internal carotid artery dissections (ICADs). Material and methods: The two patients are a 54-year-old male and a 40-year-old female. The first patient presented to our Neurology Department for one-week-old intense occipital headache. His clinical examination revealed left-sided miosis and upper eyelid ptosis. He underwent cerebral-cervical computed tomography (CT) and computed tomography angiography (CTA) scans and the latter revealed hemodynamically significant narrowing of both ICAs (right C1-C5 and left C1-C2 segments). Transcranial Doppler ultrasonography and Doppler ultrasonography (DUS) of the cervical-cerebral arteries showed right ICA occlusion at its origin (dissection fold and intraluminal thrombosis). Cervical magnetic resonance imaging (MRI) and time-of-flight magnetic resonance angiography (MRA) revealed a semilunar-shaped T2-weighted hypersignal present in the walls of the C1-C5 segments of the right ICA and of the C1-C2 segments of the left ICA, with bilaterally reduced intraluminal flow (right more than left). These findings indicated the presence of bilateral ICA intramural hematomas caused by subacute bilateral ICAD. The second patient presented to our Neurology Department for recurrent episodes of headache and lateral cervical pain on both sides. She underwent transcranial DUS and DUS of the cervicalcerebral arteries. They revealed right ICAD fold in its upper cervical segments. The CTA scan of the supra-aortic trunks showed hemodynamically significant narrowing with subsequent diminished blood flow in the upper cervical segments of right ICA. The patient was diagnosed with right ICAD. Results: Both patients were treated using antiplatelet therapy for primary prevention of ischaemic events. Follow-up at seven months and at six months, respectively, by means of CTA of the supra-aortic trunks or MRA of the cervical region, revealed the restoration of arterial patency with subsequent normal blood flow in both cases. Conclusions: The long-term outcomes of ICADs should be kept in mind when assigning medical or endovascular management on a case-by-case basis. Antiplatelet or anticoagulant therapy is a safe and effective first-line strategy in such patients, especially in cases that do not warrant particular management. [ABSTRACT FROM AUTHOR]

Objectives. Transient ischemic attacks (TIAs) can present with a large variety of clinical features that impose an extensive differential diagnosis. We report this case due to its particularities of clinical presentation and diagnosis algorithm. Material and methods. A 72-year old male patient presented to our Neurology Department for recurrent episodes of numbness felt in the right upper limb. The initial patient history deemed the episodes as consistent with simple focal seizures. The cerebral computed tomography scan showed no recent lesions. Furthermore, video-electroencephalography was performed, but revealed no abnormalities. A second, more thorough anamnesis revealed that paresthesia was also present in the left part of the upper and lower lips and that the numbness episodes were being accompanied by blurred vision, loss of balance and difficulties coordinating his right upper limb. Results. The time-of-flight magnetic resonance angiography revealed dolichoectasia of the left vertebral and basilar arteries. Furthermore, the basilar artery grooved and displaced the pons with respect to the midline. The angio-computed tomography scan of the supra-aortic trunks showed multiple stenoses located in the V4 segment of both vertebral arteries, in the intracavernous segment of the right internal carotid artery and in the proximal segment (90%) and the middle third part (80%) of the basilar artery. The patient was diagnosed with vertebrobasilar TIAs and started treatment with Clopidogrel with no recurrence of the TIAs. Conclusions. This case was chosen to be presented in order to highlight another facet of the clinical polymorphism exhibited by transient ischemic attacks. [ABSTRACT FROM AUTHOR]

Introduction: Massive intracerebral hemorrhages and large internal carotid artery infarcts may cause early death due to severe cerebral edema with elevated intracranial pressure, despite maximal medical therapy. Decompressive craniectomy may be of benefit to these patients in terms of survival and even functional outcome. The aim of our paper is to present two cases that illustrate the use of decompressive craniectomy both in ischemic and hemorrhagic stroke, followed by a discussion on the indication and right timing of the intervention, but also on the outcome of these patients. Materials and methods: We present the cases of a 38-year-old man with a right lenticular and capsular hemorrhage who underwent decompressive craniectomy in the first 24 hours from onset of symptoms and a 64-year-old patient with an ischemic stroke in the territory of the left carotid artery with a decompressive craniectomy performed at more than 72 hours from the beginning. For each of the two cases, we analyzed the following parameters: neurologic status, Glasgow Coma Scale, aspect of the cerebral computed tomography before and after surgery, in-hospital complications and modified Rankin Scale at discharge. Outcomes: While the intervention was life-saving in both cases, the procedure had different functional outcomes. Conclusion: Decompressive craniectomy may be a life-saving procedure for patients with both hemorrhagic or ischemic strokes complicated with massive edema and increased intracranial pressure. When performed in the first 48 hours, especially in patients with ischemic stroke aged less than 60, it may also improve the functional outcome compared to conservative treatment. [ABSTRACT FROM AUTHOR]

Objectives. The carotid-cavernous fistula (CCF) represents an abnormal communication developed between the internal and/or the external carotid artery (ICA, ECA) or their branches and the cavernous sinus (CS). We report this case in order to highlight the course and an alternative to treatment of a CCF. Material and methods. A 47-year old male patient with medical history of subarachnoid hemorrhage and cranio-facial comminuted fractures due to a motorcycle accident-induced craniofacial traumatism (4 months prior to admission) was referred to our clinic for further investigation regarding a potential CCF. Results. The cerebral digital substraction angiography showed a direct CCF type A. The Neurology and Interventional Radiology team opted for endovascular stent-grafting of the right ICA. Conclusions. This case is presented in order to highlight that angioplasty with stent-graft is a safe and effective procedure in selected cases of CCF. [ABSTRACT FROM AUTHOR]

Objectives. Neurocognitive impairment represents a frequent pathology among elderly people and not only, in the last decades the major focus of global health research being patient’s safety. The aim of paper is to present a system designed for patients with all types of neurocognitive impairment that can improve the quality of life of not only the patients with major neurocognitive impairment but also of their relatives or informal caregivers. Materials and methods. During October 2016 - February 2017 we used a multi-structured approach consisting in questionnaires, interviews, focus groups and co-creation sessions with the targeted people (neurologist, patients, caregivers) to identify and defi ne the characteristics of the system to be developed. We analyzed the answers of 33 patients and informal caregivers and 27 neurologists from Romania, 29 informal caregivers and 52 formal caregivers from Belgium. Results. Based on these data obtained, the technical partners participating in the project designed an application that could run on desktops, smatwatches, tablets and smartphones. The main features of this application are outdoor/ indoor localization, guidance of the patient to a specifi c destination, assistance, notifi cation, real time tracking and answering and it may help to quickly locate missing patients and to keep track of them in order to know if they leave or enter a given area (house, hospital, surroundings). Conclusion. This monitoring system represents a new technology that patients, their relatives, caregivers and doctors can use in different environments to signifi cantly increase the quality of life and also to avoid life-threatening situations. [ABSTRACT FROM AUTHOR]

The objective of this study is to investigate the frequency and risk factors for hemodynamic instability (hypotension and/or bradycardia) in response to elective carotid stenting and their association with neurological complications. Carotid artery stenting implies instrumentation of the carotid bulb where the baroreceptors are placed and therefore baroceptor's dysfunction may provoke hemodynamic instability. The study started in the Neurology Clinic of the Emergency University Hospital, Bucharest as a retrospective analysis of the charts of 130 patients (110 men with mean age of 55 years) who underwent elective carotid artery stenting with cerebral protection for high-grade (>70%) symptomatic internal carotid artery stenosis. By hemodynamic instability one can understand the drop in systolic blood pressure of more than 30mmHG and bradycardia. 20% of patients had a drop in systolic blood pressure beyond 30 mmHg and/or bradycardia despite an adequate fluid balance. We did't use atropine as premedication before carotid stenting. There was no need for aggressive resuscitation (dopamine) and none of the patients with bradycardia needed pacemaker support. Neurological complications (transient ischemic attack, minor stroke, major stroke) occurred in 9% of patients and were not significantly associated with hemodynamic instability. Extensive carotid artery manipulation, a long stenosis situated at the bifurcation and the prior use of beta-blockers were associated with an increased adjusted risk for hypotension or bradycardia. Hemodynamic instability due to hypotension and bradycardia in response to carotid artery stenting occurs in a relatively low proportion of patients. Patients who had a long (over 6 mm) stenosis situated near the common carotid artery's bifurcation and therefore underwent extensive carotid manipulation or those who were on beta-blockers were at high risk for hypotension or bradycardia. The preadministrations of intravenous fluids didn't prevent the periprocedural hypotensive response. [ABSTRACT FROM AUTHOR]

Introduction: Nucleoplasty, the most advanced form of percutaneous discectomy developed to date, has important advantages as compared to other surgical methods: minimal tissue trauma, faster recovery time, local anesthetic, short duration and a painless rehabilitation period. Aim: Since the method is newly adopted in Romania, the aim of our study is to centralize the benefits and the side effects of the method in order to spread it on national level. Material and methods: A 12-month prospective, nonrandomized, human clinical study was started in the Neurology Department of the Emergency University Hospital, Bucharest, covering one year time interval (December 2006 - December 2007). The study included 60 patients presenting lumbar pathology at more than one level. The used method was the Dekompressor, a highly efficient method for removal of intervertebral disc nucleus pulposus under fluoroscopic control. Periprocedural the patients received antibiotics treatment. Results: Up to now there were no procedure related complications. 89% of patients reported improvement of the simptomatology with almost 60% the first 6 months postprocedural while 92% of patients were satisfied with results for 12 months, reporting the reduction of the analgesic intake. In 4% of cases no benefit was reported. The follow-up of the patients is still on-going. Conclusion: The results of our study confirm that nucleoplasty provides the therapeutic benefits of earlier percutaneous disc decompression techniques without many side effects. Clinical results are very promising when the inclusion criteria are strictly respected and therefore we encourage the patients to expect rapid and sustained pain reduction after the procedure. [ABSTRACT FROM AUTHOR]

We present the case of a 50 year-old male, a former athlete with important cardiologic history who presented to our emergency department with sudden onset left side hemiparesis and dysarthria. The cerebral computed tomography showed a recent ischemic lesion in the right temporo-insular area and a spontaneously hyperdense right middle cerebral artery. The Duplex ultrasound examination of the cervico-cerebral vessels showed significantly enlarged jugular veins, with intraluminal hyperechogenic images. The echocardiography showed severely dilated cardiac cavities, especially left atrium and auricle with many mobile hipoechogenic thrombi. The final diagnosis was cardioembolic stroke due to dilated cardiomyopathy. We chose to present this case in order to raise awareness of this low incidence diagnosis. [ABSTRACT FROM AUTHOR]

The objective of this study is to investigate the frequency and risk factors for hemodynamic instability (hypotension and/or bradycardia) in response to elective carotid stenting and their association with neurological complications. Carotid artery stenting implies instrumentation of the carotid bulb where the baroreceptors are placed and therefore baroceptor's dysfunction may provoke hemodynamic instability. The study started in the Neurology Clinic of the Emergency University Hospital, Bucharest as a retrospective analysis of the charts of 130 patients (110 men with mean age of 55 years) who underwent elective carotid artery stenting with cerebral protection for high-grade (>70%) symptomatic internal carotid artery stenosis. By hemodynamic instability one can understand the drop in systolic blood pressure of more than 30mmHG and bradycardia. 20% of patients had a drop in systolic blood pressure beyond 30 mmHg and/or bradycardia despite an adequate fluid balance. We did't use atropine as premedication before carotid stenting. There was no need for aggressive resuscitation (dopamine) and none of the patients with bradycardia needed pacemaker support. Neurological complications (transient ischemic attack, minor stroke, major stroke) occurred in 9% of patients and were not significantly associated with hemodynamic instability. Extensive carotid artery manipulation, a long stenosis situated at the bifurcation and the prior use of beta-blockers were associated with an increased adjusted risk for hypotension or bradycardia. Hemodynamic instability due to hypotension and bradycardia in response to carotid artery stenting occurs in a relatively low proportion of patients. Patients who had a long (over 6 mm) stenosis situated near the common carotid artery's bifurcation and therefore underwent extensive carotid manipulation or those who were on beta-blockers were at high risk for hypotension or bradycardia. The preadministrations of intravenous fluids didn't prevent the periprocedural hypotensive response.