Search

Vagus nerve stimulation (VNS) exerts a cortical modulating effect through its diffuse projections, especially involving cerebral structures related to autonomic regulation. The influence of VNS on cardiovascular autonomic function in drug-resistant epilepsy patients is still debated. We aimed to evaluate the impact of VNS on cardiovascular autonomic function in drug-resistant epilepsy patients, after three months of neurostimulation, using the heart rate variability (HRV) analysis.

Arterial hypertension is one of the most common and widespread disorders of the adult. Less than 1% of patients experience a hypertensive crisis. Hypertensive crisis is classified as hypertensive emergency or hypertensive urgency. Hypertensive encephalopathy, an acute cerebral event due to a marked elevation in arterial pressure, is one of the main vital complication of neglected hypertensive crisis. The goal of the author is to eliminate some practical confusion and to make this entity easier to recognize and treat. [ABSTRACT FROM AUTHOR]

The young patient with cardiovascular disease - most commonly cardiomyopathy, arrhythmias and congenital heart malformations poses a challenge in terms of diagnostic and therapeutic management. Hypertension is rarely found at young patients and most oftenly has a secondary cause. We further present the clinical case of the patient D.L., 27 years old, a case without significant history, until the right hemiparesis accompanied by expressive aphasia occured, due to left fronto-temporal hematoma, in the context o f a hypertensive crisis. The laboratory tests showed a polyglobulia o f unknown etiology. He was diagnosed w ith a congenital heart disease aswell as a left adrenal formation, pheochromocytoma, which required surgical treatment and evaluation of the cardiac malformation. Clinically, the patient was hypertensive (8P=180/120 mmHg}. ECG showed sinus rhythm 56/min, right bundle branch block and right ventricle hypertrophy. The echocardiography showed dilation o f the right cavities, severe pulmonary hypertension and an atrial septal defect type ostium secundum. Cardiac catheterization revealed a high DSA mixed with right- to- left shunt. The surgical remedy of the pheochromocytoma has brought the blood pressure within normal values and the neurologically state has improved progressively. [ABSTRACT FROM AUTHOR]

Sarcopenia, first introduced as a concept by I. Rosenberg in 1989, has since been extensively studied, particularly in its correlation with chronic diseases. In recent years, sarcopenia has been increasingly associated with advanced chronic liver disease, leading to a lower quality of life and poor outcomes for these patients. Studies have shown that sarcopenia has a prevalence of 33% in individuals with advanced chronic liver disease, impacting not only the patient's health but also contributing to increased healthcare costs. The prevalence of frailty in patients with advanced chronic liver disease is 27%. Given the high prevalence of sarcopenia and frailty in this population, early diagnosis and treatment are crucial to improving patient quality of life outcomes and reducing the strain on healthcare systems globally., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s).)

Hypertension is considered a risk factor for stroke and dementia. Ambulatory blood pressure monitoring (ABPM) is a useful tool in the diagnosis and treatment of hypertension. This study aimed to evaluate blood pressure using ABPM, in 30 Alzheimer's disease (AD) patients and 30 vascular dementia (VaD) patients in comparison with 30 healthy controls. BP was recorded every 15 min from 6 AM to 10 PM, and every 30 min from 10 PM to 6 AM. Mean systolic (SBP) and diastolic (DBP) blood pressure during daytime, nighttime, diurnal index, pulse pressure, and heart rate were extracted from the ABPM recordings. VaD patients presented higher SBP values compared to AD patients and healthy controls. DBP values in the AD group were the lowest, while VaD patients presented the highest DBP values, including day and nighttime. Mean arterial pressure values were also the highest in the VaD group, while AD patients had similar values with the control group. The VaD patients presented the lowest systolic diurnal index compared to AD patients and controls. The mean pulse pressure and nighttime pulse pressure values were higher in both groups of dementia patients when compared with the control group. Increased SBP, pulse pressure, and alteration in the circadian pattern with the highest incidence of the non-dipper and reverse dipper patterns were found in patients with dementia when compared with the healthy elderly. Also, decreased values of DBP were found in AD patients, especially during the night period., (© 2021. Belgian Neurological Society.)

Objectives: Autonomic nervous system dysfunction after ischemic stroke predisposes to cardiovascular complications. We aimed to investigate cardiac autonomic activity in ischemic stroke patients using heart rate variability analysis, illustrating the sympathovagal balance at different sympathetic and parasympathetic activation tests., Patients and Methods: We studied the dynamics of the linear and non-linear heart rate variability parameters in 31 left and 40 right middle cerebral artery ischemic stroke patients in rest condition and during autonomic activation tests (handgrip, standing, deep breathing and Valsalva maneuver). Data were compared with 30 age- and sex-matched healthy controls., Results: We found different responses after autonomic activation tests in stroke patients depending on the cortical lateralization of the ischemic lesion. In resting state, left hemisphere stroke patients presented enhanced parasympathetic modulation of the heart rate (higher values for RMSSD, pNN50, HF and SD1, p < 0.05), comparing to right hemisphere stroke patients. This second group displayed a reduced cardiac parasympathetic control in resting state and during autonomic activation tests (handgrip and standing tests) compared to the left hemisphere stroke group and controls. Non-linear parameters SD1 and DFA α1 showed a decrease of variability and complexity of the heart rate in right hemisphere stroke patients, ameliorated during vagal activation tests., Conclusion: To prevent possible complications with vital risk, assessment of cardiovascular autonomic activity becomes a necessary stage in stroke patient management, facilitating immediate implementation of preventive and therapeutic strategies. Heart rate variability analysis in resting state and during autonomic activation tests allows identifying patients prone to sympathetic hyperactivity. New therapeutic perspectives for stroke management may emerge founded on the modulation of the autonomic nervous system., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Primary gastric lymphoma (PGL) represents a rare pathology, which can be easily misdiagnosed because of unspecific symptoms of the digestive tract. Histologically, PGL can vary from indolent marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) to aggressive diffuse large B-cell lymphoma (DLBCL). During the years, clinical trials revealed the important role of Helicobacter pylori (H. pylori) in the pathogenesis of gastric MALT lymphoma. Infection with Helicobacter pylori is an influential promoter of gastric lymphomagenesis initiation. Long-term studies revealed that eradication therapy could regress gastric lymphomas.

The cardiovascular system is regulated by the autonomic nervous system, under cortical modulation. Stroke can induce cardiac autonomic imbalance, therefore, causing secondary cardiovascular complications. Heart rate variability (HRV) analysis is a simple method to appraise the autonomic nervous function. The purpose of this study was to investigate the cardiac autonomic activity in patients that suffered an ischemic stroke in middle cerebral artery (MCA) territory. Using Biopac Acquisition System, we monitored ECG in rest condition and during Ewing's tests. From these measurements, HRV parameters (using time and frequency domain analysis) were determined in 20 right MCA and 20 left MCA ischemic stroke patients, in the first 6 months after the acute event. Data were compared with 20 age- and sex-matched healthy controls. All the patients were right handed. In ischemic stroke patients, HRV parameters were significantly modified compared to controls (p < 0.05) and we found asymmetric responses to different stimulation autonomic tests between right and left hemisphere. Parameters illustrating the parasympathetic predominance in time domain (RMSSD) and frequency domain (HF) analysis were higher in left hemisphere stroke compared to right hemisphere stroke patients (p < 0.01) in resting state. From Ewing's battery test, patients with left hemisphere ischemic stroke showed predominance of parasympathetic activity to deep breathing (p < 0.01), while HRV parameters in right hemisphere ischemic stroke patients described a reduced cardiac parasympathetic innervation (p < 0.01). Cardiac autonomic imbalance occurs more often after right hemisphere ischemic stroke. HRV study may highlight cardiac dysfunctions that increase the risk of cardiovascular complications and portends a poor long-term outcome.

Unlabelled: Within the framework of cardiovascular pathology, with an epidemopandemic aspect, the stroke, through its mortality and sequels, represents, worldwide, a major problem of community health. In this context, we present the results of an epidemiological and clinical study, both prospective and interdisciplinary, performed on a sample of 374 inpatients suffering from stroke, hospitalized in the Neurology Ist Clinic of Iaşi, during the period June 2001-June 2004. The characteristics of the studied sample: age--78.8% over 51 years old, sex--53.7% male; residence--51.4% urban; provenance: rural--70.0% (p<0.001); studies: higher education--7.7% ; pensioners--76.2%; passive finding--96.8%; previous hospitalizations for cardiovascular diseases and/or diabetes mellitus: 48.2%; blood groups: OI and AII--86.61%., Results: Risk factors for stroke: 56.6%--BMI > 25; "A" behavior type (Bortner's test)--63.8%; stress: familial--74.1% and occupational--25.9%; excess consumption: alcohol--11.4%; salt--32.8%; tobacco--24.9%; passive smoking--10.8%. Releasing and aggravating risk factors: arterial hypertension (AHT)--55.4% (p<0.001); obesity--12.9%; diabetes mellitus--12.5%. Hereditary antecedents: AHT--46.8%; ischemic cardiopathy and myocardial infarction--15.6%; obesity and dyslipidemia--15.0%; stroke--10.8%., Conclusions: In this study, the multifactorial and associative etiology of stroke is confirmed once more, and the estimate costs of 1.21 milliard lei, only for the 10-day average hospitalization, for each of the 374 inpatients.

Acute inflammatory demyelinating polyneuropathy (AIDP) is an autoimmune process that is characterized by progressive weakness, mild sensory changes and autonomic dysfunction. It is a rare disorder, afflicting about 1 person in 100,000. Yet, since the decline in the number of polio cases, it represents the most common cause of acute neuromuscular paralysis. AIDP is thought to arise as a result of the production of antibody to bacterial Campylobacter jejuni, sugar-containing surface antigen(s) that, due to molecular mimicry, cross-react with the myelin sheath and the axons of nerve cells. Antibody and/or cell mediated immune reactions are believed to produce degeneration of the nerve or interruption of neurotransmission. Autonomic dysfunction include: transient hypertension or, less often, hypotension, sinus tachycardia, bradycardia, urinary retention who usually improves in parallel with motor and sensory function. Our purpose was to study the disturbances of autonomic function of the patients with acute idiopathic demyelinating polyneuropathy. We had studied 36 patients with AIDP admitted in I-st Clinic of Neurology, Iassy, between 1998 and 2002. Analyzing the evolution of these autonomic disturbances we observed the early onset together with motor symptoms, tachycardia and tachypnea was more persistent and a real vital risk factor.

The progresses in clarifying the normal and pathologic cellular and molecular mechanisms are reflected in the elucidation of the way some of the most common forms of generalized seizure--absence seizures--occur and are produced. Intrinsic properties of the thalamic neurons that give them the ability to release or preserve oscillatory, low-frequency neuronal discharges, and the thalamo-cortical feedback mechanism seem to explain the pathogenesis of absence seizures. The involvement of GABA receptors in the regulation of membrane calcium channels, as well as their genetically-induced changes are new pieces in the pathogenic puzzle.

The pathogenesis of Parkinson's disease, a progressive degenerative disorder of the central nervous system, remains obscure. 20% of cases are familial. The disorder may be due to a combination of genetic and environmental factors. Some monogenic forms of Parkinson's disease have been described. Many genetic studies explore whether a candidate gene may confer an increased risk for this disease. The search for a genetic susceptibility may lead to establish a preventive therapy.

Purpose: This paper is a study concerning the clinical-imagistic correlations in lacunar infarcts causes and associated lesions in these ones. We made an attempt to find out and emphasize the risk factors, causes and pathogenic mechanisms involved in lacunar syndromes., Materials and Methods: We studied 138 patients with lacunar infarcts diagnosed by clinical examination and computer tomography. The investigation of risk factors evidenced arterial hypertension in 75 cases (54%). The clinical features of lacunar syndromes were: 1) pure motor stroke 41c; 2) pure sensory stroke 8c; 3) ataxic hemiparesis 9c; 4) dysarthria-clumsy hand 1c; 5) sensorimotor stroke 21c; 6) Landry syndrome 1c., Results: We correlated the clinical manifestations and complementary investigations what enabled us to charge in determining of lacunar infarcts: focal microangiopathy-small artery disease (75c), cardio-embolic mechanism (12c), arterio-arteriolar embolic mechanism (15c). The risk factors and pathogenic mechanisms need more adequate research in order to find appropriate prevention and medical attendance.