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Dementias are chronic, degenerative neurological disorders with a complex management that require the cooperation of different healthcare professionals. The Italian Ministry of Health produced the document “Guidance on Integrated Care pathway for People with Dementia” (GICPD) with the specific objective of providing a standardized framework for the definition, development, and implementation of integrated care pathways (ICP) dedicated to people with dementia. We searched all available Italian territorial ICPs. Two raters assessed the retrieved ICPs with a 2-point scale on a 43-item checklist based on the GICPD. Only 5 out of 21 regions and 5 out of 101 local health authorities had an ICP, with most ICPs having a moderate compliance to the GICPD, in particular for the items referring to the development and implementation of the care pathways. A low to moderate inter-rater agreement was observed, mainly due to a lack of standardized models to describe ICPs for dementias. Results suggest that policy- and decision-makers should pay more attention to the GICPD when producing ICPs. The direct communication with clinicians, and the implementation of more precise and appropriate clinical outcomes, could increase the involvement of clinicians, whose participation is crucial to guarantee that ICPs meet needs of patients and their carers.

BACKGROUND The aim of this systematic review is to gather all available studies reporting prevalence and incidence rates of iNPH and to assess their methodological quality and consistency. METHODS All available studies published up to June 2019 were retrieved searching the databases PubMed, ISI Web of Science, and the Cochrane Database of Systematic Reviews. All included studies were qualitatively assessed by two independent reviewers using the MORE Checklist for Observational Studies of Incidence and Prevalence. KEY RESULTS Bibliographic searches and other sources yielded 659 records. A total of 28 studies were selected and applied the predefined inclusion and exclusion criteria. Fourteen studies were further excluded, and 14 studies (10 on prevalence and 6 on incidence) were included in the qualitative analysis. Results from the prevalence studies reported crude overall rates ranging from 10/100 000 to 22/100 000 for probable iNPH and 29/100 000 for possible iNPH, and age-specific rates ranging from 3.3/100 000 in people aged 50-59 to 5.9% in people aged ≥ 80 years. Results from incidence studies reported overall crude rates ranging from 1.8/100 000 to 7.3/100 000 per year, and age-specific rates ranging from 0.07/100 000/year in people aged

Seasonal influenza vaccination (SIV) of health-care workers (HCWs) is recommended in most countries to protect them and their patients from infection. Although SIV can reduce the risk of influenza complications among vulnerable patients, vaccination uptake is generally unsatisfactory. The present study aimed to assess the impact of different programs in promoting SIV uptake among HCWs during the season 2017/2018 in four teaching hospitals in Rome. A multicentric cross-sectional study was carried out, in order to describe the four different campaigns and to assess their impact by identifying and developing a set of indicators that provide information about the vaccination services, the percentage of invited HCWs, the vaccinators’ workforce and the vaccination coverage rates. The hospitals organized different strategies: Hospital 1, 3 and 4 organized educational courses for HCWs and actively invited every single HCW through e-mail. All the hospitals organized a dedicated unit for influenza vaccination, and Hospital 1 added on-site vaccination sessions that required a large number of staff. Hospital 1 and hospital 4 registered a comparable vaccination coverage rate, 12.97% and 12.76%, respectively, while it was 6.88% in Hospital 2 and 4.23% in Hospital 3. Our indicators demonstrated to be effective and useful for analyzing the different SIV campaigns. The results suggest that the best practice to promote SIV among HCWs should include multiple approaches. Among those, an easy access to the vaccination site seems to play a key role in determining a higher vaccination coverage.

With today's low energy prices and with the increasing drive towards sustainability, it is essential to develop more economically efficient and ecofriendly technologies in oil and gas field development. Such a technology is self-healing cement, which was successfully applied in a large project in northern Italy in the conversion of a gas field to a gas storage field. During the construction phase of gas production and storage wells, one of the critical goals is to achieve competent hydraulic isolation between the surface and the casing to reach the reservoir. There are several cases documented in the literature where poor isolation has resulted in gas flow to surface, thereby polluting water reserves, greenbelts, and populated areas. Improper isolation can also result in interzonal communication, production of unwanted fluids, gas migration, casing corrosion, and sustained casing pressure. These can have significant health, environmental, and economic impact. Additionally, the impending need for well intervention, along with high re-entry costs, will further weaken revenue margins. Breaking through conventional cementing solutions, a global oilfield service company had established an active cement technology to improve annular isolation in gas wells. This technology is capable of self-healing when exposed to hydrocarbons of any type, unlike other self-healing systems that are limited by the level of methane (CH4) in the gas reservoir. The new system allows universal coverage for any concentration of CH4. Because the concentration of CH4 in different gas reservoirs can vary significantly, the self-healing "protection" against different levels of CH4 is tailored to suit different reservoirs. This field-proven technology, in use for more than 10 years, stemmed from the original self-healing technology commercialized more than a decade ago. Subsequently, an opportunity arose to apply this technology in a large project in the north of Italy. The project would exploit a depleted gas field by conversion to a gas storage field with the drilling of 14 wells from two clusters above the reservoir. The product testing and implementation, job execution, and results evaluation brought several benefits with positive impact to the service company and the owner/operator of the field. A higher level of isolation significantly decreases the need for future well integrity and repair, which provides medium- to long-term benefit for the operator—an added value that is sometimes omitted in well construction design. Using a zonal isolation technology, such as the self-healing cement system described here, inherently places the service company and operator in a much more secure position for the future. Furthermore, in the current industry climate, saving 30 to 40 days of rig time and the cost of remedial operations and achieving important mitigation against health and environmental impact pose a significant economic advantage.

The occurrence of dementia among individuals with a migration background and composing ethnic minorities is being recognized as a global public health issue. In the present study, we sought to explore if and how this phenomenon is mentioned and addressed by the existing National Dementia Plans (NDPs). The 32 NDPs listed on the Alzheimer’s Disease International (ADI)’s website were considered for the present analysis. First, the plans mentioning the issue of dementia among migrants and/or ethnic minorities were identified. Subsequently, the sections addressing this topic and the pertaining proposed actions were analyzed and their contents were unbundled in descriptive categories. Overall, nine NDPs (28.1% of the total), namely those promulgated by Australia, Austria, England, Israel, Norway, Switzerland, Taiwan, United States, and Wales, mentioned the issue of dementia among migrants and/or ethnic minorities and only eight proposed targeted actions to tackle this issue. With few exceptions, the proposed strategies were only marginally dashed within NDPs and crucial information on their objectives, timeline, conduction, and monitoring was missing. To our knowledge, this is the first attempt to describe and discuss how the issue of dementia among migrants and ethnic minority groups is addressed within NDPs. The issue of dementia in migrants and ethnic minorities is assuming a growing relevance under a of global health perspective. The timely identification and implementation of dedicated policies at the national and international level are fundamental to limit its future clinical and socioeconomic burden.

Rotavirus (RV) is worldwide considered as the most important viral agent of acute gastroenteritis in children less than 5 y. Since 2006, the availability of anti-RV vaccines has deeply modified the incidence and economic burden of RV infection. In Europe, some countries have introduced an anti-RV vaccination program in the last 10 y. Although community acquired RV (CARV) disease is the most studied condition of RV infection, recently some authors have highlighted the importance of nosocomial RV (nRV) disease as an emerging public health issue. The aim of this review is to summarize the epidemiology of both CARV and nRV, in order to discuss the difficulty of a clear evaluation of the burden of the disease in absence of comparable data. In particular, we focused our attention to European studies regarding nRV in terms of divergences related to definition, report of incidence rate and methodological issues.

Hepatitis A is an infectious disease caused by a virus (HAV), which is highly contagious and widespread all over the world. In industrialized countries, Hepatitis A is commonly considered a disease with an important socio-economic impact, as the clinical disease affects mostly young adults. After the development of a specific anti-HAV vaccine, a reduction in the incidence of Hepatitis A was observed, with a subsequent change in the prevalence of HAV. HAV spreads mainly in children and risk categories, whose work or activities or medical conditions lead to a close contact with the virus. In particular, in Men who have sex with Men (MSM) many outbreaks have been reported in the last five years. Aim of this paper is an evaluation of the recent literature about HAV infection in MSM in order to update the current guidelines on HAV procedures for MSM.

The high standards of safety and effectiveness of vaccines have allowed them to get a prominent role in disease prevention and health protection. However, like any other intervention, vaccination is not free from risks. Rare adverse events occur after immunization in less than one in a thousand individuals and can be linked to vaccination by causality or coincidence. These events are reported on the SmPC (Summary of Product Characteristics). We have first divided the rare adverse events in local and generalized, and then we have analyzed them according to the type of vaccine linked to the event. Communication of the benefits of vaccines, that are surely greater than their risks, must take place in a conscious and scientific way, in order to avoid vaccinations being perceived as an imposition, instead of the great opportunity for everyone that they are.

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is considered an emerging risk factor for cerebrovascular disease. Both the two conditions could share the same neurocognitive impairment, which, in the early phase of OSAS, are reversible and mediated by the excessive daytime sleepiness. Treatment with continuous positive air pressure (CPAP) device could improve the neurocognitive functions, and therefore, it could be considered as a valid treatment option in stroke patients affected by OSAS and neurocognitive impairment. Materials and Methods: Patients affected by unilateral ischemic stroke will be subdivided into two groups, according to the presence or absence of OSAS. All participants will be evaluated by using a specific neuropsychological battery exploring attention, memory, praxic abilities and executive functions. Patients presented with a moderate to severe OSAS will be treated with CPAP and followed for at least 1 year. Results: The data analysis requires a sample size of 550 to provide adequate power of the study. The outcome variable is the score of specific neuropsychological and quality of life tests at baseline, after 6 months and at 1 year follow-up. Discussion and Conclusion: This study design presents three specific analysis limitations. First, several other sleep disorders can produce drowsiness beyond OSAS. Second, the neurocognitive impairment in stroke patients is difficult to assess. Third, OSAS patients are often intolerant to diagnostic tests requiring an excessive length. However, the findings coming from the protocol may have important implications about the effect of sleep disorders on cognitive function in stroke patients. Moreover, the easy employed procedures could be translated into clinical practice to improve the quality of life of patients affected by both OSAS and stroke.

Background Rehabilitation of impaired cognitive functions begins to be considered a standard component of medical care after acquired brain injury. Indeed, many evidences support the effectiveness of the two major categories of techniques, i.e. the traditional and computer-assisted ones, which are widely used in cognitive rehabilitative treatment. Objective Aim of this study is to evaluate the effects of pc – cognitive training in brain injury patients. Methods We studied 35 subjects (randomly divided into two groups), affected by traumatic or vascular brain injury, having attended from January 2010 to December 2012 the Laboratory of Robotic and Cognitive Rehabilitation of IRCCS Neurolesi of Messina. Cognitive impairment was investigated through psychometric battery, administered before (T0) and two months (T1) after the cognitive pc-training, which was performed only by the experimental group, in addition to conventional treatment. Statistical analysis was performed using Wilcoxon test with a p Results At time T0, all patients showed language deficits and cognitive alterations in visual attention and memory abilities. After the rehabilitation program we noted a global improvement in both the groups. However, at T1, the experimental group showed a greater cognitive improvement than the control group, with significant differences in nearly all the neuropsychological tests performed. Conclusions Our data suggest that cognitive pc-training may be a promising methodology to optimize the rehabilitation outcomes following brain injury.

Patients with stroke present an asymmetric posture, severe balance dysfunction with delayed and disrupted equilibrium reactions, exaggerated postural sway and abnormal gait with an increased risk of falling. The aim of this study is to evaluate the efficacy of hydrokinesytherapy on stance, balance and gait in individuals after stroke.In this single-blinded randomized controlled trial, patients with stroke were divided into two groups: an experimental one (G1), performing hydrokinesytherapy (3 times/week) in addition to a conventional physical therapy (3 times/week) and a control one (G2), performing only a conventional physical therapy (6 times/week). All of the participants underwent a proper clinical and baropodometric evaluation before and after 8 weeks of treatment.The two groups presented similar clinical and instrumental features at enrolment (mean modified Rankin Scale of 3, and a disease duration of 6.3 ± 1.4 months). After treatment, the patients undergoing hydrokinesytherapy showed a significantly greater improvement than those undergoing traditional training.Hydrokinesytherapy may be considered a promising treatment in improving gait and balance in individuals following stroke.

Background: Leukoraraiosis is worldwide considered as a part of the normal aging process, although it is strongly associated with dementia and other disabilities. The pathogenesis of leukoaraiosis still has not been thoroughly acknowledged, even though chronic ischemia with consequent arteriolosclerosis probably due to endothelial dysfunction has been suggested. Treatment focuses on prevention of lesion formation and progression by aggressive control of risk factors, which should begin at an early age and continue on regular basis. Aim of our protocol is to evaluate the effect of long-term oral administration of high-dose L-arginine (6 g/day at least for 24 months) on white matter lesions and neurological and cognitive functions. Materials and Methods: Patients affected by mild to moderate leukoaraiosis will be enrolled in the study. After a complete neurovascular assessment (i.e. accurate blood test examinations, Echocardiography, Doppler ultrasound of the neck and peripheral arteries), they will undergo MRI, specific neuropsychological tests and gait analysis. Patients will be evaluated at baseline, at 6, 12, 18 and 24 month-follow up. Statistical Analysis will be performed using the software R. A significant level of P Preliminary Data: Two of the 4 patients currently enrolled in the study presented a mild improvement in cognitive function. Discussion: Because of its high prevalence in over-65-year-old subjects, we hypothesized that treatment with 6 gr of Larginine, as supplementary dietary option, could be helpful in patients affected by leukoaraiosis to improve the cognitive and gait impairment often observed in these subjects (as demonstrated by the LADIS study).

Introduction Painful ejaculation (PE) is an uncommon condition and it is usually associated with prostatitis, chronic pelvic pain syndrome, benign prostatic hyperplasia, ejaculatory duct obstruction, radical prostatectomy, and prostate radiation. Topiramate (TPM) is a new antiepileptic drug with recognized efficacy in neuropathic pain. Aim The study is aimed to evaluate TPM efficacy in ejaculation pain. Methods Following a spinal cord injury, a 53‐year‐old man was referred to our institute for persistent PE. Neurological examination showed mild hypoesthesia of the genital area. Urogenital examination, neurophysiological tools, and computed tomography of the dorso‐lumbar spine were normal. Main Outcome Measures The main outcome measure was the visual analogue scale. Results Since pain was refractory to conventional neuropathic pharmacological therapies, TPM was introduced up to 150 mg daily with a dramatic improvement of PE. Conclusion TPM may be considered as a valid therapeutic option for the treatment of PE. Calabro RS, Marra A, Quattrini F, Gervasi G, Levita A, and Bramanti P. Central neuropathic pain: An unusual case of painful ejaculation responding to topiramate. J Sex Med 2012;9:3274–3278.

Neurogenic erectile dysfunction can be broadly defined as an inability to sustain or maintain a penile erection due to neurologic impairment. Sexual problems can occur due to any lesion affecting the central and peripheral nervous system. The aim of this study was to evaluate the prevalence and causes of erectile dysfunction in a group of hospital inpatients suffering from neurologic disorders.Three-hundred and twenty six male patients admitted to the Neurorehabilitation Unit of IRCCS Centro Neurolesi "Bonino-Pulejo" in Messina Italy from March 2012 to June 2013 were screened for erectile dysfunction using the International Index of Erectile Function questionnaire. The patients who reported erectile dysfuntion underwent vascular, neurophysiological, and hormonal testing, and were divided into two groups according to their lesion sites: G1 (lesions above the S2-S4 center) and G2 (lesions below the S2-S4 center).Of the 326 admitted patients, 126 patients (38.6%), mean age of 54.56±11.74 years (age range 27-82 years), were affected by erectile dysfunction (i.e., scored ≤21). A statistically significant correlation between International Index of Erectile Function questionnaire scores and location of the neurologic lesions was observed in G2 (r=0.22) with an increased risk of erectile dysfuntion of around 2:1 (odds ratio=1.87) without influences related to aging.The occurence of erectile dysfunction is significantly more prevalent among neurologically disabled men, particularly those with lesions below S2-S4, than among men without neurologic disability. Considering the prevalence of erectile dysfunction among neurologically disabled men, sexual functioning should be regularly evaluated during acute and long-term rehabilitation, and any existing sexual dysfunction should be addressed in the treatment plan.

Stroke is one of the leading causes of death and disability throughout the world. Although physical and cognitive impairments after stroke have been well studied, little information is known about one of the crucial aspect of the quality of life of stroke patients, namely, sexual functioning and satisfaction. Poststroke sexual dysfunctions seem to be very common since in men affected by stroke, a decline in libido and poor or tailed erection and ejaculation are frequently observed. Sexual disorders after stroke are thought to be due to multiple etiologies, including both organic (i.e., lesion localization, premorbid medical conditions, and medications) and psychosocial (i.e., fear of recurrences, loss of self-esteem, role changes, anxiety, and depression). Thus, exploration in sexual dysfunctions and sexual counseling by trained professionals should be a part of stroke rehabilitation. The aim of this review is to evaluate the burden of stroke on sexual function taking into account the complex interaction between neurological, psychological, and relational factors.

Background. Pudendal neuralgia is a cause of chronic, disabling, and often intractable perineal pain presenting as burning, tearing, sharp shooting, foreign body sensation, and it is often associated with multiple, perplexing functional symptoms. Case Report. We report a case of a 40-year-old man presenting with chronic pelvic pain due to pudendal nerve entrapment and successfully treated with palmitoylethanolamide (PEA). Conclusion. PEA may induce relief of neuropathic pain through an action upon receptors located on the nociceptive pathway as well as a more direct action on mast cells via an ALIA (autocoid local injury antagonism) mechanism. As recently demonstrated in animal models, the present case suggests that PEA could be a valuable pharmacological alternative to the most common drugs (anti-epileptics and antidepressants) used in the treatment of neuropathic pain.

To outline specific sleep disturbances in different clinical subsets of Attention Deficit/Hyperactivity Disorder (ADHD) and to confirm, by means of nocturnal video-polysomnography (video-PSG), a variety of sleep disorders in ADHD besides the classically described periodic leg movement disorder (PLMD), restless legs syndrome (RLS) and sleep related breathing disorder (SRBD).Fifty-five ADHD children (47 M, 8F; mean age=8.9 y) were included: 16 had Inattentive and 39 Hyperactive/Impulsive or Combined ADHD subtype. Behavior assessment by Conners and SNAP-IV Scales, a structured sleep interview and a nocturnal video-PSG were administered.Most children/parents reported disturbed, fragmentary sleep at night; complaints were motor restlessness (50%), sleep walking (47.6%), night terrors (38%), confusional arousals (28.5%), snoring (21.4%), and leg discomfort at night associated with RLS (11.9%). There is a significant difference (p value0.05 or0.001) in almost all the studied sleep variables between ADHD children and controls. International RLS Rating Scale scoring, Periodic Limb Movements during Sleep (PLMS) and Wake (PLMW) indexes, hyperactivity and opposition scores and ADHD subtype appear related. Different sleep disorders seem to address specific ADHD phenotypes and correlate with severity of symptoms as in sleep related movement disorders occurring in Hyperactive/Impulsive and Combined ADHD subtypes. Besides, an abnormality of the arousal process in slow wave sleep with consequent abnormal prevalence of disorders of arousal possibly enhanced by SRBD has also been detected in 52% of our sample.This study underlines the opportunity to propose and promote the inclusion of sleep studies, possibly by video-PSG, as part of the diagnostic screening for ADHD. This strategy could address the diagnosis and treatment of different specific ADHD phenotypic expressions that might be relevant to children's symptoms and contribute to ADHD severity.

Rotaviruses are the most common etiological cause for pediatric acute gastroenteritis, particularly in children under 5 years of age or immunocompromised. Since 2008, vaccination program has determined a decrease in Rotavirus-related hospitalization, outpatient's visits, emergency department visits and mortality. These indicators of illness for Rotaviruses diseases remain high in those countries where there is no access to rehydrating therapies. In Italy vaccine coverage is very low, even if the burden of RV disease is well known, and at present vaccination is offered free of charge in a single region.

Vaccines play the main role in primary prevention in Public Health as they allow the control of many infectious diseases progression, reducing complications, morbidity and mortality. Pharmaceutical industry has spread worldwide the production and distribution of vaccines; moreover, research and new technological approaches inside industry make possible new formulations and preparations with an increasing safety. In spite of these positive aspects, lack of confidence in the utility of vaccination as well as in the real role of the pharmaceutical industry has grown in importance in recent decades. Aim of the study was to analyze these issues, with regards to cost and timing of vaccine production, and complex vaccine planning, related to efficacy, safety and tolerability assessment. Relationship between pharmaceutical industry and Public Health was finally considered; in particular, the role of Public Health as mediator between the pharmaceutical industry and the general population.

Systemic lupus erythematosus (SLE) is a clinically heteroeneous autoimmune disease characterized by the presence of utoantibodies directed against nuclear antigens. SLE is, by defiition, a multisystem disease, which can present in a large variety f ways, including cutaneous rash, arthritis, oral ulcers and renal isorders. When SLE affects the nervous system, i.e., “neuropsychiatricLE” (NP-SLE), it can present a wide spectrum of neurologic or sychiatric symptoms (see Table 1). Although patients with NPLE commonly present mild symptoms such as paresthesias or a epressive mood, almost no major cerebrovascular events, psyhoses or even coma states have been described [1]. Moreover, cardiovascular autonomic dysfunction is frequent n patients with autoimmune diseases, such as SLE, rheumatoid rthritis and Sjogren’s syndrome [2]. Herein, we describe the case of a man presenting with dystheria as a possible symptom of SLE-related peripheral neuropathy ith autonomic dysfunction.

An elderly patient affected by incomplete cauda equina syndrome underwent intravesical electrostimulation (IVES) to improve impaired bladder emptying. One month after IVES treatment, which consisted of 20 daily sessions, cistometrography evidenced a normalization of urinary pattern and a concomitant, but unexpected, improvement of constipation (Wexner score from 22 to 4).This report demonstrates that IVES may be considered another viable and less invasive option for controlling constipation secondary to spinal and peripheral nerve lesions.

Ovarian hyperstimulation syndrome (OHSS) is a severe iatrogenic complication of ovulation induction, which has a very serious impact on the patient's health, as it is often associated with a high morbidity and mortality risk. Indeed, patients classified as having severe OHSS presented with liquid imbalance signs (such as rapid weight gain, tense ascites, respiratory difficulty and progressive oliguria), which are related to the fluid shift from the intravascular space to third space compartments subsequent to an increased capillary permeability. In this way, cardiovascular system findings include decreased intravascular volume, decreased blood pressure, decreased central venous perfusion, and compensatory increased heart rate and cardiac output with arterial vasodilation might be found concomitantly. Notwithstanding that venous thromboembolic phenomena are a possible complication in advanced phases of OHSS, arterial ischemia involving the cerebral circulation is a rare but recently reported problem. The pathogenesis of thromboembolism in OHSS is not fully understood, even though hemoconcentration and blood hyperviscosity seem to play a role in developing thrombotic changes into both venous and arterial system. Interestingly, the presence of cardiac abnormalities in combination with inherited or acquired hypercoagulable state seems to increase the risk of cerebral infarct in these subjects, as recently shown by our group. This review is aimed at investigating the pathomechanism and the management of neurovascular complications related to OHSS, including new treatment options.

Leukoraraiosis is worldwide considered as a part of the normal aging process, although it is strongly associated with dementia and other disabilities. The pathogenesis of leukoaraiosis still has not been thoroughly acknowledged, even though chronic ischemia with consequent arteriolosclerosis probably due to endothelial dysfunction has been suggested. Treatment focuses on prevention of lesion formation and progression by aggressive control of risk factors, which should begin at an early age and continue on regular basis. Aim of our protocol is to evaluate the effect of long-term oral administration of high-dose L-arginine (6 g/day at least for 24 months) on white matter lesions and neurological and cognitive functions.Patients affected by mild to moderate leukoaraiosis will be enrolled in the study. After a complete neurovascular assessment (i.e. accurate blood test examinations, Echocardiography, Doppler ultrasound of the neck and peripheral arteries), they will undergo MRI, specific neuropsychological tests and gait analysis. Patients will be evaluated at baseline, at 6, 12, 18 and 24 month-follow up. Statistical Analysis will be performed using the software R. A significant level of P0.05 will be set for all the tests. PRELIMINARY DATA: Two of the 4 patients currently enrolled in the study presented a mild improvement in cognitive function.Because of its high prevalence in over-65-year-old subjects, we hypothesized that treatment with 6 gr of Larginine, as supplementary dietary option, could be helpful in patients affected by leukoaraiosis to improve the cognitive and gait impairment often observed in these subjects (as demonstrated by the LADIS study).

Stroke is the third leading cause of death and the main cause of permanent disability in western countries. Reperfusion within 3 hours of symptoms-onset is the most beneficial of all therapeutic strategies for acute ischemic stroke. Alteplase has been the first thrombolytic treatment approved by FDA. However, its use is still limited to specific patient subgroups and may be complicated by severe side effects, including massive cerebral hemorrhages. This review is aimed at investigating the current and future treatment strategies in ischemic stroke, including new fibrinolytic drugs, sonothrombolysis, mechanical clot retrievals, and recent patents.

Cerebral infarction associated with ulcerative colitis is particularly rare, but clinically important because of its high morbidity and mortality. The pathogenesis of thrombosis in ulcerative colitis remains unclear even if platelet and coagulation cascade abnormalities, systemic inflammation, and the presence of other well recognized vascular risk factors are likely to play a key role in clot formation. We report a case of a young woman with recurrent ischemic stroke secondary to the interaction between ulcerative colitis-related dysbalanced hemostasis and high levels of lipoprotein (a).

Pudendal neuralgia is a cause of chronic, disabling, and often intractable perineal pain presenting as burning, tearing, sharp shooting, foreign body sensation, and it is often associated with multiple, perplexing functional symptoms.We report a case of a 40-year-old man presenting with chronic pelvic pain due to pudendal nerve entrapment and successfully treated with palmitoylethanolamide (PEA).PEA may induce relief of neuropathic pain through an action upon receptors located on the nociceptive pathway as well as a more direct action on mast cells via an ALIA (autocoid local injury antagonism) mechanism. As recently demonstrated in animal models, the present case suggests that PEA could be a valuable pharmacological alternative to the most common drugs (anti-epileptics and antidepressants) used in the treatment of neuropathic pain.

Energy drinks are soft beverages especially marketed for adolescents in order to obtain a heightened sense of awareness. Concerns about the safety of these drinks are raised based on our observation of potentially serious adverse effects. Caffeine and taurine are psychoactive agents highly present in energy drinks, which may lead to modification of neurotransmission. We herein report the case of a 20-year-old man presenting with a generalized epileptic seizure after energy drink consumption.

Fibromuscular dysplasia (FD) is defined as an idiopathic, segmental, non inflammatory, non atherosclerotic disease of the arterial walls, leading to stenosis of small and medium-sized arteries. FD is an uncommon vascular disorder that occurs in young to middle-aged individuals affecting more often women than men1. […] Fibromuscular dysplasia as a rare cause of severe ischemic stroke in a young man

Objective: To describe the case of a woman with poststroke choreoathetosis whose symptoms improved after treatment with tetrabenazine. Case Summary: A 48-year-old left-handed woman developed progressive involuntary dystonic choreoathetoid movements of her arm following a cerebrovascular event. Involuntary abnormal movements (IAMs) were treated with hatoperidol, but they worsened 6 months later, also involving her mouth, tongue, and perioral area. Because of the suspected occurrence of drug-induced tardive dyskinesia, treatment was switched to tetrabenazine (titration up to 100 mg/daily), with rapid remission of the involuntary abnormal movements (Abnormal Involuntary Movement Scale score switching from 20 to 1). One month later, following discontinuation of tetrabenazine, the dystonic choreoathetoid movements rapidly reappeared. Subsequent rechallenge with tetrabenazine caused remission of her symptoms. Discussion: Poststroke IAMs are rare, and lesions involving the basal ganglia and/or thalamus seem to be particularly implicated in such disorders. The exact pathogenic mechanism has not bean clarified; however, it has been postulated that a central dopaminergic overactivity might play an important role in the IAM occurrence. Thus, antipsychotics are the main treatment option, but they are often associated with therapeutic failure or adverse effects, including extrapyramidal symptoms and metabolic complications. Interestingly, when our patient was treated with tetrabenazine for haloperidol-induced tardive dyskinesia, she demonstrated substantial improvement in the dystonic choreoathetoid movements of her left upper limb. Conclusions: The improved response of this case to tetrabenazine monotherapy suggests that tetrabenazine may be a pharmacologic alternative for patients with poststroke choreoathetosis that is intolerant or unresponsive to antipsychotic agents. Further studies are needed to better define the risk versus benefit profile of tetrabenazine.

Acute Disseminated Encephalomyelitis (ADEM) is an acute, multifocal, monophasic, inflammatory demyelinating disease of the central nervous system that affects predominantly children. Aim of the study was to evaluate the distribution of Human Leukocyte Antigen (HLA) class II haplotype in adult ADEM patients, in order to better characterize this rare clinical entity. Six patients (3 males and 3 females; median age 50 years) with ADEM were retrospectively studied in our Neurology Unit; 29 healthy subjects (8 males and 21 females, mean age 43.4±14.3) were the control group. All the study subjects were molecularly typed for HLA class II haplotype. The frequencies of HLA-DRB1*16 (17% vs 3% in control group; Py=0.02) and HLA-DQB1*05 (42% against 24% in the control group; Py=0.010), as well as the association HLA-DRB1*16/HLA-DQB1*05 were significantly increased in ADEM population compared to the control group. The frequencies of allelic association between 13-04 (P0.01) and homozygosis 14 (P0.05) alleles at HLA-DRB1* locus and 05-02 (P0.05) alleles at HLA-DQB* locus also were increased in ADEM patients. Our preliminary data provide further evidence that the HLA-DR/DQ haplotypes may be involved in susceptibility to immunomediate demyelinating diseases of central nervous system in the Caucasian population.

The differential diagnosis between atypical parkinsonism and Parkinson's disease is difficult, especially in the early stage. Severe postural instability, falls, and complex gait impairments are usually confined to the later stage of Parkinson's disease, while atypical parkinsonism patients may present a severe postural instability with consequent falls in the earlier stages.We retrospectively studied 20 subjects with parkinsonism using clinical and baropodometric tools to give quantitative and objective data on the postural, balance, and gait disturbances.The statistical analysis between atypical parkinsonism and Parkinson's disease patients showed a significant difference in the frequency of long lead time parameter, foot area, foot load and speed, and, in particular, atypical parkinsonism patients presented a prevalent long lead time impairment (8/8 patients) when compared with Parkinson's disease patients.Beside significant differences in the clinical features between the Parkinson's disease and atypical parkinsonism, our study showed that baropodometric investigation may a valuable tool for the definition of postural and motor extrapyramidal abnormalities, permitting an earlier differentiation between atypical parkinsonism and Parkinson's disease.

L-Arginine, a semi-essential cationic amino acid involved in multiple areas of human physiology and metabolism, is a precursor of nitric oxide, and, recently, it has been found to crucially influence endothelial function. Arginine appears to be safe and effective therapy for many health conditions, particularly vascular diseases responsive to modulation of endothelial-derived relaxing factor including intermittent claudication, angina pectoris and erectile dysfunction. However, L-arginine metabolism is still not fully understood, highlighting a complex implication for its pharmacological use in clinical practice. In this review, we want to point out the lights and pitfalls of L-arginine as potential therapeutic option in vascular disorders.