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Introduction. Ischemic stroke is a heterogeneous disorder w ith more than 100 pathologies implicated in Us pathogenesis and therefore a reliable etiologic classification of this disease is highly important. TOAST classification is widely used in clinical practice but 25-40% o f strokes are Classified as undetermined. ASCOD classification describes individual phenotypes comprising all pathologies potentially implicated in strobe development, thus minimizing strokes of truly undetermined cause. Methods. The aim of this study was to investigate ASCOD evidence grades in TOAST-undetermined strokes. We performed a retrospective analysis of prospectively collected data about 547 patients consecutively hospitalized for acute ischemic stroke. Strokes were classified according to both ASCOD and TOAST criteria. Results. According to TOAST criteria, 36% of patients were included in the undetermined subgroup: 89.7% due to incomplete evaluation, 6.7% due to tw o or more causes identified and 3.6% due to lack of evidence of any potential cause despile complete work-up. At least one ASCOD evidence grade (1,2 or 3) was identified in 37,31% of patients classified as TOAST-undetermined. in 14,29% of patients classified as TOAST-undetermined despite complete workup and in i2,99% of patients classified as TOAST-undetermined due to incomplete evaluation was identified at least one ASCOD grade 1 or 2 .71,5% of patients w ith TOAST undetermined strokes (due to both complete and incomplete evaluation] were assigned at least one ASCOD grade 3. Conclusion. The phenotypic ASCOD classification retains more relevant information regarding potential causes of stroke in TOAST undetermined patients, thus offering valuable data regarding secondary prevention strategies and adequate follow-up. [ABSTRACT FROM AUTHOR]

To date, little is known about the usefulness of ultra-high frequency ultrasound (UHF-US, 50-70 MHz) in clinical practice for the diagnosis of dysimmune neuropathies. We present a prospective study aimed at comparing UHF-US alterations of nerves and fascicles in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), distal CIDP (d-CIDP) and anti-MAG neuropathy and their relationships with clinical and electrodiagnostic (EDX) features. 28 patients were included (twelve CIDP, 6 d-CIDP and 10 anti-MAG) and ten healthy controls. Each patient underwent neurological examination, EDX and UHF-US study of median and ulnar nerves bilaterally. UHF-US was reliable in differentiating immune neuropathies from controls when using mean and/or segmental nerve and/or fascicle cross-sectional area (CSA); furthermore, fascicle ratio (fascicle/nerve CSA) was a reliable factor for differentiating d-CIDP from other types of polyneuropathies. The fascicle CSA appears to be more increased in CIDP and its variant than in anti-MAG neuropathy. UHF-US offers information beyond simple nerve CSA and allows for a better characterization of the different forms of dysimmune neuropathies., (© 2024. The Author(s).)

Background: Patent foramen ovale (PFO) is a prevalent cardiac remnant of fetal anatomy that may pose a risk factor for stroke in some patients, while others can present with asymptomatic white matter (WM) lesions. The current study aimed to test the hypothesis that patients with a PFO who have a history of stroke or transient ischemic attack, compared to those without such a history, have a different burden and distribution of cerebral WM hyperintensities. Additionally, we tested the association between PFO morphological characteristics and severity of shunt, and their impact on the occurrence of ischemic cerebral vascular events and on the burden of cerebral WM lesions., Patients and Methods: Retrospective, case-control study that included patients with PFO confirmed by transesophageal echocardiography. Right-to-left shunt size was assessed using transcranial Doppler ultrasound. Cerebral MRIs were analyzed for all participants using the semi-automated Quantib NDTM software for the objective quantification of WM lesions. WM lesions volume was compared between patients with and without a history of stroke. Additionally, the anatomical characteristics of PFOs were assessed to explore their relation to stroke occurrence and WM lesions volume., Results: Of the initial 264 patients diagnosed with PFO, 67 met the inclusion criteria and were included in the analysis. Of them, 62% had a history of PFO-related stroke/TIA. Overall burden of WM lesions, including stroke volume, was not significantly different ( p  = 0.103). However, after excluding stroke volume, WM lesions volume was significantly higher in patients without stroke (0.27 cm 3 , IQR 0.03-0.60) compared to those with stroke/TIA (0.08 cm 3 , IQR 0.02-0.18), p  = 0.019. Patients with a history of PFO-related stroke/TIA had a tendency to larger PFO sizes by comparison to those without, in terms of length and height, and exhibited greater right-to-left shunt volumes., Discussion: We suggest that PFO may be associated with the development of two distinct cerebrovascular conditions (stroke and "silent" WM lesions), each characterized by unique imaging patterns. Further studies are needed to identify better the "at-risk" PFOs and gain deeper insights into their clinical implications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Badea, Mihăilă-Bâldea, Ribigan, Negrilă, Grecu, Marinescu, Antochi, Tiu, Vinereanu and Popescu.)

Background: While stroke is one of the most dissected topics in neurology, the primary prevention of PFO-related stroke in young patients is still an unaddressed subject. We present a study concerning clinical, demographic, and laboratory factors associated with stroke and transient ischemic attack in patients with patent foramen ovale (PFO), as well as comparing PFO-patients with and without cerebrovascular ischemic events (CVEs)., Patients and Methods: Consecutive patients with PFO-associated CVEs were included in the study; control group was selected from patients with a PFO and no history of stroke. All participants underwent peripheral routine blood analyses, as well as, on treating physician's recommendations, screening for thrombophilia., Results: Ninety-five patients with CVEs and 41 controls were included. Females had a significantly lower risk of CVEs than males ( p = 0.04). PFO size was similar between patients and controls. Patients with CVEs had more often hypertension ( n = 33, 34.7%), p = 0.007. No significant differences were found between the two groups with regard to routine laboratory tests and thrombophilia status. Hypertension and gender were identified in a binomial logistic regression model as independent predictors for CVEs, but with an area under the ROC curve of 0.531, suggesting a very poor level of discrimination between the two groups., Discussion and Conclusions: There is little difference between patients with PFO with and without CVEs in terms of PFO size and routine laboratory analyses. While still a controversial topic in the specialty literature, classic first-level thrombophilic mutations are not a risk factor for stroke in patients with PFO. Hypertension and male gender were identified as factors associated with a higher risk of stroke in the setting of PFO., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Badea, Ribigan, Grecu, Terecoasǎ, Antochi, Bâldea Mihǎilǎ, Tiu and Popescu.)

Introduction: Myasthenia gravis is an autoimmune disorder affecting neuromuscular transmission, and its hallmark is fluctuating muscular weakness affecting the ocular, bulbar, respiratory, or limb muscles. Our objective is to highlight the difficulties encountered in diagnosing this disorder in patients lacking this characteristic phenomenon., Methods: Three cases of patients presenting with progressive weakness of bulbar and ocular muscles, in whom a lack of fluctuation delayed the diagnosis of myasthenia gravis, are described., Results: Amyotrophic lateral sclerosis was considered in two of the patients, while cavernous sinus thrombosis was initially diagnosed in the third. Electrodiagnostic, pharmacologic, and serologic testing ultimately established the diagnosis of myasthenia gravis., Conclusion: While the typical clinical pattern of myasthenia gravis is well known and easily recognizable, there are cases when the diagnosis, and thus the treatment, is delayed because of low or absent fluctuation of symptoms. The acknowledgment of this probably underestimated presentation is important for expeditious management., (© 2021. The Author(s).)

Background: Facioscapulohumeral muscular dystrophy (FSHD) is one of the most common myopathies in adults, displaying a progressive, frequently asymmetric involvement of a typical muscles' pattern. FSHD is associated with epigenetic derepression of the polymorphic D4Z4 repeat on chromosome 4q, leading to DUX4 retrogene toxic expression in skeletal muscles. Identifying biomarkers that correlate with disease severity would facilitate clinical management and assess potential FSHD therapeutics' efficacy., Objectives: This study purpose was to analyze serum cytokines to identify potential biomarkers in a large cohort of adult patients with FSHD., Methods: We retrospectively measured the levels of 20 pro-inflammatory and regulatory cytokines in sera from 100 genetically confirmed adult FSHD1 patients. Associations between cytokine concentrations and various clinical scores were investigated. We then measured serum and muscle interleukin 6 (IL-6) levels in a validated FSHD-like mouse model, ranging in severity and DUX4 expression., Results: IL-6 was identified as the only cytokine with a concentration correlating with several clinical severity and functional scores, including Clinical Severity Score, Manual Muscle Testing sum score, Brooke and Vignos scores. Further, FSHD patients displayed overall IL-6 levels more than twice high as control, and patients with milder phenotypes exhibited lower IL-6 serum concentration than those with severe muscular weakness. Lastly, an FSHD-like mouse model analysis confirmed that IL-6 levels positively correlate with disease severity and DUX4 expression., Conclusions: Serum IL-6, therefore, shows promise as a serum biomarker of FSHD severity in a large cohort of FSHD1 adult patients.

Background: Mutations in the GNE gene have been so far described as predominantly associated with distal lower-limb myopathies. Recent reports describe mutations in this gene in patients with peripheral neuropathy and motor neuron disease., Methods: We describe three patients displaying motor neuropathy in association with GNE mutations. Clinical, electrophysiological, imaging, pathological, and genetic data are presented in a retrospective manner., Results: The three patients had different phenotypes, ranging from mildly progressive lower limb weakness to a rapidly progressive 4-limb weakness. Genetic testing revealed GNE gene mutations in all patients; of those mutations, p.(His186Arg) has not been previously reported. All patients showed evidence of axonal motor nerve involvement on electrodiagnostic examination and/or muscle biopsy., Conclusions: Nerve involvement associated with GNE gene mutations may be an underdiagnosed pathology and may influence clinical presentation and disease progression., (© 2020 Wiley Periodicals LLC.)

Introduction: Nerve ultrasound has been used increasingly in clinical practice as a complementary test for diagnostic assessment of neuropathies, but nerve biopsy remains invaluable in certain cases. The aim of this study was to compare ultra-high-frequency ultrasound (UHF-US) to histologic findings in progressive polyneuropathies., Methods: Ten patients with severe, progressive neuropathies underwent ultrasound evaluation of the sural nerve before nerve biopsy. Ultrasound data were compared with histologic results in a retrospective manner., Results: Sural nerves were easily identified on UHF-US. Nerve hyperechogenicity correlated with inflammatory infiltrates on biopsy. Nerve fascicles could be identified and measured on ultrasound in the majority of patients., Discussion: Hyperechogenicity on UHF-US may be a marker of nerve inflammation in neuropathies. Furthermore, the UHF-US probe allows for evaluation of sensory nerves in spite of their small size, providing valuable information on their size and on their internal structure., (© 2020 Wiley Periodicals LLC.)

Arterial dissections are among the most frequent causes of stroke in young adults. Usually they are associated with trauma, but as the modern imaging tools are evolving, more dissections are being diagnosed and more etiologies are being described. Vertebral artery dissections (VADs) have the distinct particularity that they can cause ischemic stroke (in the brainstem, cerebellum or even the spinal cord), but also subarachnoid hemorrhage, when the dissection occurs in the intracranial segment of the vertebral artery. We present a review of the literature, going over etiology, clinical aspects, diagnosis and treatment of VADs and we illustrate the theory with three different types of VAD from our clinical experience.

Transient global amnesia is now considered a very rare complication of cerebral angiography. Various etiological mechanisms have been suggested to account for this complication, but no consensus has been reached yet. This case report documents one of the few reported cases of cerebral angiography-related transient global amnesia associated with magnetic resonance imaging (MRI) evidence of unilateral hippocampal ischemia, most probably as a consequence of a transient reduction in regional hippocampal blood flow. However, the possibility of a direct neurotoxic effect of the nonionic contrast media Iomeprol on the Cornu ammonis - field 1 neurons cannot be firmly ruled out.We describe the case of a 54-year-old woman admitted to our department for left upper limb weakness with acute onset 8 days before. The brain computed tomography (CT) scan performed at admission revealed subacute ischemic lesions in the right watershed superficial territories and a right thalamic lacunar infarct. Diagnostic digital subtraction cerebral angiography was performed 4 days after admission with the nonionic contrast media Iomeprol. A few minutes after completion of the procedure, the patient developed symptoms suggestive for transient global amnesia. The brain MRI performed 22 hours after the onset of symptoms demonstrated increased signal within the lateral part of the right hippocampus on the diffusion-weighted imaging (DWI) sequences, associated with a corresponding reduction in the apparent diffusion coefficient (ADC) and increased signal on the fluid-attenuated inversion recovery (FLAIR) sequences, consistent with acute hippocampal ischemia and several T2/FLAIR hyperintensities in the right watershed superficial territories and in the right thalamus, corresponding to the lesions already identified on the CT scan performed at admission. A follow-up MRI, performed 2 months later, demonstrated the disappearance of the increased signal within the right hippocampus on the DWI, T2/FLAIR, and ADC sequences.The precise mechanism of transient global amnesia related to cerebral angiography is still unclear, and further studies aimed to determine the definite pathophysiology of this syndrome and consequently to establish specific preventive measures are needed. Although the condition itself is considered to be self-limited, the long-term prognosis and the risk of recurrence in the cases where subsequent angiographic procedures are performed are not established yet.

Experimental evidence that nuclear magnetic resonance (NMR) can detect structural changes of piezoelectric La(3)Ga(5)SiO(14) induced by dilute paramagnetic ions is presented. Gd(3+) and Eu(3+) cations have been incorporated into La(3)Ga(5)SiO(14) monocrystals. As expected, the line-width of the tetrahedral (29)Si magic angle spinning (MAS) NMR spectra as well as the inverse of the T(2) relaxation time of (71)Ga increases with the concentration of the paramagnetic ions. A surprising result is shown by (71)Ga multiple quantum (MQ) MAS NMR spectrum, which changes with the concentration of paramagnetic ions. The changes in the (71)Ga MQMAS spectra can be explained by a more ordonated distribution of Ga ions inside the oxygen tetrahedra. The (71)Ga MQMAS NMR spectra allow identification of the one octahedral and two tetrahedral Ga sites.

Until 2008 in Romania poliomyelitis has been controlled by predominantly using trivalent oral poliovirus vaccine (TOPV). The alternative vaccination schedule (formalin inactivated poliovirus vaccine IPV/OPV) has been implemented starting September 2008 and at the begining of 2009 was decided only vaccination with IPV. Between 1995-2006 the risk of the vaccine-associated paralytic poliomyelitis (VAPP) decreased with an average of less than 2 VAPP cases/year and no VAPP case between 2007 - September 2009. Begining with 2007 the number of the poliovirus strains isolated was less. All 9 poliovirus strains (PV) isolated between 2007-2009 and investigated by RT-PCR-RFLP in VP1-2A and VP3-VP1 coding regions showed Sabin-like profiles, and only one strain poliovirus type 3 showed Sabin 2-like profile by RFLP in 3D coding ARN polymerase region. The study about the seroprevalence of antibodies against poliovirus types in serum samples from the acute flaccid paralysis (AFP), facial paralysis (FP) cases showed that the seroprevalence of antibodies against types 1 and 2 Sabin strains was higher (>90%) than for type 3 Sabin strains (average 85%). It was confirmed the necessity of maintaining a proper vaccine coverage in population, after the switch in the vaccination strategy in Romania until all threats of poliovirus are eliminated globally.