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The aim of this study was to assess the neurological complications of SARS-CoV-2 infection and compare phenotypes and outcomes in infected patients with and without selected neurological manifestations.The data source was a registry established by the European Academy of Neurology during the first wave of the COVID-19 pandemic. Neurologists collected data on patients with COVID-19 seen as in- and outpatients and in emergency rooms in 23 European and seven non-European countries. Prospective and retrospective data included patient demographics, lifestyle habits, comorbidities, main COVID-19 complications, hospital and intensive care unit admissions, diagnostic tests, and outcome. Acute/subacute selected neurological manifestations in patients with COVID-19 were analysed, comparing individuals with and without each condition for several risk factors.By July 31, 2021, 1523 patients (758 men, 756 women, and nine intersex/unknown, aged 16-101 years) were registered. Neurological manifestations were diagnosed in 1213 infected patients (79.6%). At study entry, 978 patients (64.2%) had one or more chronic general or neurological comorbidities. Predominant acute/subacute neurological manifestations were cognitive dysfunction (N = 449, 29.5%), stroke (N = 392, 25.7%), sleep-wake disturbances (N = 250, 16.4%), dysautonomia (N = 224, 14.7%), peripheral neuropathy (N = 145, 9.5%), movement disorders (N = 142, 9.3%), ataxia (N = 134, 8.8%), and seizures (N = 126, 8.3%). These manifestations tended to differ with regard to age, general and neurological comorbidities, infection severity and non-neurological manifestations, extent of association with other acute/subacute neurological manifestations, and outcome.Patients with COVID-19 and neurological manifestations present with distinct phenotypes. Differences in age, general and neurological comorbidities, and infection severity characterize the various neurological manifestations of COVID-19.

Background: Guillain–Barré syndrome (GBS)—a rare condition characterized by acute-onset immune-mediated polyneuropathy—has been registered as a neurological manifestation of COVID-19, suggesting a possible link between these two conditions. Methods: We report a case series of patients with COVID-19-related GBS hospitalized in the Neurology Department of Colentina Clinical Hospital, Bucharest, Romania, between March 2020 and March 2021. Several variables were analyzed, such as the mean interval between the onset of COVID-19 symptoms and neurological ones, clinical features, treatment course, and outcome. Further on, we conducted a thorough literature review based on the PubMed and ScienceDirect scientific databases. Results: A total of 9 COVID-19 patients developed symptoms of GBS, out of which in 7, it manifested as an acute inflammatory demyelinating polyneuropathy (AIDP). Five patients presented respiratory failure, 2 requiring mechanical ventilation. All patients received a course of intravenous immunoglobulins, 2 additionally requiring plasma exchange. Upon discharge, all but 1 patient (who had not regained the ability to walk) had a positive outcome, and 1 died during admission. In the literature review, we analyzed the published sources at the time of writing. Conclusions: A link between COVID-19 and GBS might be possible; therefore, increased vigilance is required in the early identification of these cases for prompt diagnosis and treatment. Some notable differences such as an earlier onset of GBS symptoms, higher respiratory dysfunction, and higher mortality rates in COVID-19 patients have been observed between the presentation of GBS in the context of COVID-19 and GBS of other causes.

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory syndrome with systemic involvement leading to various cardiovascular, metabolic, and neurological comorbidities. It is well known that conditions associated with oxygen deprivation and metabolic disturbance are associated with polyneuropathy, but current data regarding the relationship between COPD and peripheral nervous system pathology is limited. This review summarizes the available data on the association between COPD and polyneuropathy, including possible pathophysiological mechanisms such as the role of hypoxia, proinflammatory state, and smoking in nerve damage; the role of cardiovascular and metabolic comorbidities, as well as the diagnostic methods and screening tools for identifying polyneuropathy. Furthermore, it outlines the available options for managing and preventing polyneuropathy in COPD patients. Overall, current data suggest that optimal screening strategies to diagnose polyneuropathy early should be implemented in COPD patients due to their relatively common association and the additional burden of polyneuropathy on quality of life.

Cytokine storm seems to be one of the main culprits for developing a severe form of COVID-19, IL-6 being one of its basic components Therefore, currently, tocilizumab is widely studied as a powerful treatment in patients with severe forms of COVID-19 Our aim was to determine whether it could potentiate a favourable outcome in such patients We conducted a retrospective observational study including all consecutive admitted patients with confirmed SARS-CoV-2 infection that received treatment with tocilizumab in the period between 01 05-23 08 2020 in Matei Bals National Institute for Infectious Diseases and Neurology Department of the Colentina Clinical Hospital in Bucharest, Romania 22 patients were enrolled with a severe form of COVID-19, predominantly women, with an average age of of 61 72 ± 14 5 years The fatality rate was 31 81% It was observed that following tocilizumab administration, patients presented improvement in the majority of the studied parameters, statistically significant in the case of fibrinogen, C reactive protein and blood oxygen level (p < 0 05) Tocilizumab might be regarded as a valuable drug in the management of severe SARS-CoV-2 infection © 2020, Romanian Society for Pharmaceutical Sciences All rights reserved

The novel coronavirus has generated the Coronavirus Disease 2019 (COVID-19) pandemic, which has become the new challenge for the healthcare systems, since there is no etiological treatment and the infectiousness of SARS-CoV2 is exceeding the expectations. Therefore, various treatments have been tried in an attempt to stop the spread of the virus and to enhance the early recovery of the patients. Hydroxychloroquine, an antimalarial drug used for decades, has been one of the first drugs tried to reduce the infectivity of the virus. First data were promising, but afterwards, adverse events and long-term evolution of patients outweighed the potential benefits, and its utility was questioned. In this article we are reviewing literature regarding the use of Hydroxychloroquine during the COVID-19 pandemic and we present the experience of its use in the Neurology Department in Colentina Clinical Hospital, Bucharest, Romania.

Noul coronavirus SARS-CoV-2 determină cea mai importantă pandemie din ultimul secol, care continuă să evolueze și ale cărei consecinţe sunt încă incomplet elucidate. Prezentăm cazul unui bărbat în vârstă de 65 de ani, fără comorbidităţi semnificative, care s-a prezentat în serviciul de neurologie cu deficit motor la nivelul membrelor drepte, asimetrie facială, dizartrie, asociate cu vărsături și cefalee, instalate brusc. Examenul neurologic iniţial a sugerat accident vascular cerebral (AVC) acut, dar CT-ul cerebral iniţial nu a evidenţiat modificări de ischemie precoce sau hemoragice. Conform protocolului terapeutic, s-a iniţiat tromboliza intravenoasă, care a evoluat iniţial fluctuant, fiind întreruptă din cauza hematemezei intempestive, urmată de diaree, crampe abdominale si vărsături recurente. Imagistica cerebrală repetată a confirmat diagnosticul de AVC acut în teritoriul vertebrobazilar, iar examenul CT abdominal a evidenţiat modificări inflamatorii la nivelul colonului proximal și perirenal, precum și pleurezie dreaptă minimă, cu zone de hipoventilaţie la nivelul bazelor pulmonare. Analizele de laborator au indicat ușoară leucocitoză cu neutrofilie, nivel crescut al D-dimerilor și moderată retenţie azotată. În contextul epidemic COVID-19, pacientul a fost testat pentru SARS-CoV-2, care a fost confirmat pozitiv prin examen RT-PCR. Electrocardiograma iniţială a evidenţiat fibrilaţie atrială, necunoscută anterior, sugerând mecanismul cardio-embolic al AVC-ului ischemic, posibil potenţat de infecţie. Evoluţia ulterioară a pacientului a fost favorabilă, beneficiind de prevenţie secundară cu anticoagulant oral, asociat cu tratament hipotensor și statină. În concluzie, infecţia COVID-19 se poate asocia urgenţelor vasculare, chiar în absenţa simptomelor sugestive, febrile sau respiratorii. Manifestările gastrointestinale, coroborate cu imagistica abdominală, pot reprezenta indicii pentru infecţia concomitentă cu SARS-CoV-2, constituind o particularitate a cazului.

The most important pandemic in the last century triggered by SARS-CoV-2 infection is ongoing, and longterm implications are still unknown. We report the case of a 65-year old man, who presented with sudden onset of right-sided limb weakness, facial asymmetry, and dysarthria, accompanied by vomiting and headache. The initial neurological exam suggested acute stroke, although the cerebral CT-scan was not relevant neither recent ischemic, nor haemorrhage findings. According to the therapeutic protocol, intravenous thrombolytic therapy was timely administered, with a neurofluctuating course. The infusion was premature interrupted due to the sudden hematemesis, following by concurrent diarrhoea, abdominal cramps and recurrent vomiting. The new cerebral imaging confirmed the acute ischemic stroke in the vertebrobasilar territory and the abdominal CT-exam displayed an inflammatory aspect inflammation surrounding the right kidney and the proximal colon, minimal right pleural effusion and hypo-ventilated areas in the pulmonary bases. The laboratory work-up revealed mild leukocytosis with neutrophilia, increased levels of D-dimers, altered renal function. Considering the epidemic COVID-19, a RT-PCR test for SARS-CoV-2 have been request and, surprisingly, it was positive. Previous unknown paroxysmal atrial fibrillation was found at admission by electrocardiography, suggesting the cardioembolic nature of the ischemic stroke, while a favouring role of infection is possible. The subsequent evolution was positive, following by the secondary prevention with oral anticoagulation, along with hypotensive and statin medication. Apart from the respiratory affection, COVID-19 infection can be present in patients with other major medical emergencies, including acute stroke, with no apparent sign of infection. Additional signs of gastrointestinal affection, along with attentive evaluation of abdominal CT-scan represent important hints for concomitant SARS-CoV-2 infection.

Background and objectives: Multiple sclerosis (MS) patients tend to present peculiar personality traits that highly impact their quality of life. Our study aimed to determine which personality traits are more common in MS patients compared to a sex- and age-matched control group. Methods and materials: Patients with relapsing–remitting MS along with a sex- and age-matched control group were included. All subjects completed the DECAS Personality Inventory and an additional form including demographic characteristics. Data (including descriptive statistics and univariate and multivariate analysis) were analyzed using SPSS. Results: 122 subjects were included, out of which 61 were in the patient group, mostly females (71.31%) with a mean age of 42.06 ± 10.46 years. Mean duration of disease was 10.18 ± 5.53 years and mean EDSS score was 2.09; 36% of patients were treated with Interferon-beta 1a. Subjects in the patient group presented significantly lower scores for extraversion (p = 0.036), specifically those with higher EDSS score, even after adjusting for possible confounders (age, sex, marital status, early retirement, alcohol, and tobacco consumption). Additionally, regarding orientation in life, MS patients were more often philosophers (p = 0.001), especially young males, whereas the dominant emotional feeling was less common, the actor profile (p = 0.022). Regarding task involvement, MS patients were often passive and compassionate concerning other people. Higher EDSS score also correlated with avoidant (p = 0.006) and melancholic (p = 0.043) personality traits. Subjects with higher education associated more often pragmatic, experimenter, popular, and optimist traits, whereas the elderly had actor, authoritarian, and experimenter profiles. Conclusions: Some MS patients may have reduced levels of extraversion and specific personality traits compared to age- and sex-matched subjects. Determining the exact personality profile might help the neurologist to establish a better therapeutic alliance and to apply specific interventions.

Despite the increasing number of reports on the spectrum of neurological manifestations of COVID-19 (neuro-COVID), few studies have assessed short- and long-term outcome of the disease.This is a cohort study enrolling adult patients with neuro-COVID seen in neurological consultation. Data were collected prospectively or retrospectively in the European Academy of Neurology NEuro-covid ReGistrY ((ENERGY). The outcome at discharge was measured using the modified Rankin Scale and defined as 'stable/improved' if the modified Rankin Scale score was equal to or lower than the pre-morbid score, 'worse' if the score was higher than the pre-morbid score. Status at 6 months was also recorded. Demographic and clinical variables were assessed as predictors of outcome at discharge and 6 months.From July 2020 to March 2021, 971 patients from 19 countries were included. 810 (83.4%) were hospitalized. 432 (53.3%) were discharged with worse functional status. Older age, stupor/coma, stroke and intensive care unit (ICU) admission were predictors of worse outcome at discharge. 132 (16.3%) died in hospital. Older age, cancer, cardiovascular complications, refractory shock, stupor/coma and ICU admission were associated with death. 262 were followed for 6 months. Acute stroke or ataxia, ICU admission and degree of functional impairment at discharge were predictors of worse outcome. 65/221 hospitalized patients (29.4%) and 10/32 non-hospitalized patients (24.4%) experienced persisting neurological symptoms/signs. 10/262 patients (3.8%) developed new neurological complaints during the 6 months of follow-up.Neuro-COVID is a severe disease associated with worse functional status at discharge, particularly in older subjects and those with comorbidities and acute complications of infection.

Toxoplasmosis is an ubiquotus infection caused by an intracellular parasite with specific tropism for brain and muscle tissue, most frequently encountered in HIV infected patients. Multiple sclerosis is the most prevalent immune-medi-ated demyelinating disease of the central nervous system, especially in young women. The co-occurence of these two pathologies in an immunocompetent patient should not be missed out, as it a requires particular approach regarding treatment.

Introduction: The emerging Coronavirus Disease (COVID-19) pandemic caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a serious public health issue due to its rapid spreading, high mortality rate and lack of specific treatment. Given its unpredictable clinical course, risk assessment, and stratification for severity of COVID-19 are required. Apart from serving as admission criteria, prognostic factors might guide future therapeutic strategies.Aim: We aimed to compare clinical features and biological parameters between elderly (age ≥ 65 years) and non-elderly (age Methods: All consecutive patients with COVID-19 and new neurological symptoms/conditions admitted in our Neurology Department between April 1 and August 23, 2020 were enrolled in this observational retrospective cohort study. Patient characteristics such as demographic data, comorbidities, biological parameters, imaging findings and clinical course were recorded. All-cause in-hospital mortality was the main outcome, whereas COVID-19 severity, hospitalization duration and the levels of supplemental oxygen were the secondary outcomes.Results: One hundred forty-eight patients were included, out of which 54.1% were women. The average age was 59.84 ± 19.06 years and 47.3% were elderly, the majority having cardiovascular and metabolic comorbidities. In the elderly group, the most frequent neurological symptoms/manifestations responsible for hospitalization were stroke symptoms followed by confusion, whereas in the non-elderly, headache prevailed. The final neurological diagnosis significantly varied between the two groups, with acute cerebrovascular events and acute confusional state in dementia most commonly encountered in the elderly (65.71 and 14.28%, respectively) and secondary headache attributed to SARS-CoV-2 infection often experienced by the non-elderly (38.46%). The elderly had statistically significant higher median values of white blood cell (8,060 vs. 6,090/μL) and neutrophil count (6,060 vs. 4,125/μL), C-reactive protein (29.2 vs. 5.72 mg/L), ferritin (482 vs. 187 mg/dL), fibrinogen (477 vs. 374 mg/dL), D-dimer (1.16 vs. 0.42), prothrombin time (151.15 vs. 13.8/s), aspartate transaminase (26.8 vs. 20.8 U/l), creatinine (0.96 vs. 0.77 mg/dL), and blood urea nitrogen level (51.1 vs. 27.65 mg/dL), as well as lower median value of hemoglobin (13.05 vs. 13.9 g/dL) and lymphocyte count (1,245 vs. 1,670/μL). Moreover, advanced age was significantly associated with more extensive lung involvement (25 vs. 10%) and higher fatality rate (40 vs. 9%). Overall, the mortality rate was 23.6%. Age as well as neutrophil count, C-reactive protein, fibrinogen, and activated partial thromboplastin time levels were independently associated with mortality.Conclusions: Older age, higher neutrophil count, C-reactive protein, fibrinogen, and activated partial thromboplastin time levels are independent predictors of mortality in COVID-19 patients with new neurological manifestations/conditions at admission.

(1) Background: Emerging evidence indicates that non-motor symptoms significantly influence the quality of life in dystonic patients. Therefore, it is essential to evaluate their psychological characteristics and personality traits. (2) Methods: Subjects with idiopathic dystonia and a matched control group were enrolled in this prospective observational cohort study. Inclusion criteria for patient group included idiopathic dystonia diagnosis, evolution exceeding 1 year, and signed informed consent. Inclusion criteria for the control group included lack of neurological comorbidities and signed informed consent. All subjects completed the DECAS Personality Inventory along with an additional form of demographic factors. Data (including descriptive statistics and univariate and multivariate analysis) were analyzed with SPSS. (3) Results: In total, 95 participants were included, of which 57 were in the patient group. Females prevailed (80%), and the mean age was 54.64 ± 12.8 years. The most frequent clinical features of dystonia were focal distribution (71.9%) and progressive disease course (94.73%). The patients underwent regular treatment with botulinum toxin (85.95%). In addition, patients with dystonia obtained significantly higher openness scores than controls, even after adjusting for possible confounders (p = 0.006). Personality traits were also different between the two groups, with patients more often being fantasists (p = 0.007), experimenters (p = 0.022), sophists (p = 0.040), seldom acceptors (p = 0.022), and pragmatics (p = 0.022) than control subjects. (4) Conclusion: Dystonic patients tend to have different personality profiles compared to control subjects, which should be taken into consideration by the treating neurologist.

Background: Natalizumab is a humanized monoclonal antibody with high efficacy and an acceptable safety profile used in the treatment of patients with multiple sclerosis (MS). Objectives: Our aim was to report data regarding long-term administration of Natalizumab in patients with Relapsing-Remitting Multiple Sclerosis (RRMS) from our clinic. Methods: A retrospective observational study was performed including RRMS patients who underwent treatment with ≥ 24 Natalizumab infusions. We analyzed EDSS values, the relapse rate and the rate and type of adverse events related to Natalizumab administration. Results: 51 subjects were included with a predominance of women (62.74%), with an average age of 40.43±1.49 years, a mean disease duration of 9.86±0.7 years and mean number of Natalizumab infusions of 45.58±2.74. An increased number of patients (80.39%) were relapse-free and a mild reduction of the mean EDSS value following Natalizumab initiation in patients who had not been treated with other disease modifying therapies anteriorly was observed. Among the encountered adverse events such as increased liver transaminases (13.72%), local infections (7.84%) and dysmenorrhea in one patient were registered in this study. The rate of severe adverse events was 3.92 and no cases of Progressive Multifocal Leukoencephalopathy (PML) were registered. Conclusions: Natalizumab proves to be effective, has an adequate safety profile and can be administered with good tolerability for a rather extended period of time, provided that the patients are closely monitored.

© 2021 Milanesi et al., [Purpose]: Chronic low-grade inflammation and oxidative stress are present in most of the pathologic mechanisms underlying non-communicable diseases. Inflammation and redox biomarkers might therefore have a value in disease prognosis and therapy response. In this context, we performed a case–control study for assessing in whole blood the expression profile of inflammation and redox-related genes in elderly subjects with various comorbidities. [Patients and Methods]: In the blood of 130 elderly subjects with various pathologies (cardiovascular disease, hypertension, dyslipidemia including hypercholesterolemia, type 2 diabetes mellitus), kept under control by polyvalent disease-specific medication, we investigated by pathway-focused qRT-PCR a panel comprising 84 inflammation-related and 84 redox-related genes. [Results]: The study highlights a distinctive expression profile of genes critically involved in NF-κB-mediated inflammation and redox signaling in the blood of patients with cardiovascular disease, characterized by significant down-regulation of the genes NFKB2, NFKBIA, RELA, RELB, AKT1, IRF1, STAT1, CD40, LTA, TRAF2, PTGS1, ALOX12, DUOX1, DUOX2, MPO, GSR, TXNRD2, HSPA1A, MSRA, and PDLIM1. This gene expression profile defines the transcriptional status of blood leukocytes in stable disease under medication control, without discriminating between disease- and therapy-related changes. [Conclusion]: The study brings preliminary proof on a minimally invasive strategy for monitoring disease in patients with cardiovascular pathology, from the point of view of inflammation or redox dysregulation in whole blood., Research and publication of the present study was funded by the Romanian Ministry of Education and Research through the European Regional Development Fund, Competitiveness Operational Program 2014–2020 [the REDBRAIN project, ID: P_37_732] and through Programme 1 – Development of the national researchdevelopment system [grant 7PFE/2018].

Alzheimer's disease is the most common neurodegenerative disorder, and its prevalence increases with age. Although there is a large amount of scientific literature focusing on Alzheimer's disease cardinal cognitive features, autonomic nervous system dysfunction remains understudied despite being common in the elderly. In this article, we reviewed the evidence for autonomic nervous system involvement in Alzheimer's disease. We identified four major potential causes for dysautonomia in Alzheimer's disease, out of which two are well-studied (comorbidities and medication) and two are rather hypothetical (Alzheimer's pathology and brain co-pathology). Although there appears to be some evidence linking Alzheimer's disease pathology to autonomic nervous system dysfunction, there is an important gap between two types of studies; histopathologic studies do not address dysautonomia manifestations, whereas clinical studies do not employ histopathologic diagnostic confirmation. Moreover, brain co-pathology is emerging as an important confounding factor. Therefore, we consider the correlation between dysautonomia and Alzheimer's disease to be an open question that needs further study. Nevertheless, given its impact on morbidity and mortality, we emphasize the importance of assessing autonomic dysfunction in patients with Alzheimer clinical syndrome.

Brain metastases arising from cervical cancer are exceedingly rare. We report the case of a 62-year old woman with a history of cervical cancer who was admitted in our Department and was diagnosed with a solitary symptomatic brain metastasis. Treatment included aggressive tumor resection, followed by radiotherapy, but overall with a poor prognosis. Histopathologic examination confi rmed the metastatic origin from a primary cervical squamos cell carcinoma.

Somatization represents the appearance of unexplained symptoms or other unintentionally produced complaints which are frequently related to nervous system, so that neurologists are often the fi rst step where patients come for diagnosis. After exclusion of organic pathology and lack of results of symptomatic treatments, patients are sometimes related to a psychiatrist, even though this should happen more often, but fear of attending a psychiatrist is one one of the greatest prejudices of the Romanian society today. We’re reviewing the Classifi cation of Somatic Symptoms and Related Disorders according Diagnosis and Statistical Manual (DSM-5) of Mental Disorders; this is a new category in the classification, as this kind of pathology is a frequent one, in direct relation with anxiety and mood disorders, and incidence of this kind of troubles is increasing constantly, with immense associated health care costs and a high burden of disease, as up to 33.7% of the population is affected by an anxiety disorder during their lifetime (1) and this percent is constantly rising.

Over the past 70 years, the incidence of syphilis has dramatically decreased and consequently the neurosyphilis one. Therefore, when a patient is presented with neuropsychiatric symptoms such as psychosis, mania, memory loss, neurocognitive troubles, attention deficits, behavioral changes, or depression, a neurosyphilis diagnosis is not the first that comes to a clinician’s mind. In fact, many times, patients are first treated with psychiatric medication when penicillin would be the appropriate line of treatment. In this article, after we review neurosyphilis, we report 11 clinical cases with neuropsychiatric manifestations of syphilis and make the case for careful syphilis screening in patients presenting with psychiatric and neurological symptoms.

Life expectancy increases neurological and psychiatric pathology in the elderly. Neurocognitive disorders have an increasing incidence and therefore Alzheimer’s disease and vascular dementia become a common pathology. Delirium is a quite frequent symptom in general practice and managing agitation in elders can become challenging for the doctor, especially because of presence of comorbidity and sometimes of paradoxical reactions due to cerebral vulnerability. Neuropsychiatric symptoms are a challenge in management of patients with neurodegenerative disorders, being a real burden for patients themselves, caregivers and medical staff. A concise guide for managing these symptoms with non-pharmacological methods and drugs allowed in such conditions

Cerebral venous thrombosis (CVT) is a very rare and particular type of stroke. This disease mainly affects young adults and especially women of childbearing age. We performed a retrospective observational study in which we included all consecutive patients admitted with the diagnosis of cerebral venous thrombosis in the Neurology Department of Colentina Clinical Hospital between October 2013 and May 2017. Inclusion criteria were imaging confirmation of cerebral venous thrombosis either by conventional angiography, computed tomography (CT) with contrast or magnetic resonance imaging (MRI) with venography. Exclusion criteria were limited to age under 18 years old. We performed this study in order to show the genetic profile of the Romanian patient with cerebral venous thrombosis. It is the first prospective observational study performed on this disease in Romania. The results of our study concerning hereditary thrombophilia were in agreement with current data in the literature, especially given the fact that all patients presented at least one mutation. The population of patients we enrolled showed clinical and genetic aspects similar to the known epidemiologic profile of the patient with cerebral venous thrombosis, regarding age of onset, prior or concomitant infections, presence of prothrombotic factors and favourable outcome.

Neurodegenerative diseases such as Parkinson&rsquo, s disease (PD)have increasing incidence, due to lifespan expansion. The association between PD and Myasthenia Gravis (MG) is uncommon, and so far, since 1987, 26 cases have been reported. We report here a series of three new cases, two men and one woman with this peculiar combination of conditions, identified in the Neurology Department of Colentina Clinical Hospital. In this article, the pathogenesis of MG in patients with PD is discussed, along with a literature review regarding the co-occurrence of these two neurological diseases.

The most common tumours of the central nervous system, meningiomas are frequently diagnosed by accident when patients undergo imaging studies of the brain for other reasons. Most patients lack symptoms and thus can live their whole lives without knowing they have a brain tumour. Less fortunate patients seek medical advice for troubling symptoms – like seizures or disturbances of the cranial nerves – get surgery for the excision of the tumour and years later fi nd out their tumour has come back. We are presenting the case of such a patient with a recurrent parietal meningioma.

Cerebral venous thrombosis is a rare form of stroke treated with anticoagulant compounds both in the acute phase as well as in long term. We present the case of a 56 year old female that suffered two different forms of stroke in 2 years.

Ischemic or hemorrhagic stroke may be accompanied by movement disorders (1), either hyperkinetic or hypokinetic. Hyperkinetic movement disorders after stroke comprise dystonia (2-4), chorea with or without hemiballismus (5), tremor (6), parkinsonism (7), segmental or focal myoclonus, athetosis, pseudathetosis, and asterixis (8). Hemiballismus is a movement disorder characterized by involuntary, arrythmic, and large amplitude excursion of a limb, usually from a proximal joint, witn an element of rotation (9). Ballismus is explainable with lesions in the subthalamic nuclei, cerebral cortex, corpus striatum, thalamus and brainstem. (10) The frequency of post-stroke abnormal movements is unclear, the prevalence in a swiss registry being 1% with an incidence of 0.08% per year (8). Of them, hemichorea-hemiballismus is the most common, while dystonia is the next most common disorder (11).

Neuro-ophtalmology is a borderline specialty, as the eye is not an isolated organ but an extension of the brain. A lot of diseases can cause visual troubles and the vascular ones are quite frequent. The precocious evaluation of the visual function is essential for the therapeutical approach and for the recovery, and all this process seldom needs involvment of a medical team. The anterior ischemic optic neuropathy includes some pathogenic entities which determine the optic nerve ischemia, with a papilar edema present acutely, painless and without any predicting signs. This disease is very often associated with giant cell arteritis, and the non-arteritic one is the most frequent cause of vision loss in patients over 50 years. The main risk factors are hypertension, diabetes and dyslipidemia. The antiagregant therapy remains essential. Retinal artery occlusion is the ocular equivalent of cerebrovascular disease. The occlusion may be central, causing a loss of central vision in the affected eye, or in a branch of the retinal artery, affecting only a part of the retina served by that branch retinal vessel and sparing central visual acuity. The main cause is the carotidian stenosis and less the cardiac embolia. This is a medical emergency which can be approached with intra-arterial trombolysis if the pacient comes within 100 minutes from the beginning. The transient ischemic attack with ocular implications is manifested with a transitor monocular blindness (amaurosis fugax) and represents a medical emergency, as it could predict a definitive stroke. The ethiology differs, depending on the patient’s age, in young ones it can be associated with migraine and the antiphospholipid antibodies syndrome, and in the elderly the main mechanism is the atherosclerotic one.

Monitorizarea stării neurologice și biologice în scleroza multiplă este extrem de importantă, mai ales în era agenților modificatori ai bolii. Pacienții trebuie evaluați clinic și biologic la fiecare trei luni, imagistic în fiecare an, și desigur ori de câte ori este necesar, dacă apar pusee sau reacții adverse ale terapiei. Evaluarea clinică se face utilizând mai multe scale, cum ar fi EDSS, Neurostatus, Multiple Sclerosis Functional Composite, Indexul de ambulație Hauser, Independența funcțională și Scalele de evaluare a calității vieții.

Prezentăm rezultatele terapiei cu interferon beta-1b la un lot de 38 de pacienți tratați timp de 3 ani, având o vârstă medie de 32,61 ani și o vechime medie a bolii la inițierea terapiei de 3,68 ani, cu EDSS inițial de 2,31 și o rată medie inițială a puseelor de 4 pe an. Evoluția clinică per ansamblu a fost favorabilă la peste 75% dintre pacienți. După cum era de așteptat, evoluția cea mai bună au avut-o pacienții cu vârstă medie inițială mai mică și scor EDSS inițial sub 3,0 la inițierea terapiei. Efectele adverse pe calea hematologică au fost minore și nu au determinat întreruperea terapiei. Aspectele imagistice au arătat ameliorări mai puțin nete comparativ cu evoluția clinică cuantificată prin scorul EDSS.