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The proto-oncogene MYCN is considered a transcription factor involved in the regulation of neuroblastoma (NB) cell biology. Since minimally invasive-surgery represents a debated treatment of NB, we investigated COSH-SY5Y and IMR-32 were exposed to COCOOur results suggest that CO

BackgroundBehavioral and psychological symptoms of dementia (BPSD) have a high prevalence, and their presence is associated with a severe impact in terms of social costs. However, dedicated clinical tools or biomarkers to detect these symptoms are lacking. Thus, BPSD management in clinical settings is challenging. The aim of this study was to investigate the perception and the treatment strategies for BPSD in Italian centers working in the dementia field.MethodsA multicenter, national survey was developed by BPSD Study Group of the Italian Neurological Society for Dementia (SINDEM). The survey consisted of a semi-structured questionnaire that was e-mailed to SINDEM members, dementia centers part of the national network of memory clinics (Centers for Cognitive Deterioration and Dementia [CDCD]), and clinicians working in dementia care settings. The questions were focused on (1) perceived global frequency and relevance of BPSD; (2) tools used to assess BPSD; (3) pharmacological treatment for psychosis, apathy, agitation, aggression, depression, anxiety, sleep, and nutrition disturbances; (4) non-pharmacological treatments; (5) drugs side effects.ResultsOne-hundred and thirty-six clinicians participated in this study. Seventy-nine participants worked in a CDCD and 57 in other settings. The perceived frequency of BPSD was 74%. BPSD are detected by means of a clinical assessment for 96.3% or a caregiver interview for 97%. For psychosis treatment the first choice was atypical antipsychotics (83.3%), followed by typical antipsychotic (8.9%) and antidepressants (4.8%). For agitation, atypical antipsychotics were the first-choice treatment in 64% of cases and antidepressants in 16.1%. For aggression, the most used drugs were atypical antipsychotics (82.9%). For anxiety, 55.2% use antidepressants, 17.9% use atypical antipsychotics, and 16.9% use benzodiazepines. Interestingly, most of the centers apply non-pharmacological treatments for BPSD. Some differences emerged comparing the responses from CDCD and other care settings.ConclusionThe survey results revealed many differences in BPSD perception, treatment options, and observed side effect according to the clinical setting. This variability can be explained by the absence of clear guidelines, by differences in patients' characteristics, and by clinical practice based on subjective experience. These results suggest that producing guidelines for the pharmacological treatment of BPSD is a major need.

Because hyper-excitability has been shown to be a shared pathophysiological mechanism, we used the latest and largest genome-wide studies in amyotrophic lateral sclerosis (n = 36,052) and epilepsy (n = 38,349) to determine genetic overlap between these conditions. First, we showed no significant genetic correlation, also when binned on minor allele frequency. Second, we confirmed the absence of polygenic overlap using genomic risk score analysis. Finally, we did not identify pleiotropic variants in meta-analyses of the 2 diseases. Our findings indicate that amyotrophic lateral sclerosis and epilepsy do not share common genetic risk, showing that hyper-excitability in both disorders has distinct origins. ispartof: NEUROBIOLOGY OF AGING vol:92 ispartof: location:United States status: published

Background The aim of this study is to investigate the use of methylene blue in perioperative identification of the patent processus vaginalis in a group of boys presenting with congenital or recurrent hydrocele where surgery was performed by junior surgeons in training. Methods We retrospectively reviewed the notes of 22 boys with hydrocele, of which two recurrences, who were operated via a standard inguinal approach, by trainees. Methylene blue 0.3-0.5 mL was injected into the hydrocele fluid through the scrotal wall. A processus vaginalis was identified as a blue line. Results Methylene blue injection clearly identified a patent processus vaginalis in 91% of patients. In 9% (N.=2), of which one recurrence, methylene blue injection demonstrated a hydrocele with an obliterated processus vaginalis. There were no intraoperative complications. No testicular atrophy was recorded. Conclusions Injection of methylene blue into the hydrocele sac may be considered a useful aid for a clearer identification of a difficult patent processus vaginalis. In the present series, there were no complications, and thus we believe that this technique might be suitable and especially helpful, in cases of recurrent hydrocele, and for junior surgeons in training.

Background It has been widely reported that anticoagulants (ACs) are underused for primary and secondary prevention of ischemic stroke in patients with atrial fibrillation (AFib). Furthermore, precise evidence-based guidelines about the best timing for AC initiation after acute stroke are currently lacking. Methods and Results In this retrospective, observational study, we analyzed prescription trends in AFib patients with acute ischemic stroke who were hospitalized in four neurologic stroke units of our region (Lombardia, Italy). In-hospital antithrombotic prescription was performed in highly heterogeneous patterns. A prestroke treatment with AC was the leading factor enhancing AC prescription during hospitalization. The other factors promoting AC were male gender, younger age, lower prestroke disability and stroke severity, and smaller stroke volumes. AFib subtype influenced AC prescription only in AC-naive patients. Interestingly, Congestive heart failure, Hypertension, Age higher than 75 years, Diabetes, previous Stroke or TIA or thromboembolism, Vascular disease, Age 64–75 years, female Sex (CHA 2 DS 2 -VASc) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INRs, Elderly, Drugs and alcohol (HAS-BLED) scores were not associated with AC prescription. However, patients who were treated with AC, including early treatment ( Conclusions Our findings potentially suggest that, although apparently neglecting the common risk stratification tools, our neurologists were able to select the more suitable candidates for prompt AC treatment. Further studies are needed to develop new scoring systems to aid ischemic and hemorrhagic risk estimation in the secondary prevention of stroke.

International audience; BACKGROUND:The Aphasia Rapid Test (ART) is a screening questionnaire used for examining language in acute stroke patients. The ART was initially developed and validated in French. The purpose of this study was to assess the inter-rater reliability of Italian ART.METHODS:The original version of the ART was translated into Italian. The inter-rater reliability was assessed by two independent neurologists who were blind to each other's ratings in 52 acute post-stroke patients.RESULTS:The 52 patients (28 men, 24 women; mean age 73.73 ± 28.99 years) were included within 1 week of stroke onset (46 ischemic, 6 hemorrhagic), as assessed by clinical examination and confirmed by CT and/or MRI. The mean (± SD) ART value was 9.38 (± 9.26) for rater 1 and 9 (±9.31) for rater 2. The inter-rater agreement was very good, with a coefficient of concordance of 0.99 (95% CI 0.986-0.995; p

Purpose: The purpose of this study was to evaluate the experience of various institutions with enteric duplication cysts in 215 children during the last 25 years and to demonstrate the variability of their presentations and focus the attention to adopt the more correct and timely treatment.

Background: Lichen sclerosus (LS) is a disease of the skin of unclear etiology that can occur in the foreskin. Topical therapy with corticosteroids is recommended, but they can have side effects. Objectives: We aimed to compare the effects of ozonides with vitamin E acetate (OZOILE) versus topical corticosteroid in children undergoing circumcision. Method: Twenty children undergoing circumcision were treated before surgery: 10 children with OZOILE cream and 10 with 0.1% mometasone furoate once a day for 7 days. Ten age-matched patients with LS of the foreskin without any treatment were recruited as controls. Transcript levels of proinflammatory and anti-inflammatory cytokines and e-cadherin were evaluated in removed foreskins by qRT-PCR. Results: OZOILE and steroid topical treatment produced a similar reduction of TNF-α and IL-1β mRNA levels in foreskins from patients with LS when compared to untreated patients (p < 0.001). OZOILE and steroid treatment caused an increase in the transcript levels of IL-13 and e-cadherin in the foreskin of patients affected by LS in comparison to untreated foreskin (p < 0.001). Conclusions: On the basis of our biochemical data, a randomized clinical trial might be useful to verify the actual clinical effect of OZOILE as alternative treatment to corticosteroids in children affected by LS of the foreskin.

GENetics of mOyaMoyA (GEN-O-MA) project is a multicenter observational study implemented in Italy aimed at creating a network of centers involved in moyamoya angiopathy (MA) care and research and at collecting a large series and bio-repository of MA patients, finally aimed at describing the disease phenotype and clinical course as well as at identifying biological or cellular markers for disease progression. The present paper resumes the most important study methodological issues and preliminary results. Nineteen centers are participating to the study. Patients with both bilateral and unilateral radiologically defined MA are included in the study. For each patient, detailed demographic and clinical as well as neuroimaging data are being collected. When available, biological samples (blood, DNA, CSF, middle cerebral artery samples) are being also collected for biological and cellular studies. Ninety-eight patients (age of onset mean ± SD 35.5 ± 19.6 years; 68.4% females) have been collected so far. 65.3% of patients presented ischemic (50%) and haemorrhagic (15.3%) stroke. A higher female predominance concomitantly with a similar age of onset and clinical features to what was reported in previous studies on Western patients has been confirmed. An accurate and detailed clinical and neuroimaging classification represents the best strategy to provide the characterization of the disease phenotype and clinical course. The collection of a large number of biological samples will permit the identification of biological markers and genetic factors associated with the disease susceptibility in Italy.

Thrombolysis represents the best therapy for ischemic stroke but the main limitation of its administration is time. The avoidable delay is a concept reflecting the effectiveness of management pathway. For this reason, we projected a study concerning the detection of main delays with following introduction of corrective factors. In this paper we describe the results after these corrections.Consecutive patients admitted for ischemic stroke during a 3-months period to 35 hospitals of a macro-area of Northern Italy were enrolled. Each time of management was registered, identifying three main intervals: pre-hospital, in-hospital and total times. Previous corrective interventions were: 1.increasing of population awareness to use the Emergency Medical Service (EMS); 2.pre-notification of Emergency Department; 3.use of high urgency codes; 4.use of standardised operational algorithm. Statistical analysis was conducted using time-to-event analysis and Cox proportional hazard regression.1084 patients were enrolled. EMS was alerted for 56.3% of subjects, mainly in females and severe strokes (p0.001). Thrombolytic treatment was performed in 4.7% of patients. Median pre-hospital and in-hospital times were 113 and 105min, while total time was 240. High urgency codes at transport contributed to reduce pre-hospital and in-hospital time (p0.05). EMS use and high urgency codes promoted thrombolysis. Treatment within 4.5hours from symptom onset was performed in 14% of patients more than the first phase of study.The implementation of an organizational system based on EMS and concomitant high urgency codes use was effective to reduce avoidable delay and to increase thrombolysis.

Objectives: In the last years, many surgical techniques of preputioplasty have aimed to preserve the foreskin in case of phimosis. These techniques are not reliable for patients affected by phimosis linked to balanitis xerotica obliterans (BXO) and scarred foreskin. We tried an original technique of resection of the pathological foreskin, removing the mucosal internal layer followed by reconstruction of the foreskin. The aim was to evaluate the outcome of paediatric patients who underwent modified partial circumcision for pathological phimosis. Patients and methods: In all, 360 patients with phimosis underwent modified partial circumcision at our institution. The mean age of the boys was 8.9 years, range 5–15 years. In 145 (40.3%) cases, indication for surgery was clinical suspicion of BXO, in 215 (59.7%) cases it was chronic inflammation of the foreskin. Results: In all cases, the postoperative period was uneventful. Cosmesis was considered by parents as excellent in 95.2% of patients. In these patients, the glans was almost completely covered by soft foreskin. Histopathological examination of the removed foreskin documented BXO in 162 (45%). Twelve (3.3%) patients complained of recurrences and five (1.4%) patients of smegmatic cysts. Conclusion: The described surgical technique of modified partial circumcision for the correction of pathological phimosis appears cosmetically well accepted, safe, and simple with low rate of late postoperative complications. Keywords: balanitis xerotica obliterans, circumcision, partial circumcision, phimosis

We report a case of congenital diaphragmatic hernia (CDH) with perinatal bowel strangulation requiring intestinal resection. Ten hours after birth, the newborn started to be lethargic and developed bilious emesis. X-ray documented distended loops of bowel with air fluid levels in the abdomen and a gasless, non-homogeneous opacity of the left hemithorax, a right mediastinal shift and loss of the sharp left hemidiaphram line. On gastrographin enema the left colon was above the adjacent left diaphragm. Emergency surgery was performed at 16 h of age. The entire small bowel appeared reddish and compromised. After 24 h, second-look laparotomy was performed and only 25 cm of small bowel were viable. The postoperative period was uneventful. Neonatal bowel strangulation in CDH should be taken into account when estimating postnatal morbidity and mortality and, even if CDH treatment is not an emergency procedure, if gastrointestinal symptoms prevail over respiratory symptoms, surgery should be carried out without delay.

Purpose To report our experience in surgical management of nonpalpable intraabdominal testis (NPIT) by inguinal orchidopexy without division of the spermatic vessels. Methods We reviewed the records of NPIT patients who underwent orchidopexy between 2012 and 2015. All patients were evaluated ultrasonographically. When the testis was not detected ultrasonographically, a laparoscopic exploration was performed. If the testis was found on laparoscopy, surgery was resumed through an inguinal incision. A follow-up was performed at 1week, 1, 3 and 6months. Results Twenty-one NPIT patients were treated, mean age 21.0±11.7months. Ultrasound identified 15 cases of NPIT (71%); diagnostic laparoscopy was performed in 6 (29%). All patients underwent an inguinal orchidopexy. At 1week, four testes were in a high scrotal position. At 6months follow-up, one testis was in a high scrotal position and one retracted up to the external inguinal ring. No atrophy was recorded. Conclusions Despite several attempts to find a surgical technique without any significant complications, all described procedures failed to meet the target. In our experience, inguinal orchidopexy is a safe, reliable and successful surgical procedure for the management of NPIT. It should be preferred to a technique requiring vascular division, burdened with a higher incidence of atrophy. Type of study Treatment study. Levels of evidence Case series with no comparison group.

Aim of the study is to report the experience in the last three years about endourological treatment of newborns affected by genito- and urinary malformation, implying critical urinary tract dilatation and bladder mass requiring a neonatal operative management. Seven – four males and three female – patients were treated cystoscopically during the neonatal period. Three newborns with a posterior urethral valves (PUV), underwent a successful ablation of PUV. In a male with infected persistent large mullerian duct and subsequent acute urinary retention, a cystoscopically-assisted catheterization was performed. Two females, one with cloaca and the other with high persistent urogenital sinus and massive associated hydrometrocolpos underwent a cystoscopical drainage of the vagina and a positioning of a balloon catheter into the bladder. Another female with a bladder mass had a endoscopical biopsy. Thanks to modern neonatal operative urethrocystoscope, today is possible to treat early many pathological genito-urinary conditions in newborns.

Background and Purpose— Lombardia GENS is a multicentre prospective study aimed at diagnosing 5 single-gene disorders associated with stroke (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, Fabry disease, MELAS [mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes], hereditary cerebral amyloid angiopathy, and Marfan syndrome) by applying diagnostic algorithms specific for each clinically suspected disease Methods— We enrolled a consecutive series of patients with ischemic or hemorrhagic stroke or transient ischemic attack admitted in stroke units in the Lombardia region participating in the project. Patients were defined as probable when presenting with stroke or transient ischemic attack of unknown etiopathogenic causes, or in the presence of Results— In 209 patients (57.4±14.7 years), the application of the disease-specific algorithm identified 227 patients with possible monogenic disease. Genetic testing identified pathogenic mutations in 7% of these cases. Familial history of stroke was the only significant specific feature that distinguished mutated patients from nonmutated ones. The presence of cerebrovascular risk factors did not exclude a genetic disease. Conclusions— In patients prescreened using a clinical algorithm for monogenic disorders, we identified monogenic causes of events in 7% of patients in comparison to the 1% to 5% prevalence reported in previous series.

Introduction: Mild cognitive impairment (MCI) usually is the early stage of dementia which is defined as decreasing in mental abilities such cognition, memory, and speech not too severe to interfere daily activities. MCI diagnosis is rather hard and usually assumed as normal consequences of aging. Diagnosis is usually performed through a combination of extensive testing and eliminations of other possible causes. “Seizures” or neuronal hyperexitability in the temporal lobe, transiently impair cognition and steadily damage hippocampal circuitry, leading to progressive memory loss. Objective: The objective of this study was demonstrated that EEG pattern abnormalities in the left temporal in healthy subjects, are an early sign of progressive cognitive impairment. Material and methods: This was an clinical and neurophysiology observational study in healthy adults patients with EEG pattern characterized by slow activity in left temporal region. This study lasted three years in total, being divided into two phases: recruitment (for an entire year) and follow-up after 1 year. Admission criteria were checked. The follow-up consisted of neuropsychological assessment with Mini Mental State Examination (MMSE) and MRI scan. Our analysis was based on pooled of patients from neurophysiology department in Italy from February 2010 to July 2013. The EEG activity was recorded continuously from 19 electrodes positioned according to the 10–20 International system. Results: One hundred forty patients were recruited and one hundred thirty completed the 24-month study. Of the ten patients who did not complete the study. In case group we had 60 subjects, 15 males and 45 females with sharp slow-wave in left temporal region on EEG. In control group we had 70 subjects, 30 males and 40 females with normal EEG. 57 patients (Case) and 33 patients (Controls) showed a mild cognitive impairment (MMSE ≥ 23 adjusted for age and education). 49 patients (Case) and 21 patients (Controls) with deep lacunar infarcts or subcortical white matter alterations on MRI scan. Analysis performed according to methods proposed by Koch showed that pattern EEG of slow waves significantly correlated with both variables MCI (P

Background The monoclonal antibody natalizumab (NTZ) is a highly effective treatment for patients with multiple sclerosis (MS). However, this drug is associated with increased risk of developing Progressive Multifocal Leukoencephalopathy (PML), an opportunistic infection of central nervous system (CNS) caused by the John Cunningham polyomavirus (JCV). Objective To describe the 12-month clinical course of 39 patients with MS (28 women, 11 men) who developed NTZ-related PML after a mean exposure of 39 infusions. Methods An Italian independent collaborative repository initiative collected and analyzed socio-demographic, clinical, magnetic resonance imaging (MRI) data and number of JCV-DNA copies detected on cerebrospinal fluid (CSF) samples of patients diagnosed as affected by NTZ-related PML. The evolution of disability, measured by the Expanded Disability Status Scale, was assessed at NTZ start, at PML diagnosis and after 2, 6 and 12 months from PML diagnosis. The effect of clinical and paraclinical characteristics at PML diagnosis on the final outcome was also investigated. Results Ten patients (25.6%) were diagnosed before 24 NTZ infusions. In six cases (15.4%) the PML suspect was made on the basis of highly suggestive MRI findings in absence of any detectable change of clinical conditions (asymptomatic PML). In patients with symptomatic PML, the diagnosis was quicker for those who presented with cognitive symptoms (n = 12) rather than for those with other neurological pictures (n = 21) (p = 0.003). Three patients (7.7%) died during the 12-month observation period, resulting in a survival rate of 92.3%. Asymptomatic PML, more localized brain involvement and gadolinium-enhancement detected at MRI, as well as lower viral load were associated with a better disability outcome (p-values

Cluster headache (CH) is excruciating attack of pain in one side of the head, often felt around the eye. It occurs 1 in 500-1000 people, is more common in men and tend to develop in people over the age of 20.

Introduction: To evaluate the outcome of circumcised patients with balanitis xerotica obliterans (BXO) using uroflowmetry (UF). Methods: Between 2011 and 2013, 180 children underwent a circumcision for phimosis. The foreskin was examined on microscopy. Patients with an histological diagnosis of BXO were included in the study. Patients with BXO underwent UF two weeks after surgery and treatment with clobetasol propionate ointment. Patients were re-evaluated at 6, 12, 18 and 24 months postoperatively clinically and using UF. Results: 75 of 180 circumcised patients (41.6%) were included. At two weeks, Thirtytwo of 75 patients (42.7%) displayed a pathological UF. At six months, 15 patients (20%) had pathological UF and a new cycle of clobetasol was prescribed. At one year, 10 patients (13.3%) displayed patholgocial UF and underwent progressive urethral dilatation or meatoplasty. At 18 months, 71 patients (94.7%) displayed regular UF, 3 underwent a meatoplasty and one a staged urethroplasty for a severe urethral stenosis. At two years, UF was normal in 74 out of 75 (98.7%). Conclusions: We recommend to send for hystological examination all foreskins excised after circumcision. We believe that a clinical and uroflowmetric follow-up of pediatric patients with BXO is mandatory for a prompt identification of post-voiding dysfunction.

Balanitis xerotica obliterans (BXO) is a chronic inflammatory skin disorder, considered the male genital variant of lichen sclerosus. Anti-inflammatory drugs are commonly used in BXO. We evaluated the effects of an innovative formulation of ozonated olive oil with vitamin E acetate (OZOILE®) on the inflammatory status and tissue remodeling in male children with BXO. The mRNA transcripts of proteins involved either in inflammation or in dynamics of tissue regeneration were analyzed by quantitative real-time PCR, in foreskins affected by BXO removed from patients untreated or treated with OZOILE® cream for 7 days before circumcision. We found a significant reduction in mRNA levels of IL-1β, TNF-α, INF–γ, transglutaminase 2 and NOS2 in foreskins treated with OZOILE® in comparison to untreated ones (p < 0.001). No significant differences were observed in NF-κB activation in the specimens obtained from treated and untreated patients. Hence, OZOILE® treatment up-regulated hypoxia-inducible factor (HIF)-1alpha, vascular endothelial growth factor (VEGF) and E-cadherin gene expression (p < 0.001). The treatment with OZOILE® showed effective results in children affected by BXO by reducing the inflammatory process and stimulating mechanisms for tissue regeneration of the foreskin. A randomized clinical trial on a large number of children affected by BXO might be useful to verify the efficacy of topical treatment with OZOILE®.

Influenza vaccination has been implicated in Guillain Barre Syndrome (GBS) although the evidence for this link is controversial. A case–control study was conducted between October 2010 and May 2011 in seven Italian Regions to explore the relation between influenza vaccination and GBS. The study included 176 GBS incident cases aged ≥18 years from 86 neurological centers. Controls were selected among patients admitted for acute conditions to the Emergency Department of the same hospital as cases. Each control was matched to a case by sex, age, Region and admission date. Two different analyses were conducted: a matched case–control analysis and a self-controlled case series analysis (SCCS). Case–control analysis included 140 cases matched to 308 controls. The adjusted matched odds ratio (OR) for GBS occurrence within 6 weeks after influenza vaccination was 3.8 (95 % CI: 1.3, 10.5). A much stronger association with gastrointestinal infections (OR = 23.8; 95 % CI 7.3, 77.6) and influenza-like illness or upper respiratory tract infections (OR = 11.5; 95 % CI 5.6, 23.5) was highlighted. The SCCS analysis included all 176 GBS cases. Influenza vaccination was associated with GBS, with a relative risk of 2.1 (95 % CI 1.1, 3.9). According to these results the attributable risk in adults ranges from two to five GBS cases per 1,000,000 vaccinations.

Introduction Classically, surgical approach for palpable undescended testis (pUDT) consists is an inguinal orchidopexy. In fact, a double incision allows an adequate mobilization of the spermatic cord and an easy dissection of a patent processus vaginalis and also to perform a subdartos pouch. For reduce potential mobility of the inguinal approach, in 1989 Bianchi and Squire proposed a transcrotal orchidopexy, using a high scrotal incision. We report our experiences and retrospectively evaluate the feasibility and postoperative success of the transcrotal approach for treatment of pUDT. Patients and Methods From January 2012 to June 2014, 217 patients, affected by pUDT were treated at our Institution, for a total of 231 orchidopexies (203 monolateral pUDT, 14 bilateral pUDT). Patients, in whom, under anesthesia, the testis could be moved to the neck of the scrotum, have been treated with a transcrotal approach using a high scrotal incision. All patients have been clinically followed up at 1 week and at 1, 2, 3, and 6 months, at 1 year, and then annually and using scrotal sonography with color-Doppler at 2, 3, and 6 months. Results A total of 205 pUDT (88.7%) were considered eligible for transcrotal. Eight (3.9%) pUDT, that were first approached transcrotally, have been converted to inguinal approach. At follow-up, two moderate scrotal hematomas and one inguinal hernia were noted. No recurrence or testicular atrophy was showed in transcrotal approached testes, while 2 recurrences out of 26 procedures (7.7%) were displayed after inguinal orchidopexy. Conclusions In our experience, transcrotal approach is possible in almost 90% of pUDT. No major complication, such as recurrence or testicular atrophy, has been complained. Just 3 out of the 205 cases (1.5%) reported minor complications and 1 of which required a successful day-case procedure. Our data confirm that transcrotal orchidopexy can be considered effective, safe, and with a success rate being equivalent or better to classical inguinal approach.

Benign proliferative lesions of the bladder are exceptional in neonates. We describe a case of a 3-day-old neonate, presenting with bloody meconium and sonographic diagnosis of bladder mass. Cystoscopic biopsies were performed and a diagnosis of polypoid cystitis was made. The patient was treated conservatively and the lesion healed during follow-up. We review the literature of other cases of neonatal bladder masses.

The present case report underlies the importance of modifications in the characteristics of post-lumbar puncture headache, which led us to diagnose cerebral venous thrombosis in a 34-year-old woman affected by multiple sclerosis. The patient underwent a lumbar puncture for diagnostic purposes and successively was treated with megadoses of methylprednisolone (1 g intravenously for 6 days). After lumbar puncture, the patient developed an orthostatic headache sue to cerebrospinal fluid (CSF) hypotension. Eight days later, and two days after finishing the cycle of methylprednisolone, the headache worsened, became diffuse and persisting, and was longer modified by postural changes. This was associated with psychomotor slowing and, the day after, a partial epileptic status. Magnetic resonance imaging showed an alteration in the signal corresponding to the sagittal superior, transverse and sigmoid sinuses, indicative of venous thrombosis. The potential role of lumbar puncture, steroid treatment and other associated risk factors, and the importance of considering modifications in post-puncture headache as a condition which needs specific neuroradiological examinations are discussed.

Background and Purpose: Early treatment (i.e. thrombolysis) is crucial for a successful care of ischemic stroke. In the management of stroke, two phases are crucial: the pre-hospital and the in-hospital interval. This work investigated factors influencing pre- and in-hospital delay in a large geographic area of Northern Italy. Methods: Enrolled were patients presenting with ischemic stroke in four administrative districts of Northern Italy (Como, Lecco, Sondrio and Varese) over a 4-month period. Pre-hospital time and in-hospital time with single management steps were recorded prospectively. Age, gender, recruiting hospital, EMS transport and triage codes, clinical severity and thrombolytic treatment were also recorded. Univariate and multivariate analysis of factors predicting pre- and in-hospital delay were performed. Results: Median pre-hospital time and in-hospital time were, respectively, 120 min (interquartile range, IQR 62-271) and 150 min (IQR 80-214). Pre-hospital time was halved in patients hospitalized via EMS (p < 0.001) and clinically more severe (p < 0.001). At multivariate analysis, transport code was associated with delay at any time (p < 0.05). Conclusions: EMS use and transport code predicted treatment delay in patients with ischemic stroke. A more intensive use of EMS and high urgency codes could help increase the number of stroke patients treated appropriately.

Stroke is the leading cause of disability in adulthood, and the principal aim of care in cerebrovascular disease is the reduction of this negative outcome and mortality. Several studies demonstrated the efficacy of thrombolytic therapy in ischemic stroke, but up to 80% of cases could not be treated because the diagnostic workup exceeds the time limit. In this article, we described the design of a study conducted in the northern Lombardy, within the district of Sondrio, Lecco, Como, and Varese. The awaited results of this study are reduction of avoidable delay, organization of an operative stroke emergency network, and identification of highly specialized structures. The study schedules education and data registration with implementation and training of acute stroke management algorithms. The use of standardized protocols during prehospital and in-hospital phase can optimize acute stroke pathways. The results of this study could contribute to the assessment of an effective and homogeneous health system to manage acute stroke.

Lymphoma of the central nervous system[1] accounts for 2% of cerebral tumors; it is typically located in the supratentorial and periventricular white matter; extra-axial localization is rare. When found in the cerebellopontine angle or the Meckel cave[2], the differential diagnosis includes meningioma, trigeminal neurinoma or epidermoid carcinoma. Correlated painful symptoms are often atypical, mimicking trigeminal neuralgia, cluster headache or trigeminal autonomic cephalgias (TACs). Recommended therapy involves: chemotherapy with cyclophosphamide, high dose cytarabine, steroid (dexamethasone), etoposide, and rituximab (CHASER) followed by whole-brain irradiation. We describe the case of a young man who came to our observation for excruciating headache related to mediastinal lymphoma with bilateral infiltration of the the ganglion of Gasser.

• The extent of the anterior speech region (defined as pars opercularis and pars triangularis of the third frontal convolution) and of the planum temporale was measured in 12 brains belonging to strictly right-handed persons. When the portion of the anterior speech region visible on the hemispheric surface was measured, no interhemispheric difference was found. By contrast, when both the extrasulcal and intrasulcal portions of cortex were considered, the anterior speech region in the left hemisphere was found to be significantly larger than the homologous areas in the right hemisphere. The planum temporale was significantly larger on the left than on the right, but there was no necessary correspondence between the presence of a larger right planum and a larger right anterior speech region.