Delirium is associated with lower quality of life, increased healthcare costs, longer hospitalizations, and worse prognosis when detected in patients who are already confronted with a severe and invalidating disease, like the major neurocognitive disorder (MND). In order to identify the most evidence-based interventions that could be included in case management for patients with both delirium and MND, this narrative review explored three electronic databases (Pubmed, Cochrane, and Web of Science/Clarivate) for primary and secondary sources dedicated to this topic. All papers published in English between the inception of each database and September 2024 were screened for relevant data on pharmacological and non-pharmacological therapies targeting delirium. The results supported the use of a multicomponent approach as the first line of treatment, mitigating the precipitating factors, and only as a second line, the use of pharmacological instruments. There is a lack of validated therapies targeting specifically the delirium superimposed on MND, most of the recommendations being extrapolated from studies with delirium in the general population or in elderly patients with different organic diseases. Further studies are required to investigate the specifics of delirium in patients with MND and potential strategies focused on neurobiological mechanisms instead of just clinical manifestations.
There is a potential lateralization of vegetative influences at the cerebral level. We sought to understand the impact of these influences in the setting of ischemic stroke. We conducted a prospective study on 110 who presented with acute ischemic stroke (symptom onset maximum 24 hours before admission). We investigated correlations between stroke subtype, insular location or lateralization, stroke severity, hospital mortality, and the dynamic of enzymes (Tn, TnT, CK, CK-MB). We demonstrated that a higher cardiac enzyme value is associated either with stroke severity or with a higher risk of death in the short term, this growth being a marker for a more severe prognosis of a large stroke rather than an independent cause of mortality. Cardiac monitoring in the acute phase of ischemic stroke can prevent cardiac morbidity and mortality, which is why it is important to identify patients at high risk of heart complications after stroke.
More and more research in recent years has focused on neurogenesis and neuroplasticity. The hippocampus is a key location of adult neurogenesis. Because this part of the brain is regulated by environmental variables, it must be mentioned the therapeutic potential for neurodegenerative illnesses and brain injuries. Furthermore, this information challenges the historical concept of a static brain and tries to demonstrate its flexibility, adaptability, and possibility for regeneration. Those mechanisms which are found in a variety of mammalian species, including humans, are important when it comes to adaptive learning and memory, thus providing insights into cognitive well-being and mental health. The discovery of the brain's dynamic nature represented by new neurons, marks a shift in the field of neurology with far-reaching potentials. This paper highlights the significant potential of adult neurogenesis when it comes to clinical applications such as Alz-heimer’s disease.
The primary objective of this narrative review is to evaluate the most frequently recommended structural and functional imaging methods in managing epilepsy cases as effectively as possible from a neurologist’s perspective. This review examines the background of current practice, from the beginnings of neuroimaging by computer tomography to the newly introduced methods and their combination, which helps diagnose and monitor these patients. The neuroimaging investigations required for the presurgical evaluation of patients with epilepsy are presented, and recommendations for specific MRI protocols are provided. The clinical use of functional imaging methods is also considered, and correlations between clinical aspects and specific imaging methods are explored, based on the retrieved data in the literature. In conclusion, this review emphasizes using functional and structural imaging methods, guided by clinical evidence, for better therapeutic management in patients with epilepsy.
Background. Primary headaches are comprised of three big categories: migraines (with or without aura), the third most common and the 6th most disabling disease worldwide, tension-headaches, and trigeminal autonomic cephalalgias, each with different, complex, and not completely understood pathophysiological, clinical, and neuroimagistic characteristics. Structures like the brain stem, hippocampus, or hypothalamus have been depicted as being the main triggers of these types of headaches, which have a significant impact on the quality of life. Methods. We performed a broad literature review on primary headaches from January 2016 to June 2023, analyzing the latest scientific updates and emphasizing the pathophysiological and neuroimagistic characteristics. Results. We provide a concise review of the main neuroimaging studies that help in differential diagnosis between several types of primary headaches. Conclusions. It is difficult to approach the pathophysiology of these three primary headache categories. Keeping in mind that neuroimagistic methods are rapidly developing (especially in the MRI sphere), the most important endpoint of future studies will be to establish a reliable distinction system for all these types of cephalalgias, thus updating the protocols and guidelines. Currently, imaging studies are indicated only in certain circumstances.
Erectile dysfunction (ED) has an intricate pathogenesis, with organic and psychosocial factors contributing to the shaping of its clinical manifestations and functional impairment. ED disrupts not only an individual’s sexual life but may also contribute to impairments of self-esteem, social functioning, quality of life, overall well-being, mood, etc. The assessment process and therapeutic interventions should be adequate to the specific profile of each patient, therefore an interdisciplinary approach is usually recommended, in order to find the vulnerability factors, recent triggers, psychiatric and organic comorbidities or causes, and elements that contribute to maintaining the sexual dysfunction, such as lifestyle factors, interpersonal conflicts, or inadequate sexual education. This narrative review explores the evidence-based approaches to structured psychiatric, psychological, and therapeutical assessment in patients with ED, and the most validated psychosocial treatments available. The results support the use of recognized diagnostic criteria within DSM-5TR and ICD-11, together with structured instruments (scales, questionnaires, and inventories), in a multidisciplinary approach. The cognitive model and cognitive-emotional model of ED support the initiation of cognitive-behavioral therapy in these patients. Other interventions, like the PLISSIT model, sexual therapy, couple therapy, and sexual-focused psychoeducation are also supported by evidence. In conclusion, ED requires a combined, psychiatric, psychologic, psychotherapeutic, and organic-oriented assessment, with the purpose of tailoring the treatment to the patient’s particularities.
Besides the motor and sensory dysfunction that characterizes multiple sclerosis, during the disease evolution and with the accumulation of new demyelinating lesions in specific areas of the central nervous system, autonomic dysfunction be-comes more prevalent among patients suffering from multiple sclerosis. Although not usually addressed, the complex spectrum of autonomic dysfunction manifestations has the potential of a negative impact on the daily activities of multiple sclerosis patients, needing specific investigations and therapeutic measures destined to alleviate symptoms and increase the quality of life. Since urinary dysfunction is evident from the early stages of multiple sclerosis on urodynamic studies even in patients without urinary complaints, it is indicated to thoroughly screen for urinary tract dysfunction as well as other autonomic dysfunctions in all the multiple sclerosis patients.
The assessment of coping mechanisms in patients diagnosed with oncological diseases is essential for mental health specialists, who have to design the most appropriate case management strategy for comorbid mood disorders, anxiety disorders, adjustment disorders, and other psychiatric conditions that may be detected in this vulnerable population. The adequate treatment of these disorders is important for the preservation of mental health status, quality of life, and overall functionality in patients diagnosed with cancer. Coping mechanisms modulate the vulnerability toward psychiatric disorders, but they also have an impact on treatment adherence, which is an important factor correlating with prognosis. Appraisal-focused, problem-focused, emotion-focused, and occupation-focused coping represent the most well-defined strategies patients use when confronted with a stressful life situation, like a diagnosis with potentially vital consequences. Maladaptive coping strategies may also be identified in these patients, e.g., withdrawal from reality, including complete or partial denial of the disease, substance abuse, behavioral addictions, refusal of the recommended treatment, etc. The psychotherapeutic approach in patients with oncological diseases should include an initial evaluation of the coping strategies used either currently or in the past stressful conditions, an assessment of all the psychosocial resources the patients have (e.,g., support group, professional insertion, hobbies), and screening for mood and anxiety disorders that may have been triggered by the cancer diagnosis. Consequently, within the psychotherapeutic framework, a trained specialist can enhance the role of adaptive coping strategies and highlight the disadvantages of dysfunctional ones. This process may possess a favorable impact on treatment adherence, mental health status, and quality of life in patients with cancer.
Nutritional interventions in the field of psychiatry have been explored more intensively in the last two decades, but definitive conclusions based on the retrieved data in the literature about the efficacy of this therapeutic approach are difficult to formulate. This observation has multiple explanations, e.g., these therapeutic interventions are very heterogenous, cohort studies usually enroll different psychiatric populations or healthy subjects with minor psychiatric symptoms, nutritional supplements or special diets are commonly recommended as add-ons to the pharmacological interventions (thus making it difficult to differentiate the impact of each therapy on the outcomes), placebo-controlled randomized studies are still very few, etc. Therefore, a narrative review focused on the main challenges reported during the research in the field of nutritional psychiatry (NP) may be useful for clinicians interested in strategies to augment the efficacy of pharmacological treatments or to find new solutions with low risk of adverse events in patients with organic comorbidities or multiple concomitant medications. Data about the efficacy and tolerability of nutritional interventions explored for psychiatric disorders were searched in four electronic databases (PubMed, Cochrane, Clarivate/Web of Science, and EMBASE). Omega-3 polyunsaturated fatty acids supplementation, healthy diet interventions, folate and vitamin B12, S-adenosyl-L-methionine, N-acetyl cysteine, vitamin B1 and B6, vitamin D, minerals, psychobiotics, inositol, and herbal products were the main interventions identified, and their demonstrated efficacy was quite heterogenous, while their tolerability and safety were good. Therefore, NP is a domain of research that may benefit from more good-quality and longer-duration trials, in order to verify the effectiveness of such augmentation strategies to the already validated treatments.
Gynecologic cancers are among the most common cancers in women and are a significant cause of mortality in women worldwide. FDG-PET images play a critical role in several areas of oncology and are an essential tool for the diagnosis and staging of gynecologic cancer, providing information about tumor metabolism. Aim: The aim of this study was to investigate the relationship between tumor differentiation, type of malignancy, and glucose metabolism in patients with confirmed gynecologic cancer. Materials and Methods We performed a retrospective review of 60 consecutive patients (ages 31-76) with histopathologically confirmed gynecologic cancer who underwent PET-CT in our department between January 2021 and March 2022. Quantitative data on glucose metabolism were collected using the maximum standardized uptake value normalized by lean body mass (SULmax). We reviewed a total of 60 patients with a mean age of 60±9 years, and a median of 62. Results: 14 patients were diagnosed with cervical cancer, 20 with endometrial cancer, and 26 with ovarian cancer; 13 patients had well- differentiated cancer, 11 had moderately differentiated cancer, and 36 had poorly differentiated cancer. A positive correlation was observed between the measured SULmax and the degree of tumor differentiation, indicating higher glucose uptake in poorly differentiated cancer. When examining the relationship between the type of cancer and SULmax, we found that endometrial cancer exhibited the highest mean SULmax (8.36±6.75), followed by ovarian cancer and cervical cancer. Additionally, we noted that glucose uptake was higher in patients aged over 62 years. Regardless of the tumor differentiation, the findings in endometrial cancer showed the highest mean SUVmax values in all grades of tumor differentiation. Conclusion: Our study showed that glucose consumption correlates not only with the degree of differentiation but also with age and type of tumor, with the highest values in patients older than 62 years with endometrial cancer. Given the correlation between glucose consumption and tumor aggressiveness, this finding may be important for prognostic evaluation of patients with gynecologic malignancies.
The conundrum of post-psychotic depression (PPD) is still present in the psychiatric literature, for more than a century since it was first described by Mayer-Gross. After a short existence in the DSM-IV and ICD-10, this nosological construct was excluded from newer versions of the mental disorders classifications. Therefore, an exploratory analysis of the PPD concept was considered useful both from clinical and theoretical perspectives. There is a high prevalence of depressive symptoms in patients with schizophrenia spectrum disorders (SSD) and, although not all of them represent cases of PPD, they are considered risk factors for suicide. The arguments and contra-arguments for/against PPD were reviewed, and the potential pharmacological interventions for this disorder were analyzed. The explored evidence indicates that PPD is worth further investigation, and in order to differentiate it from schizoaffective disorder, negative symptoms of SSD, or depressive manifestations within the acute psychotic episodes, clearly defined criteria should be found. The use of validated scales, like the Calgary Depression Scale for Schizophrenia and the InterSePT Scale for Suicidal Thinking, is recommended for the initial assessment of depression and suicidal risk in patients with SSD, but also for their monitoring during the acute and maintenance phases. Besides the administration of combined, antidepressant and antipsychotic treatment, the use of clozapine, and the recommendation to initiate treatment for SSD with atypical antipsychotics whenever possible, there is a dearth of studies exploring specific interventions for PPD. Future studies are expected to address the validity of the nosological construct of PPD and the most adequate therapeutic and prophylactic interventions in patients with SSD.
Obesity affects the population worldwide. A hypercaloric diet associated with a sedentary life, stress, and genetic background, triggers various metabolic disorders, such as metabolic syndrome, diabetes mellitus, cancer, cardiovascular diseases, non-alcoholic fatty liver disease, and cognitive impairment. A healthy diet correlated with physical activity, not smoking, and moderate alcohol consumption reduces the risk of developing metabolic diseases. The Mediterranean diet contains antioxidants, fiber, polyunsaturated fats, and compounds with anti-inflammatory, anti-oxidant, anti-cancer, and anti-obesity properties. In a wide variety of species including humans, the reduction of calories between 20-40% significantly improves health, increases longevity, and delays the development of various pathologies. The main aim of this review is to present the comparative effects of the Mediterranean diet versus the hypercaloric diet on insulin sensitivity.
This article aims to highlight the burnout burden among neurologists and provide information on some of its causes and consequences. We report an original article that reviews our current understanding of burnout matter in the neurology field. The main search engine through which we performed extensive literature research was PubMed, Scopus, and Google Scholar. The following information was collected: triggers of burnout and factors that perpetuate it, major complaints, values, and goals that dictate how coaching with it. Physician burnout is an umbrella term characterized by symptoms determined by exposure to chronic workplace stressors. Simply put, it encompasses many dimensions: emotional exhaustion, feelings of cynism, detachment (depersonalization), and a sense of ineffectiveness at work (low personal accomplishment). Burnout is common among all medical specialties, but neurology ranks at the top of the list. Several identified factors continue to fuel this problem. Properly addressing them, rethinking practice, and implementing wise, modern strategies can make significant contributions to reducing it. Aside from the chronic harm to the physician, burnout puts at risk the healthcare community at many levels including patients, other professionals, finances, etc. This paper wants to emphasize that burnout in neurology should be regarded as a global crisis. Thus, some strategies are proposed.
Retinal migraine (ophthalmic migraine, ocular migraine, anterior visual pathway migraine) is a rarely encountered medical condition, but with an interesting and complex clinical presentation. The goal of this article is to compile the literature on retinal migraine, detailing nomenclature, pathophysiology, differential diagnosis, and medical investigations including newer imaging modalities, like optical coherence tomography (OCT). We will approach topics of great concern such as risk factors, complications, treatment, and management of this condition. Retinal migraine is mainly a diagnosis of exclusion and it must be isolated from transient monocular vision loss (TMVL) developed from other causes, for instance, papilledema, giant cell arteritis, carotid artery disease (amaurosis fugax), intermittent angle closure glaucoma, and others. Its treatment is similar to migraine treatment; topiramate, amitriptyline, and nortriptyline are some of the pharmacological drugs successfully used.
Cannabinoids' usefulness in the treatment of neurological disorders (epilepsy, and various neurodegenerative diseases, such as Multiple Sclerosis and Alzheimer's Disease) has been demonstrated in a growing number of studies. Of the 11 known general types of natural cannabinoids, the focus has been mainly directed at cannabidiol (CBD) due to its specificity in stimulating cannabinoid receptors and the low rate of side effects, as well as on Δ (9)-tetrahydrocannabinol (Δ9-THC). The natural and synthetic analogs of CBD have been described as a potential treatment in neurological diseases, as they showed their therapeutic benefits in reducing the seizures from epilepsy and their neuroprotectivity in neurodegenerative diseases. First and foremost, CBD's neuroprotective properties are due to its capacity to act as an endogenous cannabinoid receptor agonist. Second, CBD enhances neuroprotection by interacting with many signal transduction pathways mediated indirectly through cannabinoid receptors. CBD also reduces the hyperphosphorylation of glycogen synthetase kinase 3 (GSK-3) induced by the buildup of Amyloid β in the physiopathology of Alzheimer's disease.
Million people worldwide are affected by the hepatitis C virus (HCV). The highest incidence of illness was between 1945 and 1975. It was also estimated that 70% of those people were not tested for the disease. Most recent treatment concepts are safe, highly effective and have a vital public health influence by achieving a viral constant response in a significant proportion of treated patients. It helps reduce liver fibrosis, liver cancer risk and dissemination. With its increased population incidence, HCV becomes a serious public health problem. This review discusses the current literature in this field in terms of the importance of screening of HCV, follow-up, treatment and includes considerations in specific populations such as patients with cirrhosis, with HIV/HCV co-infection, patients with HBV/HCV co-infection and with renal damage.
Worldwide, adults and childhood obesity are increasing alarmingly, being a major health problem. Obesity is correlated with an increased incidence of various systemic diseases including cancer, heart diseases, and diabetes mellitus type 2. Risk factors for obesity are dysbiosis, genetic, socioeconomic, behavioural and environmental. The gut microbiota has beneficial effects on human health, like host immune system stimulation, being influenced by pH, or nutrient intake. Studies performed on humans and animal models reported differences regarding microbiota at lean and obese individuals. The consumption of probiotics and prebiotics may balance the microbiota with positive effects in obesity. The main aim of this review is to reveal the interaction between dysbiosis and obesity.
Auto-immune rheumatic diseases are characterised by high levels of inflammation that accelerate the development of atherosclerosis, increasing the cardiovascular risk. Direct evaluation of arteries such as of intima media thickness measurement is a simple test that asesses the cerebral and cardiovascular risk. In the initial stages, an increase of the intimal media thickness can be observed. Later on, atherosclerosis (plaques), stenosis and occlusion of the arteries can be identified. Indirect evaluation of the cardiovascular risk can be performed using serological markers - fibrinogen, C reactive protein, estimated sedimentation rate, total cholesterol, low density lipoproteins and high density lipoproteins, homocysteine levels etc. The presence of certain lifestyle factors that increase the risk, such as smoking, sedentarism and associated pathologies such as obesity, diabetes, hypertension were assesed in patients with rheumatoid arthritis. The aim of the study is to prove the relationship between anti-tumor necrosis factor alpha therapy effect on the cardiovascular risk in rheumatoid arthritis patients.
Multiple sclerosis is a chronic autoimmune disease, characterized by the appearance of demyelinating lesions with inflammatory character in the CNS. Given the unpredictable evolution of the disease, numerous attempts have been initiated to find some pathogenic factors and by default targeted treatment methods. The intestinal microbiota of these patients is often significantly altered compared to the healthy population and given the complex connections between the intestine and the central nervous system, the idea of causality between dysbiosis and this condition was launched. The intestinal mucosa represents the interface between the external environment and the organism, so that it is considered the starting point of some local immunological processes but with systemic resonance, especially neurological. The classic medication scheme widely used to treat MS nowadays can also affect the integrity of the intestinal mucosa by breaking the fine balance at this level. Data from recent studies around the subject open new treatment opportunities around preserving the intestinal microbiota and strategies like vitamin A intake and fat-soluble vitamin D supplementation, probiotic complexes or faecalis microbiota transplantation appear more promising and easier to apply in daily clinical practice.
Objective: Cerebrovascular Accidents (CVAs) represent the second most prominent cause of death globally, surpassed only by ischemic heart diseases, thus constituting a significant economic burden for healthcare systems. Despite this, little is known about the correlation between the different times of the year and intracerebral hemorrhages. This review investigates said link, as well as seek to identify whether vascular risk factors (i.e. diabetes and high blood pressure) vary through seasons. Method: This paper undertakes the study of 97 patients, all of whom have suffered a hemorrhagic CVA and were hospitalized and treated within the Central Military Emergency University Hospital’s Department of Neurology in Bucharest, in the period between 29th of June, 2017 and 29th of July, 2019. The scope of this study is to optimize prophylaxis within the groups most susceptible to the imminent danger of an intracranial hemorrhage during a certain season. Results: Our study has shown that the season with the highest values of morbidity and mortality is autumn, followed closely by spring. Conclusion: Given the set of yielded data, which is mirrored in the case of risk factors, we conclude that the results vary slightly from those put forward in the literature. Therefore, whilst hemorrhaging CVAs have a consequential impact upon society, both through the disastrous effects of the incident per se, and its disabling nature in the long-term, a positive percentage of them could be avoided by changing one’s behavior during the high-risk periods.
Background: Late-delayed complications after radiotherapy (RT) results from an imbalance between cell lesions and the protective capacities of the CNS. Temozolomide (TMZ) after RT may represent a potent radiosensitizing regimen. Although radionecrosis (RN) of the anterior visual pathway has been documented, in our opinion this is the first report of reversible visual field loss associated with occipital lobe radionecrosis. Case observation: We report a patient who suffered a left lateral homonymous hemianopia one year after radiochemotherapy (RCT) for an infiltrative low grade fibrillary astrocytoma. The visual field deficit was completely reversible after one month. Visual field defects have been described after the use of conventional external beam therapy for lesions near the anterior visual pathway. The cortex is relatively spared after RT. Conclusions: Given the new scientific data, we suppose that neuroplasticity may play a role in the reversibility of visual field deficit. At this time there is no proven treatment of radionecrosis. Homonymous hemianopia caused by occipital lesions are attributable to vascular disease and tumors, but take into account radiation effects. The risk of neurogenic visual loss must be factored into the decision to irradiate the whole brain.
Epilepsy is one of the world's oldest diseases. Social stigma, misunderstanding and thus, discrimination have surrounded patients and their families from the beginnings until nowadays. Approximatively up to 80% of epilepsy cases worldwide are found in developing regions. The risk of premature death is two to three times higher than for the general population. There is contradictory evidences concerning the question of whether to inform patients about the possibility of sudden unexpected death in epilepsy (SUDEP). Actual guidelines states that individuals with epilepsy and their families or careers should be given access to information on SUDEP. We have information about how, when and what to say to the patients and families about SUDEP. But it's a delicate subject, and some patients do not want to know that they are at risk for this.
A male from rural area, S.M., aged 77 years, was admitted in our department for discontinuous headache. His medical history was irrelevant. He has been experiencing intermittent right parietal-occipital headaches during the last 3 months. Neurologic exam revealed a slight right limb ataxia. Initial laboratory findings revealed a white blood cell count of 6500/mm3 with 75% polymorphonuclear leukocytes, 15% lymphocytes and 8% monocytes. His serum glucose was 90 mg/dL. Non Gadolinium CT scan shows rounded, inhomogenous spontaneous hyperdense area (40-45 UH) between 5-12 mm diameter, localized frontal, temporal, occipital and cerebellar bilaterally. The question was whether the lesions were metastasis or parasitic infection? Cerebral MRI showed unenhanced,well lesions defined,multiple lesions between3-17 mm, with iso- • Active parenchymal stage: the scolex within acyst hyperintensityT1, T2, and FLAIR, spreadout may appear as a hyperdense dot periventriculary, subcortically, infrontal, temporal, • Calcified stage: when the parasite dies, parietal lobes andsubtentorially, right and left nodularparenchymal calcifications are seen. cerebellum(figure 2). After serological testsfrom blood and CSF the diagnosticof neurocysticercosis was certified(an enzyme-linked immunosorbentassay of the CSF was positivefor immunoglobulin G cysticercosisantibody, with 1.32 optical densityunits (OD) (positive result > 0.50OD); his serum IgG cysticercosis antibodywas positive with 5.12 OD). CT findings are depending on the stageof evolution: • Vesicular stage (viable larva): hypodense, nonenhancinglesions • Colloidal stage (larval degeneration): hypodense/isodense lesions with peripheral enhancementand edema • Nodular-granular stage: nodular-enhancinglesions • Cysticercotic encephalitis: diffuse edema,collapsed ventricles, and multiple enhancingparenchymal Our patient has multiple lesions in differentphases of evolution (active and calcified). DISCUSSIONS Neurocysticercosis is a parasitic brain infection,caused by larval cysts of the tapeworm Taenia soliumby accidental ingestion of eggs. It is the most common parasitic disease of the nervous system and it is themain cause of acquired epilepsy mainly in developingcountries. Once in the human intestine, Taenia eggsevolve to oncospheres 1 Carol Davila Central Emergency Military Hospital, Bucharest 2 Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest 40
