A multinodular and vacuolating neuronal tumor (MVNT) is a rare non-malign central nervous system tumor. The cerebral cortex of young to middle-aged adults is affected and seizures and focal neurological deficits could reveal it. Despite being considered a low-grade tumor, MVNT can be challenging to diagnose and manage due to its histopathological similarities to other neuronal tumors. The limited number of reported cases makes it difficult to establish definitive guidelines for treatment and follow-up. Given the relatively recent discovery of MVNT, there is a need for further research to better understand its pathogenesis, optimal treatment and long-term strategies. Furthermore, studying MVNT can contribute to the broader understanding of brain tumor biology and the intricacies of tumor heterogeneity. This paper explores the challenges and perspectives surrounding MVNT to improve clinical decision-making and patient outcomes. Based on the present narrative review, advancements in diagnostic technologies have shown promise in addressing the challenges associated with diagnosing MVNTs. Liquid biopsy is an innovative and non-invasive diagnostic tool that analyzes biomarkers to provide information about tumors, and radiomics is a method that extracts quantitative data from medical images to provide detailed insights into tumor characteristics. Such innovative diagnostic technologies are important because they have the potential to significantly improve the current diagnostic landscape for MVNTs, allowing for earlier detection, accurate classification, and personalized treatment strategies.
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.
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.
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.
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.
Normal pressure hydrocephalus (NPH) is a rare pathological condition that generally affects older people (>65 years old), and can take one of two forms: idiopathic or secondary. It is a reversible cause of dementia, and it manifests itself through a very specific triad: gait impairment, urinary incontinence, and dementia. The clinical diagnosis of NPH is particularly difficult to establish due to the association between these symptoms and old age, as well as due to the absence of specific paraclinical markers. Nevertheless, a holistic application of clinical, imagistic, paraclinical criteria, as well as of the various developed scales may, in time, lead to a diagnosis. Moreover, the evolution of magnetic resonance imaging has certainly made easier to establish the condition. The sole therapeutic method proven to be efficient is shunting surgery which has good results in the majority of the cases, showing clear signs of improvement from the very first-day post- surgery.
Many patients, usually over 60 years old, presenting presenile dementia associated with marked gait disorders, impaired balance, urinary incontinence, have been shown to have enlarged ventricles associated with relatively small cortical atrophy. Intracranial pressure monitoring indicates normal values, or subject to only minor peaks, usually at night. Because some of these patients improve markedly after ventricular shunting procedures it has been suggested that their neurological dysfunction may be caused by a pressure effect on the brain from the increased internal surface of the ventricles. Many of these patients do benefit from surgery, and a lot of them have a history of subarachnoid hemorrhage, traumatic brain injury or meningitis which might have impaired the CSF absorption.
