Basal cerebral computed tomography as diagnostic tool to improve patient selection in asymptomatic carotid artery stenosis

One-hundred patients were included to evaluate the role of cerebral computed tomography (CT) to improve patient selection in asymptomatic internal carotid stenosis. Symptomatic patients were assigned to group A, asymptomatic patients to group B. A cerebral CT pattern A was observed in groups A and B in 60% and 20%, respectively (P < .0001). Between A and B groups, type 6 plaques were found, respectively, in 26.7% and 7.5% of patients (P = .01); a type 5 in 51.7% and 45% (P = .32) of patients; and a type 4 in 21.7% and 47.5% of patients, respectively (P = .006). Within B group, the association of CT pattern A and histological plaque level 4, 5, and 6 was, respectively, 25% (P = .15), 50% (P = .53), and 25% (P = .16). In group B, a 7-fold risk increase in CT pattern A was found in patients with level 6 plaque. In asymptomatic patients with high-risk plaque, a basal cerebral CT scan can be used as diagnostic tool to improve patient selection for intervention.     

Multifocal nivolumab immune-related adverse effects during asymptomatic SARS-CoV-2 infection: causality or casuality?

Neurological Sciences -     

Epilepsia partialis continua following a Western variant tick-borne encephalitis

Epilepsia partialis continua (EPC) is a rare entity, first described in 1894 by Ko?evnikov, as a variant of simple focal motor status epilepticus. EPC is most frequently characterized by motor symptoms, but as recently described, non-motor manifestations may occur, such as somatosensory symptoms or aura continua. EPC in adults has been attributed to various etiologies: infectious, vascular, neoplastic, and metabolic. According to the recent definition, we reported a case of EPC with behavioral symptoms, following a tick-borne encephalitis (TBE) contracted in an endemic area (North Eastern Italy). Patient’s symptom was a poorly localized “whole body sensation”, which is reported as a condition occurring only in frontal lobe epilepsy. Patient’s EEG showed a left frontal predominance of epileptiform discharges. Literature highlighted the importance of the Far-eastern TBE variant as a cause of EPC, since no Western variant TBE cases are reported. In contrast to what was claimed so far, our case demonstrates that not only the Far-eastern TBE variant, but also Western variant TBE is a cause of EPC. Prognosis of EPC depends largely on the underlying etiology, and it is frequently drug-resistant. Our patient was treated with intravenous levetiracetam, with a subsequent clinical recovery and a disappearance of epileptiform discharges. The rapid clinic and electroencephalographic response to levetiracetam confirm that it can be a promising therapeutic option for treatment of EPC.     

ASL MRI and 18F-FDG-PET in autoimmune limbic encephalitis: clues from two paradigmatic cases

Neurological Sciences - Autoimmune limbic encephalitis (LE) is a neurological condition characterized by seizures and cognitive dysfunction. Fluorine-18 fluorodeoxyglucose (18F-FDG-PET) has...     

Unveiling the relationship between autonomic involvement,fatigue, and cognitive dysfunction in early relapsing–remitting multiple sclerosis

Neurological Sciences - Fatigue is a common, yet disabling, symptom in patients with multiple sclerosis (PwMS). Fatigue has shown to be associated with self-reported autonomic nervous system (ANS)...     

Neurofilament light chain: a promising diagnostic biomarker for functional motor disorders

Journal of Neurology - Functional motor disorders (FMDs) are disabling neurological conditions characterized by abnormal movements which are inconsistent and incongruent with recognized...     

Late, giant brachial artery aneurysm following hemodialysis fistula ligation in a renal transplant patient: case report and literature review

Brachial artery aneurysm (BAA) following long-standing arteriovenous fistula ligation after renal transplantation is uncommon. Herein, we describe the case of a 64-year-old man who developed a giant symptomatic BAA 21?years after ligation of the fistula. He was submitted to surgical excision of the aneurysm followed by interposition prosthetic graft.     

Nabiximols and botulinum toxin injections for patients with multiple sclerosis: efficacy on spasticity and spasms in a single-centre experience

Neurological Sciences - Spasticity is a common and disabling symptom in patients with multiple sclerosis (PwMS): as highlighted by many epidemiological studies, it is often a severe and not well...     

Evidence of greater severity of diabetic foot ulcers during COVID-19 pandemic: A real-life single-centre cohort study

Aims

In the Sars-Cov-2 pandemic era, patients with diabetes mellitus (DM) manifested more severe forms of Sars-Cov-2 with greater mortality than non-diabetic patients. Several studies documented more aggressive forms of diabetic foot ulcers (DFU) during the pandemic period even though the results were not unanimously confirmed. The aim of this study was to evaluate the clinical-demographic differences between a cohort of Sicilian diabetic patients hospitalised for DFU in the pre-pandemic 3 years and a cohort of patients hospitalised in the pandemic 2 years.

Materials and Methods

One hundred and eleven patients from the pre-pandemic period 2017–2019 (Group A) and 86 patients from the pandemic period 2020–2021 (Group B) with DFU, admitted to the division of Endocrinology and Metabolism of the University Hospital of Palermo, were retrospectively evaluated. The clinical assessment of the type, staging and grading of the lesion, and the infective complication from DFU was performed.

Results

No differences in HbA1c values were observed between the two groups. Group B showed a significantly higher prevalence of male subjects (p = 0.010), neuro-ischaemic ulcers (p < 0.001), deep ulcers with involvement of bones (p < 0.001), white blood count levels (p < 0.001), and reactive C protein (p = 0.001) compared to group A.

Conclusions

Our data show that in the COVID-19 pandemic, a greater severity of ulcers requiring a significantly greater number of revascularisations and more expensive therapy, but without an increase in the amputation rate, was observed. These data provide novel information on the impact of the pandemic on diabetic foot ulcer risk and progression.