Weber syndrome – clinical-imaging correlations

An 89 years-old female patient was brought in by the family for altered mental status and left-sided motor deficit. Medical history revealed high blood pressure for which the patient was receiving anti-hypertensive treatment. Upon examination, the patient presented altered mental status, dysarthria, dysphagia, left central facial palsy, ataxic tetraparesis with marked paralysis on the left side, bilateral Babinski signs, right-sided ophthalmoplegia with limitation of gaze in all directions, left-sided skew deviation, limited abduction and upgaze movements of the left eye, and bilateral ptosis (complete on the right side and incomplete on the left side). The clinical picture was thus compatible with a vertebrobasilar stroke. A possible diagnosis of Weber syndrome was suggested, given the left-sided hemiparesis and right-sided ophtalmoplegia. Both head CT and brain MRI confirmed this by demonstrating a right-sided thalamo-mesencefalic subacute ischemic stroke. No cardio-embolic source was identified on cardiac assessment. Consequently, the patient was discharged with antiplatelet therapy, statin and anti-hypertensive treatment. We provide a short review on Weber syndrome, emphasizing the correlations between the clinical pictures and imaging findings

Mesenchymal stem cell-based therapy for ischemic stroke

Ischemic stroke represents a major, worldwide health burden with increasing incidence. Patients affected by ischemic strokes currently have few clinically approved treatment options available. Most currently approved treatments for ischemic stroke have narrow therapeutic windows, severely limiting the number of patients able to be treated. Mesenchymal stem cells represent a promising novel treatment for ischemic stroke. Numerous studies have demonstrated that mesenchymal stem cells functionally improve outcomes in rodent models of ischemic stroke. Recent studies have also shown that exosomes secreted by mesenchymal stem cells mediate much of this effect. In the present review, we summarize the current literature on the use of mesenchymal stem cells to treat ischemic stroke. Further studies investigating the mechanisms underlying mesenchymal stem cells tissue healing effects are warranted and would be of benefit to the field

The contribution of oligodendrocytes and oligodendrocyte progenitor cells to central nervous system repair in multiple sclerosis: perspectives for remyelination therapeutic strategies

Oligodencrocytes (OLs) are the main glial cells of the central nervous system involved in myelination of axons. In multiple sclerosis (MS), there is an imbalance between demyelination and remyelination processes, the last one performed by oligodendrocyte progenitor cells (OPCs) and OLs, resulting into a permanent demyelination, axonal damage and neuronal loss. In MS lesions, astrocytes and microglias play an important part in permeabilization of blood-brain barrier and initiation of OPCs proliferation. Migration and differentiation of OPCs are influenced by various factors and the process is finalized by insufficient acummulation of OLs into the MS lesion. In relation to all these processes, the author will discuss the potential targets for remyelination strategies

Neurological complications of hematopoietic cell transplantation in children and adults

Hematopoietic cell transplantation (HCT) is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen (HLA)-matched donor (allogeneic) or from the patient (autologous). Before HCT, the patient is prepared with high dose chemotherapy and/or radiotherapy to destroy residual malignant cells and to reduce immunologic resistance. After HCT, chemotherapy is used to prevent graft rejection and graft versus host disease (GvHD). Neurological complications are related to the type of HCT, underlying disease, toxicity of the conditioning regimens, immunosuppression caused by conditioning regimens, vascular complications generated by thrombocytopenia and/or coagulopathy, GvHD and inappropriate immune response. In this review, neurological complications are presented according to time of onset after HCT: (1) early complications (in the first month) - related to harvesting of stem cells, during conditioning (drug toxicity, posterior reversible encephalopathy syndrome), related to pancytopenia, (2) intermediate phase complications (second to sixth month) - central nervous system infections caused by prolonged neutropenia and progressive multifocal leukoencephalopathy due to JC virus, (3) late phase complications (after sixth month) - neurological complications of GvHD, second neoplasms and relapses of the original disease

From cirrhosis to paraparesis

We present the case of a 61-years-old male, diagnosed with liver cirrhosis, portal hypertension and type II diabetes mellitus, who developed bilateral signs of parkinsonism, intention tremor and spastic paraparesis. Based on laboratory workup, brain CT, brain MRI and thoraco-lumbar MRI, a diagnosis of acquired hepato-cerebral degeneration with hepatic paraparesis was established. Although a rare entity, hepatic paraparesis needs to be considered in the right setting. As a result, we describe its key features, as well as new concepts that have emerged in recent years using advanced imaging, with emphasis on pathogenesis

Impact of Infusion Therapies on Quality of Life in Advanced Parkinson’s Disease

Viorelia A Constantin,1,* József A Szász,1,2,* Adriana Octaviana Dulamea,3,4 Peter Valkovic,5 Jaime Kulisevsky6 1Second Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania; 2Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania; 3Neurology Clinic, Fundeni Clinical Institute, Bucharest, Romania; 4University of Medicine and Pharmacy “Carol Davila” Bucharest, Bucharest, Romania; 5Second Department of Neurology, Comenius University Faculty of Medicine and University Hospital Bratislava, Bratislava, Slovakia; 6Movement Disorders Unit at the Neurology Department of Sant Pau Hospital, Barcelona, Spain*These authors contributed equally to this workCorrespondence: Adriana Octaviana Dulamea, Tel +40212750500, Fax +40212750700, Email [email protected]: A high burden of motor and non-motor parkinsonian symptoms is known to have a significant negative impact on the quality of life (QoL) of people with Parkinson’s disease (PD). Effective control of these symptoms with therapies that enable patients to maintain a good QoL is therefore a key treatment goal in PD management. When symptom control can no longer be accomplished with oral or transdermal PD treatment regimens, device-aided therapies (DAT), namely levodopa and apomorphine infusion therapies, and deep brain stimulation, are valuable options to consider. DAT options may also help reduce pill burden and thereby improve compliance with treatment. Since PD therapy relies on symptomatic management, the efficacy and tolerability of any intervention is undoubtedly important, however the impact of different therapies on patient-related outcome measures, in particular health-related QoL, is also a critical consideration for those living with a chronic and disabling condition. This review discusses clinical evidence and ongoing research regarding the QoL benefits of levodopa and apomorphine infusion therapies from studies that have used validated QoL outcome measures. The data suggest that timing of these interventions is important to achieve optimal treatment effects, and that early initiation onto infusion therapies at the point when motor fluctuations emerge, and before patient QoL and functioning have significantly declined, may provide the best long-term outcomes. Healthcare professionals caring for people with PD should therefore discuss all available DAT options with them at an early stage in the course of their disease so they can make informed and timely choices that best suit them, their families and care network.Keywords: Parkinson’s disease, infusion therapies, motor symptoms, quality of life, patient-reported outcome