Cephalalgic syndrome in autosomal dominant cerebral arteriopathy with subcortical infarctions and leucoencephalopathy

Background: Autosomal Dominant Cerebral Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is caused by mutations in NOTCH3 gene, classic symptoms include migraine with aura, ischemic strokes, apathy, depression and dementia. Headache is usually the first symptom, characterized by recurrent attacks of migraine with typical, hemiplegic or prolonged aura with unusual frequency. Material and methods: All the data were picked from the patient’s medical recordings. The patient had undergone a complete clinical exam, a contrast enhanced MRI-scan and a genetic test. Then a literature review was done based on the peculiarities of the case. Results: A 43-year-old woman presented with pulsatile, alternating, severe headache, accompanied by phono, and photophobia, nausea and vomiting, with an onset at 35 years and a frequency of 12/30, triggered by menstruation and stress, preceded by a day by a visual aura lasting 5-6 minutes. Family history revealed cases of stroke and migraine. Neurologic examination was normal, but a contrast enhanced MRI showed diffuse polymorph confluent subcortical white matter lesions, involving external capsule and anterior poles of the temporal lobes. NOTCH3 gene sequencing revealed the presence of a heterozygote missense c.421C>T mutation, localized in the 4thexone. After establishing the diagnosis, the patient was prescribed a symptomatic treatment. Conclusions: Headache in CADASIL patients has well-defined diagnostic criteria in the International Classification of Headache Disorders, is being considered a secondary headache which may resemble or not migraine with aura. The patient presented a migraine-with-aura-like headache but with some peculiarities

Moldova’s Convergence with the Acquis - A Pro-Growth and Pro-Integration Strategy. CEPS Working Documents No. 238, 1 March 2006

The enlargement of the EU and the European Neighbourhood Policy (ENP) have revived the debate in the ‘neighbourhood countries’ around the need to converge legislation with EU internal rules and regulations, known as the acquis communautaire. The political incentive of accession to the EU, which has driven legal approximation in new EU member states, is missing for ENP countries. Yet, in the case of countries like Moldova, the cost of non-compliance is significant and translates into loss of existing export markets (e.g. in Romania) and the inability to expand into new markets (SEE countries and the EU). The situation is made still worse by a poor level of economic governance. As convergence with the acquis is a huge task, the key challenge for ENP countries is to determine the priorities, sequence and degree of legal approximation. This paper argues that the optimum degree and appropriate pace of convergence need to be driven by economic rationale and the development of the trade potential of the country. Thus, to secure benefits and avoid high costs for the economy, the legal approximation agenda will be moving along clearly identified economic integration scenarios, i.e. achieving a functioning market economy; taking full advantage of EU trade preferences (GSP and APTs), preparing for an FTA with the EU and, over a considerable number of years, gradually achieving a stake in the EU’s Internal Market

The Limits of the European Union’s Transformative Power: Pathologies of Europeanization and Rule of Law Reform in Central and Eastern Europe

This thesis examines the impact of the European Union (EU) on the development of the rule of law in Central and Eastern Europe. The topic is addressed through a mixed methods study which consists of a quantitative comparative analysis of three country groups from Central and Eastern Europe (1. Central Europe and the Baltics, CEB; 2. South Eastern Europe, SEE; 3. Commonwealth of Independent States, CIS) and three qualitative case studies on Poland, Romania and Moldova. The empirical analysis is based on an innovative set of indicators and revealing insights from numerous qualitative interviews. The findings of the study suggest that the impact of the EU is differential, both healthy and pathological. While EU-driven judicial reforms increase judicial capacity and align domestic legislation with European and international standards (substantive legality), they do not improve and even lead to a deterioration of judicial impartiality and formal legality, resulting in several reform pathologies, such as instable, incoherent and non-enforced laws and in more politicized and incoherent judicial systems, which undermine the development of the rule of law. These pathological effects occur mostly in weak rule of law countries from SEE (Romania) and CIS (Moldova), in contrast to more healthy effects in advanced, strong rule of law countries from CEB (Poland). The dissimilar development in the rule of law across countries is explained in relation to the conduct of reforms. Successful reformers like Poland, which consolidate the rule of law, have strong and independent horizontal accountability institutions (e.g. Constitutional Court, Ombudsman, judiciary), which mitigate or alleviate reform pathologies and ensure that reforms are conducted in an accountable, gradual and non-politicized way. Unsuccessful reformers, like Romania and Moldova, lack these independent checks on reformers and thus fail to establish the rule of law. Based on the findings from the case studies an original typology of healthy and pathological reform paths is proposed, which draws on the logic of circular and cumulative causation and emphasizes the mutual reinforcement between domestic conditions and the reform approach of transnational coalitions. The proposed typology implies that EU conditionality is not transformative, but rather reinforces existing healthy and pathological reform paths, thus cementing the existing divergence in the rule of law across post-communist countries. This thesis further makes several policy recommendations to remedy the pathological impact of donor-driven reforms