Clinical Reasoning: A dizzy architect.

There is an increasing body of evidence describing an association between anti Kelch-like protein 11 (KLHL11) encephalitis and various tumors such as seminoma. However, when the diagnosis of neoplasia is uncertain and the clinical syndrome resembles those caused by other etiologies, the possibility of anti-KLHL11 encephalitis may not be obvious during early clinical evaluations. We present the case of a 68-year-old man with clinical features of anti-KLHL11 encephalitis, in whom no clear signs of an active neoplasia could be found. However, a burnt-out germ-cell tumor was suspected. This case highlights the importance of having a high clinical suspicion for anti-KLHL11 encephalitis in patients who exhibit symptoms and signs, even in absence of an active tumor

Migraine Aura-Catch Me If You Can with EEG and MRI-A Narrative Review.

Roughly one-third of migraine patients suffer from migraine with aura, characterized by transient focal neurological symptoms or signs such as visual disturbance, sensory abnormalities, speech problems, or paresis in association with the headache attack. Migraine with aura is associated with an increased risk for stroke, epilepsy, and with anxiety disorder. Diagnosis of migraine with aura sometimes requires exclusion of secondary causes if neurological deficits present for the first time or are atypical. It was the aim of this review to summarize EEG an MRI findings during migraine aura in the context of pathophysiological concepts. This is a narrative review based on a systematic literature search. During visual auras, EEG showed no consistent abnormalities related to aura, although transient focal slowing in occipital regions has been observed in quantitative studies. In contrast, in familial hemiplegic migraine (FHM) and migraine with brain stem aura, significant EEG abnormalities have been described consistently, including slowing over the affected hemisphere or bilaterally or suppression of EEG activity. Epileptiform potentials in FHM are most likely attributable to associated epilepsy. The initial perfusion change during migraine aura is probably a short lasting hyperperfusion. Subsequently, perfusion MRI has consistently demonstrated cerebral hypoperfusion usually not restricted to one vascular territory, sometimes associated with vasoconstriction of peripheral arteries, particularly in pediatric patients, and rebound hyperperfusion in later phases. An emerging potential MRI signature of migraine aura is the appearance of dilated veins in susceptibility-weighted imaging, which may point towards the cortical regions related to aura symptoms ("index vein"). Conclusions: Cortical spreading depression (CSD) cannot be directly visualized but there are probable consequences thereof that can be captured Non-invasive detection of CSD is probably very challenging in migraine. Future perspectives will be elaborated based on the studies summarized

Cerebral Venous Sinus Thrombosis Associated with Vaccine-Induced Thrombotic Thrombocytopenia—A Narrative Review

In March 2021, cerebral venous sinus thrombosis and thrombocytopenia after vaccination with adenovirus-based vaccine against SARS-CoV-2 were first reported. The underlining condition has been termed vaccine-induced immune thrombocytopenia (VITT). Anti-platelet factor 4 antibodies have been proposed as a central component of the pathomechanism. Treatment recommendations entailed immunomodulation with intravenous immunoglobulins, avoidance of heparins and avoidance of platelet transfusions. Although mortality from VITT-associated cerebral venous sinus thrombosis has decreased over time, it remains high. The aim of this narrative review is to describe different aspects of this disease according to the current state of knowledge

Instrumental investigations in urethral stricture

Secţia Urologie IMSP Spitalul Clinic Republican, Secţia Imagistică IMSP Spitalul Clinic Republican, Catedra Urologie şi Nefrologie Chirurgicală, USMF „N. Testemiţanu”, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Summary. Contemporary imaging methods help to localize, to determine the severity and the length of urethral stricture. The precise information of these parameters contribute significantly to the treatment method selection assuring its optimal results. Such methods as intravenous urography, kidney and urine bladder echography, dynamic renal scintigraphy and radioisotope-based renography are necessary for exclusion or confirmation of the eventual urological complications of urethral stricture

Natural course of visual snow syndrome: a long-term follow-up study.

Visual snow syndrome is characterized by a continuous visual disturbance resembling a badly tuned analogue television and additional visual and non-visual symptoms causing significant disability. The natural course of visual snow syndrome has not hitherto been studied. In this prospective longitudinal study, 78 patients with the diagnosis of visual snow syndrome made in 2011 were re-contacted in 2019 to assess symptom evolution using a semi-structured questionnaire. Forty patients (51% of 78) were interviewed after 84 ± 5 months (mean ± SD). In all patients, symptoms had persisted. Visual snow itself was less frequently rated as the most disturbing symptom (72 versus 42%, P = 0.007), whereas a higher proportion of patients suffered primarily from entopic phenomena (2 versus 17%, P = 0.024). New treatment was commenced in 14 (35%) patients, of whom in seven, visual snow syndrome was ameliorated somewhat. Three (7%) experienced new visual migraine aura without headache, and one (2%) had new migraine headache. There were no differences in the levels of anxiety and depression measured by the Patient Health Questionnaire 8 and the Generalized Anxiety Disorder Scale 7. Thirty-eight patients (49%) were lost to follow-up. In visual snow syndrome, symptoms can persist over 8 years without spontaneous resolution, although visual snow itself might become less bothersome

Modern approaches to the diagnosis of urethral strictures

Secţia Urologie IMSP Spitalul Clinic Republican, Catedra Urologie şi Nefrologie Chirurgicală, USMF „N. Testemiţanu”, Secţia Imagistică IMSP Spitalul Clinic Republican, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Summary. It is well known that the clinical presentation of urethral stricture is not specific, therefore it is mainly diagnosed through various diagnostic modalities. Conventional urethrography remains the basic diagnostic method in the urethral strictures evaluation, even if sonourethrography, magnetic resonance investigation and multislice computed tomography have higher sensibility and specifity. The preferable implementation of urethrography can be explained through relatively lower costs as well as wider accessibility of urethrography from technical point of view

Cardiologic aspects of erectile dysfunction

Secţia Urologie IMSP Spitalul Clinic Republican, Catedra Urologie şi Nefrologie Chirurgicală, USMF „N.Testemiţanu”, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Summary. We have presented in this article the issues of the erectile dysfunction (ED) in the patients with cardiovascular pathologies. The erectile dysfunction (ED) can hide severe coronary affections, present even in men who don’t belong to the risk groups of cardiovascular diseases – the smokers, the obese people and the diabetic people. The erectile dysfunction (ED) is the most frequent pathology that affects the sexual life of millions of men in the whole world regardless their age, race, religion and social status. The fact that the erectile dysfunction quite often serves as the first manifestation of the cardiovascular pathology is demonstrated, and it must be included in the list of risk factors for cardiac diseases ; the use of the cardiovascular preparations allow improving considerably the life quality of the patients suffering from the erectile dysfunction

The role of uroflowmetry in dinamic complex evaluation of urethral strictures

Secţia Urologie IMSP Spitalul Clinic Republican, Catedra Urologie şi Nefrologie Chirurgicală, USMF „N. Testemiţanu”, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Summary. Uroflowmetric examination during the early postoperative period (at 1-3 months distance after the surgical intervention) has an important prognostic role in patients with urethral strictures. Therefore, uroflowmetry presents as an important diagnostic modality that provides important prognostic information in patients with operated urethral strictures. This investigation also carries importance for the objectification of patients’ complaints, taking into consideration often lack of correlation between the latter and the stricture’s severity

The efficacy of Lithoren for the treatment of urolithiasis

Catedra de urologie şi nefrologie chirurgicală USMF „Nicolae Testemițanu”, Chișinău, Republica Moldova, Al VII-lea Congres de Urologie, Dializă și Transplant Renal din Republica Moldova cu participare internațională 19-21 iunie 2019Litiaza urinară este o problemă importantă de sănătate la nivel mondial, cu o prevalenţă a populaţiei generale estimată la 2-3% şi o rată de recurență în decursul vieții de aproximativ 70%. În Republica Moldova, de această boală suferă aproximativ 10% din toată populația. Cercetările științiice și practicile în domeniul urologiei se concentrează pe procesul de diagnostic și tratament al litizei reno-ureterale. Luând în considerare recurența înalta a patologiei, pacienții care suferă de această maladie au nevoie de un tratament suicient atât pentru proilaxie, cât și pentru metailaxie pe un termen lung.Urinary lithiasis is a major global health problem with a prevalence of 2-3% in general population and a lifetime recurrence rate of about 50%. In the Republic of Moldova, 10% of the whole population sufer from this desease. Scientiic and practical research in urology focuses on the diagnosis and treatment of kidney lithiasis. Taking into account the high recurrence rate of urolithiasis, patients sufering from this disease need adequate and long-term metaphylactic treatment

Strictura uretrei la bărbați: protocol clinic naţional PCN-390

Acest protocol a fost elaborat de grupul de lucru al Ministerului Sănătăţii, Muncii și Protecției Sociale al Republicii Moldova (MSMPS RM). Protocolul naţional este elaborat în conformitate cu sursele ştiinţifice contemporane privind conduita stricturilor uretrale la bărbați. Recomandările expuse corespund principiilor medicinii bazate pe dovezi şi va servi drept bază pentru elaborarea protocoalelor instituţionale. La recomandarea MSMPS RM, pentru monitorizarea protocoalelor instituţionale pot fi folosite formulare suplimentare, care nu sunt incluse in protocolul clinic national