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Renna R.,Catholic University | Pilato F.,Catholic University | Profice P.,Catholic University | Della Marca G.,Catholic University | And 7 more authors.
Journal of Stroke and Cerebrovascular Diseases

Background Approximately 10%-14% of ischemic strokes occur in young adults. Aims To investigate risk factors and etiologies of strokes of young adults admitted to the "stroke unit" of Policlinico "Gemelli" of Rome from December 2005 to January 2013. Methods In all, 150 consecutive patients younger than 50 years diagnosed with ischemic stroke were enrolled. Clinical evaluation consisted of a complete neurologic examination and the National Institutes of Health Stroke Scale. Diagnostic workup consisted of anamnesis, extensive laboratory, radiologic, and cardiologic examination. Stroke etiologies were classified according to the Trial of Org 10172 in Acute Stroke Treatment. Results Patients' mean age was 41 ± 8.0 years. The most common risk factors were dyslipidemia (52.7%), smoking (47.3%), hypertension (39.3%), and patent foramen ovale (PFO, 32.8%). Large-artery atherosclerosis was diagnosed as the cause of stroke in 17 patients (11.3%). Cardioembolism was presumed in 36 patients (24%), most of them presented a PFO at transesophageal echocardiography. Small-vessel occlusion was diagnosed in 12 patients (8%); all of them were hypertensive and most of them presented additional risk factors. Forty-one patients (27.3%) presented a stroke of other determined etiology and 44 (29.3%) presented a stroke of undetermined etiology. The 3-year survival was 96.8% and recurrent strokes occurred in only 3 cases. Conclusions Traditional vascular risk factors are also very common in young adults with ischemic stroke, but such factors increase the susceptibility to stroke dependent to other causes as atherosclerosis and small-artery occlusion represent less than 20% of cases. Prognosis quoadvitam is good, being characterized by low mortality and recurrence rate. © 2014 by National Stroke Association. Source

Marano M.,Biomedical University of Rome | Quattrocchi C.,Biomedical University of Rome | Annibali O.,Biomedical University of Rome | Avvisati G.,Biomedical University of Rome | And 2 more authors.
Journal of Stroke and Cerebrovascular Diseases

Cerebrovascular events are very common in sickle cell disease (SCD), and multiple mechanisms are probably involved in their pathophysiology. We report a 30-yearold woman who presented a large volume silent stroke followed 2 months later by a second large volume stroke that manifested only with transient arm weakness. In the acute phase, magnetic resonance angiography revealed a segmental stenosis of the 2 different large intracranial vessels supplying the stroke territories. Partial regression of vascular stenosis was revealed by a follow-up magnetic resonance imaging. Present case suggests that stenosis of large intracranial vessels, possibly related to vascular injury promoted by the endothelial adhesion of reticulocytes and inflammatory elements, is involved in large volume brain infarcts in SCD. © 2014 by National Stroke Association. Source

Luigetti M.,Catholic University of the Sacred Heart | Vollaro S.,Biomedical University of Rome | Corbetto M.,Biomedical University of Rome | Salomone G.,Biomedical University of Rome | And 4 more authors.
Acta Neurologica Belgica

Lyme disease is a diffuse zoonosis caused by spirochaetes of the Borrelia burgdorferi species complex. Neurological manifestations of the disease, involving central or peripheral nervous system, are common. This study describes four consecutive patients with an MRI-proven lumbosacral spondylosis, who complained of progressive worsening of symptoms in the last months in which serological evaluation suggested a superimposed B. Burgdorferi infection. Four patients, all from the Lazio region, were admitted to the Department of Neurology. Extensive laboratory studies and clinical, anamnestic and neurophysiological evaluation were performed in all cases. In all cases, anamnesis revealed a previous diagnosis of lumbosacral foraminal stenosis. Clinical and neurophysiological findings were consistent with a lumbosacral multiradiculopathy. Considering serological evaluation suggestive of a superimposed B. burgdorferi infection a proper antibiotic therapy was started. All cases showed a marked improvement of symptoms. Clinicians should be aware that in all cases of lumbosacral multiradiculopathy, even if a mechanical cause is documented, B. burgdorferi may be a simply treatable condition. © 2014, Belgian Neurological Society. Source

Di Lazzaro V.,Biomedical University of Rome | Di Lazzaro V.,Research Institute for Ageing | Rothwell J.C.,University College London
Journal of Physiology

A number of methods have been developed recently that stimulate the human brain non-invasively through the intact scalp. The most common are transcranial magnetic stimulation (TMS), transcranial electric stimulation (TES) and transcranial direct current stimulation (TDCS). They are widely used to probe function and connectivity of brain areas as well as therapeutically in a variety of conditions such as depression or stroke. They are much less focal than conventional invasive methods which use small electrodes placed on or in the brain and are often thought to activate all classes of neurones in the stimulated area. However, this is not true. A large body of evidence from experiments on the motor cortex shows that non-invasive methods of brain stimulation can be surprisingly selective and that adjusting the intensity and direction of stimulation can activate different classes of inhibitory and excitatory inputs to the corticospinal output cells. Here we review data that have elucidated the action of TMS and TES, concentrating mainly on the most direct evidence available from spinal epidural recordings of the descending corticospinal volleys. The results show that it is potentially possible to test and condition specific neural circuits in motor cortex that could be affected differentially by disease, or be used in different forms of natural behaviour. However, there is substantial interindividual variability in the specificity of these protocols. Perhaps in the future it will be possible, with the advances currently being made to model the electrical fields induced in individual brains, to develop forms of stimulation that can reliably target more specific populations of neurones, and open up the internal circuitry of the motor cortex for study in behaving humans. © 2014 The Authors. Source

Capone F.,Biomedical University of Rome | Capone F.,Research Institute for Ageing | Profice P.,University Cattolica | Pilato F.,University Cattolica | And 4 more authors.
Spine Journal

Background context Low back pain (LBP) is a very common complaint in pregnancy. For this reason, it is often considered directly attributable to the pregnancy rather than a medical problem requiring diagnostic workup. Pregnancy-related LBP should be differentiated from the rare cases of LBP associated with serious spinal diseases. Hemangioblastoma is a vascular tumor of the central nervous system that very rarely can involve the spinal cord. Pregnancy can increase the growth of hemangioblastomas, leading to the appearance of neurologic symptoms. Purpose To describe an unusual cause of LBP in pregnancy. Study design A case report. Methods A 38-year-old woman, with a history of surgical resection of a cerebellar hemangioblastoma at the age of 15 years, presented at 38 weeks of gestation with worsening LBP and numbness of the lower limbs. Diagnostic workup led to a diagnosis of spinal hemangioblastoma. The tumor was removed after cesarean section in the 39th week of gestation. Results The detection of spinal hemangioblastoma resulted in a good outcome for both mother and infant. Conclusions This case emphasizes the main role of clinical evaluation in establishing the diagnostic workup, especially in pregnancy. Although LBP is commonly reported, this patient's medical history and the presence of clinical signs on neurologic examination suggested the need for further investigation. Source

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