Background: Spontaneous cervicocephalic artery dissection (sCAD) of more than two cervical arteries is rare.

Failing cerebral blood flow (CBF) autoregulation may contribute to cerebral damage after traumatic brain injury (TBI). The purpose of this study was to describe the time course of CO(2)-dependent vasoreactivity, measured as CBF velocity in response to hyperventilation (vasomotor reactivity [VMR] index). We included 13 patients who had had severe TBI, 8 of whom received norepinephrine (NE) based on clinical indication. In these patients, measurements were also performed after dobutamine administration, with a goal of increasing cardiac output by 30%. Blood flow velocity was measured with transcranial Doppler ultrasound in both hemispheres. All patients except one had an abnormal VMR index in at least one hemisphere within the first 24 h after TBI. In those patients who did not receive catecholamines, mean VMR index recovered within the first 48 to 72 h. In contrast, in patients who received NE within the first 48 h period, VMR index did not recover on the second day. Cardiac output and mean CBF velocity increased significantly during dobutamine administration, but VMR index did not change significantly. In conclusion, CO(2) vasomotor reactivity was abnormal in the first 24 h after TBI in most of the patients, but recovered within 48 h in those patients who did not receive NE, in contrast to those eventually receiving the drug. Addition of dobutamine to NE had variable but overall insignificant effects on CO(2) vasomotor reactivity.

Following the creation of the first university chair for neurology (Zurich 1894), the Swiss Neurological Society (SNG) was founded in 1908.. In 1932, neurology was recognized in Switzerland as an independent specialty and included in the medical (undergraduate) curriculum. The postgraduate training (residency program) in neurology lasted first 4 years (including 1 year of internal medicine, 0.5 years of psychiatry and 2.5 years of clinical neurology as mandatory rotations). In 1985, it grew to 5 years, and in 1996 to 6 years (including 1 year of internal medicine, 3 years of clinical neurology, and 1 year of clinical neurophysiology). Considering the results of a survey among young neurologists and "landscape changes" such as the increasing subspecialization, economic pressure, requirements for research, number of foreign doctors, and restrictions of working hours, the SNG undertook a revision which was approved in 2016. Today, the Swiss neurology postgraduate training includes 1 year of internal medicine, a "common trunk" of 3 years of general neurology (with 1 year of clinical neurophysiology including sleep), and 2 years of "fellowships" with rotations in different subspecialties and up to 12 months of research.

Background Intracranial stenoses can cause TIA/ischaemic stroke. The purpose of this study was to assess vascular risk factors, clinical and imaging findings and outcome in Caucasians with intracranial stenosis under best prevention management. Methods In this prospective observational study (from 05/2012, to last follow-up 06/2017) we compared vascular risk factors, imaging findings and long-term outcome in Swiss patients with symptomatic versus asymptomatic intracranial atherosclerotic stenoses on best prevention management. Results 62 patients were included [35.5% women, median age 68.3 years], 33 (53.2%) with symptomatic intracranial stenoses.Vascular risk factors (p = 0.635) and frequency of anterior circulation stenoses (66.7% vs. 55.2%; p = 0.354) did not differ between symptomatic and asymptomatic patients, but CT/MR-perfusion deficits in the territory of the stenosis (81.8% vs. 51.7%; p = 0.011) were more common in symptomatic patients. Outcome in symptomatic and asymptomatic patients at last follow-up was similar (mRS 0-1:66.7% vs. 75%; adj p = 0.937, mRS adj p-shift = 0.354, survival:100% vs. 96.4%; adj p = 0.979). However, during 59,417 patient follow-up days, symptomatic patients experienced more cerebrovascular events (ischaemic stroke or TIA) [37.5% vs. 7.1%; adj HR 7.58; adj p = 0.012], mainly in the territory of the stenosis [31.3% vs. 3.6%; adj HR 12.69; adj p = 0.019], more vascular events (i.e. ischaemic stroke/TIA/TNA and acute coronary/peripheral vascular events) [62.5% vs. 14.3%; adj HR 6.37; adj p = 0.001]) and more multiple vascular events (p-trend = 0.006; ≥ 2:37.5% vs. 10.7%; adj OR 5.37; adj p = 0.022) than asymptomatic patients. Conclusions Despite best prevention management, one in three patients with a symptomatic intracranial stenosis suffered a cerebrovascular event, three in five a vascular event and two in five ≥ 2 vascular events. There is an unmet need for more rigorous and effective preventive strategies in patients with symptomatic intracranial stenoses.