Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a neurovascular condition characterized by a severe sudden-onset headache that may be associated with focal neurological deficits. On imaging, the suggestive finding corresponds to multifocal vasoconstriction of the cerebral arteries, with a spontaneous resolution of approximately 12 weeks. The identification of precipitating factors and diagnosis must be carried out early, so that adequate management is established and the patient has a good prognosis, given the risk of secondary complications and residual neurological deficits. This study consists of a literature review based on the analysis of articles published between 2017 and 2022 in PubMed, SciELO, and ScienceDirect on RCVS, intending to understand the clinical and radiological characteristics, diagnosis, treatment, and prognosis of patients with RCVS. The pathophysiology, drug management, and prognosis still lack solid evidence; therefore, further studies on RCVS are needed to expand medical knowledge and avoid underdiagnosis and inadequate treatment of this important condition.
This critical review of the literature shows that there is a close link between the microbiome, the gut, and the brain in Parkinson’s disease. The vagus nerve, the main component of the parasympathetic nervous system, is involved in the regulation of immune response, digestion, heart rate, and control of mood. It can detect microbiota metabolites through its afferents, transferring this gut information to the central nervous system. Preclinical and clinical studies have shown the important role played by the gut microbiome and gut-related factors in disease development and progression, as well as treatment responses. These findings suggest that the gut microbiome may be a valuable target for new therapeutic strategies for Parkinson’s disease. More studies are needed to better understand the underlying biology and how this axis can be modulated for the patient’s benefit.
Background: stroke is a highly common neurologic disease, with great mortality and morbidity rates. It is a cerebrovascular condition characterized by a deficiency in the blood supply that should reach the nervous tissue. It can be classified into two types, depending on its etiology: ischemic and hemorrhagic stroke, the first one being the most common. The correct diagnosis of this condition is a challenge, especially in cases of confusing conditions, such as stroke mimics (SM). A highly detailed epidemiologic description and previous knowledge of the disease can help to recognize it. In cases of stroke, a quick revascularization treatment is necessary for a good clinical outcome, however, the inadvertent administration of thrombolytics to the patient with SM can cause hemorrhage and death, as well as unnecessary costs. The present study consisted in evaluating the patients admitted in the stroke unit of the Clinical Hospital Complex of the Federal University of Paraná in Brazil, between October 2012 and September 2013, and describing the prevalence, clinical presentation, etiology, and treatment outcomes in the SM cases primarily diagnosed as a stroke.
Results: 10 patients (7.1%) of the total number of patients with less than four hours of symptoms onset were considered SM and six were submitted to intravenous thrombolysis. The main clinical presentations were motor symptoms (90%) and dysarthria and sensitive symptoms (60%). Regarding the etiology of the patients with SM, six patients (60%) had functional disorders, one (10%) had Todd paresis, one (10%) exogenous intoxication, one (10%) diabetic ketoacidosis, and one (10%) presented with a clinically isolated syndrome.
Conclusions: our results showed that an important percentage of patients admitted to a stroke unit are SM and that a significant part of these SM is subjected to unnecessary thrombolytic procedures. Thus, further studies are necessary and important to develop well-defined guidelines that stratify the risk of SM and evaluate, based on the stratification, the risk-benefit of soliciting imaging methods that can help to distinguish between stroke and SM.
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