Subjects and Methods. We analysed 5000 cerebrovascular ultrasound records. A total of 0.4% of the patients had common carotid artery occlusion (CCAO). Results. The mean age was 59.8 ± 14.2 years, and the male/female ratio was 2.33. The most frequent risk factors were hypertension, ischaemic heart disease, dyslipidemia, diabetes mellitus, and smoking. Right-sided and left-sided CCAO occurred in 65% and 30% of the cases, respectively, and bilateral occlusion was detected in one case (5%). Patent bifurcation was observed in 10 cases of CCAO in which the anterograde flow in the ICA was maintained from the external carotid artery with reversed flow. In two of the cases, the occluded CCA was hypoplastic. The aetiology of CCAO in the majority of cases was the atherosclerosis (15 cases). The male/female ratio was higher in the patients with occluded distal vessels, and the short-term outcome was poorer. Only two cases from this series underwent revascularisation surgery. Spontaneous recanalisation was observed in one case. Conclusions. The most frequent cause of CCAO was atherosclerosis. The outcome is improved in the cases with patent distal vessels, and spontaneous recanalisation is possible. Treatment methods have not been standardised. Surgical revascularisation is possible in cases of patent distal vessels, but the indications are debatable.

Interferon-β was the first disease-modifying therapy used for recurrent-remissive multiple sclerosis, with an intricate mechanism of action. The objectives of the current study were identifying the cytokine profile in recurrent-remissive multiple sclerosis serum samples, both naïve and after one year of Interferon-β1a treatment, in order to study the mechanism of action. 37 recurrent-remissive multiple sclerosis patients and 37 healthy subjects were included. Serum levels of 15 cytokines were evaluated for the recurrent-remissive multiple sclerosis patients in the beginning of the study and after one year of treatment, respectively at the beginning for healthy subjects. The recurrent-remissive multiple sclerosis lot had at the beginning significantly higher levels of interleukin (IL)-10, IL-17F, IL-23, IL-31, sCD40L, TNF-α and "cytokine signature" compared to healthy controls. Treatment with Interferon-β1a significantly reduced the levels of IL-23, IL-31, sCD40L, tumour necrosis factor (TNF)-α and cytokine signature. IL-21 and TNF-α positively correlated with the activity of the disease (relapses, disability). The serum levels of the pro-inflammatory cytokines are higher in naïve recurrent-remissive multiple sclerosis patients compared to healthy controls. Treatment with Interferon-β significantly decreases the inflammatory profile. RezumatInterferonul β (Interferon-β), primul imunomodulator utilizat în tratamentul sclerozei multiple recurent remisive (SM-RR), prezintă un mecanism de acțiune intricat. Studiul își propune identificarea profilului de citokine în serul pacienților cu SM-RR naivi și după 1 an de tratament cu Interferon-β1a, în vederea aprofundării mecanismului de acțiune. Au fost incluși 37 pacienți cu SM-RR si 37 martori sănătoși. S-au determinat nivelurile serice a 15 citokine pentru lotul SM-RR la debutul și la finalul studiului, respectiv pentru martori la debutul studiului. Lotul SM-RR a avut la debut valori semnificativ mai mari ale interleukinei (IL)-10, IL-17F, IL-23, IL-31, sCD40L, factorului de necroză tumorală (TNF)α și "cytokine signature" comparativ cu subiecții sănătoși. Tratamentul a determinat scăderea semnificativă a valorilor serice ale IL-23, IL-31, sCD40L, TNFα și "cytokine signature". Nivelurile serice ale IL-21 si TNF-α s-au corelat pozitiv cu activitatea bolii (recurențe, dizabilitate). Tratamentul cu Interferon-β1a scăzut semnificativ acest profil proinflamator.

Vertebrobasilar dolichoectasia (VBD) is a rare condition characterized by a significant dilation, elongation and tortuosity of the arteries emerging from the vertebrobasilar system. In this study, we report a 57-year-old male, with medical history of recurrent migraines and right peroneal nerve palsy, which presents the sudden onset of clinical signs of brainstem and cerebellar stroke. The brain CT scan revealed an inhomogeneous, hyperdense prepontine lesion, situated in the area of basilar artery (BA) projection. The cerebral angiography showed in the V4 segment of the left vertebral artery (VA) a focal, concentric stenosis of 70%, followed by a fusiform dilation extended to the BA bifurcation, a saccular aneurysmal dilation in the communicant segment of the internal carotid artery and tortuous trajectory of the abdominal and thoracic aorta, including the supra-aortic vessels. The brain MRI revealed a bulbopontin and left cerebellum infarction. Patient developed at 48 hours after hospitalization livedo reticularis at the level of the right thoracic wall and thighs. The nerve conduction studies revealed mononeuritis multiplex. The vascular anomaly that was identified in the presented case respects the criteria for a VBD, however the involvement of the aorta with the presence of tortuosities, the simultaneous presence of the internal carotid artery aneurysm, together with the presence of the mononeuritis multiplex and the skin condition (livedo reticularis) suggest the possibility of coexistence of a systemic vasculitis, possible polyarteritis nodosa.

Introduction. Creutzfeldt-Jakob Disease (CJD) is a very rare neurodegenerative disease with no cure that always leads to death. It is the most frequent prion disease and has multiple recognized forms, from which the sporadic form (sCJD) is the most common. The defining histological characteristic of CJD is the accumulation of the abnormal prion protein (PrPSc) along with neuronal loss and spongiform vacuolation. Typical neurological signs found in sCJD are rapidly progressive dementia, myoclonus, visual disturbances, pyramidal signs, extrapyramidal signs, behavioral changes and akinetic mutism. Material and method. We performed a retrospective study over the 2007-2017 period that included five cases of patients diagnosed with probable sCJD from our department. Results. The most common findings in the patients’ MRI were cerebral atrophy and ventricular enlargement, but we also found typical MRI changes such as increased T2 and FLAIR signal intensity in the head of the caudate nucleus, putamen and cerebral cortex. Repeated electroencephalograms showed typical sCJD patterns like periodic sharp wave complexes, mostly with biphasic or triphasic aspect. A complex differential diagnosis and numerous routine investigations (CBC, biochemical analysis, autoimmune panel, HIV antibodies, VDRL, anti-Borrelia antibodies, anti-TPO antibodies, anti-neuronal antibodies, B12 vitamin) were performed, without indicating an alternative diagnosis. All the patients died several months after the onset of symptoms. Conclusions. Given the rarity of the disease and the broad differential diagnosis, CJD proves to be a diagnostic challenge. In the absence of an alternative diagnosis, the association of rapidly progressive dementia, myoclonus, visual and cerebellar signs are highly suggestive for sCJD.

No abstract