bluuebunny/crossref_metadata_2025 huggingface dataset:
How to activate intuitive and reflective thinking in behavior research? A comprehensive examination of experimental techniques
Authors: Isler Ozan , Yilmaz Onurcan
Published: October 2022

Experiments comparing intuitive and reflective decisions provide insights into the cognitive foundations of human behavior. However, the relative strengths and weaknesses of the frequently used experimental techniques for activating intuition and reflection remain unknown. In a large-scale preregistered online experiment (N = 3667), we compared the effects of eight reflection, six intuition, and two within-subjects manipulations on actual and self-reported measures of cognitive performance. Compared to the overall control, the long debiasing training was the most effective technique for increasing actual reflection scores, and the emotion induction was the most effective technique for increasing actual intuition scores. In contrast, the reason and the intuition recall, the reason induction, and the brief time delay conditions failed to achieve the intended effects. We recommend using the debiasing training, the decision justification, or the monetary incentives technique to activate reflection, and the emotion induction, the cognitive load, or the time pressure technique to activate intuition.
Effect of exercise on rehabilitation of breast cancer surgery patients: A systematic review and meta-analysis of randomized controlled trials
Authors:   Air Force Medicine University, Lin Yawei , Chen Yi , Liu Rongrong , Cao Baohua
Published: October 2022

Review question / Objective: Exercise after breast cancer surgery has proved beneficial to rehabilitation. We evaluate the best exercise for different post-surgery complications. Information sources: China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP China Science and Technology Journal Database, China Biology Medicine, EMBASE and PubMed databases were searched. Combinations of breast cancer (“breast tumor”,“breast carcinoma”,“mammary carcinoma”,“breast neoplasm”) and rehabilitation exercise (“exercise”,“physical therapy”) were employed when screening abstracts/keywords of articles. Two researchers independently searched, read the title and abstract of the literature, read the full text of the preliminary included literature, and extracted the data. In case of divergence, a third researcher was consulted.
Implementation of intervention programs specifically tailored for patients with CI in early rehabilitation during acute hospitalization: a scoping review protocol
Authors:   Agaplesion Bethanien Hospital Heidelberg, Hauer Klaus , Dutzi Ilona , Werner Christian , Bauer Jürgen M. , Ullrich Phoebe
Published: October 2022

Review question / Objective: What is the current status of implementation of interventional programs on early functional rehabilitation during acute, hospital-based medical care, specifically tailored for older patients with CI and what are the most appropriate programs or program components to support early rehab in this specific population? This study combines a systematic umbrella review with a scoping review. While an umbrella review synthesizes knowledge by summarizing existing review papers, a scoping review aims to provide an overview of an emerging area, extracting concepts and identify the gaps in knowledge. The study focuses on older hospitalized adults (>65 yrs.) receiving ward based early rehabilitation. The focus within this review is on study participants with cognitive impairment or dementia. The study targets at controlled trials independent of their randomization procedure reporting on an early functional rehabilitation during hospitalization. Trials that were conducted in different or mixed settings (e.g. inpatient and aftercare intervention) without a clear focus on hospital based rehabilitation were excluded. The study aim is to identify the presence of CI specific features for early rehabilitation including: CI/dementia assessment, sub-analysis of results according to cognitive status, sample description defined by cognitive impairment, program modules specific for geriatric patients CI.
EVALUASI PENGGUNAAN OBAT PADA PASIEN BEDAH DIGESTIF DI RUMAH SAKIT X DI YOGYAKARTA
Authors: Murdiana Happy Elda
Published: October 2022

Tindakan bedah digestif merupakan tindakan operasi yang memiliki resiko terjadinya infeksi luka operasi (ILO). Tingkat kematian yang berhubungan langsung dengan kejadian ILO di Rumah Sakit seluruh dunia lebih dari 50%. Pemberian antibiotik profilaksis pada pasien bedah yang secara klinis tidak menunjukkan tanda infeksi bertujuan mencegah terjadinya ILO. Tujuan penelitian ini adalah untuk melihat kerasionalan penggunaan antibiotika  profilaksis pre dan postoperasi serta obat penyerta. Penelitian ini merupakan penelitian cross sectional dengan pengambilan data secara retrospektif melalui rekam medis pasien bedah digestif pada bulan maret 2019 dengan data bulan Januari-Februari 2019. Teknik pengambilan data berupa total sampling dengan kriteria inklusi dan eksklusi. Analisa data dilakukan dengan mengevaluasi penggunaan antibiotik profilaksis pre dan post serta obat penyerta dengan   berpanduan pada SIGN 104, Antibiotic Prophylaxis in Surgery, WHO Guideline of Surgery, Drug Intraction Handbook, AHFS, Interactions Drug Handbook, Stockley’s Drug Interaction. Evaluasi penggunaan meiiputi jenis obat,, dosis, aturan pakai dan  rute pemberian. Hasil penelitian penggunaan antibiotik profilaksis rasional untuk jenis antibiotik dan rute pemberian cefuroksim, cefotaksim dan metronidazole tetapi tidak rasional untuk ceftriakson.  Pemberian antibiotik postoperasi rasional untuk jenis dan rute pemberian cefuroksim dan metronidazole tetapi tidak rasioanal untuk meropenem, ceftriakson dan ciprofloksasin. Pemberian analgetik rasional, pemberian ranitidine tidak tepat dosis. Potensial interaksi terjadi pada pemberian obat NSAID-NSAID, NSAID-ranitidin, dexketoprofen-antihipertensi, paracetamol-ranitidine, MST-paracetamol-dexketoprofen.
Three anti-correlated neuronal networks managing brain activity - Review
Authors:   Synergon Consulting, Bucharest, Romania, Cirneci Dragos
Published: October 2022

In order to understand how the brain operates we should take into account it’s component which consume most of the energy, which is spontaneous neuronal activity. Imaging techniques like resting state functional connectivity MRI and Independent Component Analysis technique arrived at the conclusion that there are a couple of neuronal networks activated in tasks implying goal-oriented activity, and include the systems named “dorsal and ventral attention networks”. These networks are anti-correlated with another network comprising regions which are deactivated during these tasks, and are involved in the self referential activity. The last ones are named Default network and it’s abnormalities are associated with depressive disorders, schizophrenia, Alzheimer disease and autism. Various studies revealed that the “attention networks” are responsive to specific cognitive trainings using working memory and inhibitory control tasks, both in children and adults, and can be used as an effective treatment for some mental disease or for optimizing healthy people mental performance.
Is nerve biopsy useful in diagnosis of CIDP?
Authors:   School of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Mindruta Ioana ,   Department of Neurology, University Hospital, Bucharest, Romania, Cobzaru Ana ,   Department of Neurology, University Hospital, Bucharest, Romania, Ene Amalia ,   Department of Neurology, University Hospital, Bucharest, Romania, Bajenaru Ovidiu ,   School of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,   Department of Neurology, University Hospital, Bucharest, Romania, Manole Emilia ,   Laboratory of Molecular Medicine, “Victor Babes” National Institute of Pathology, Bucharest, Romania, Popescu Bogdan O. ,   School of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,   Department of Neurology, University Hospital, Bucharest, Romania,   Laboratory of Molecular Medicine, “Victor Babes” National Institute of Pathology, Bucharest, Romania
Published: October 2022

Chronic inflammatory demyelinating polyradiculopathy is mainly based on clinical and electrophysiological criteria. If electrophysiological findings remain questionable for the diagnosis of CIDP and/or clinical presentation is atypical, nerve biopsy may assist the diagnosis. We present a case in which the nerve biopsy was helpful in diagnosis of CIDP and revealed the peculiar presence of tomacula.
Cerebral vein and dural sinus thrombosis: an evaluation of 30 cases
Authors:   “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania, Jianu Dragos Catalin ,   First Department of Neurology, Clinical Emergency County Hospital, Timisoara, Romania, Serpe Mircea ,   First Department of Neurology, Clinical Emergency County Hospital, Timisoara, Romania, Deme Sanda Maria ,   “Vasile Goldis” West University Arad, Romania, Jianu Silviana Nina ,   Department of Ophthalmology, Emergency Military Hospital, Timisoara, Romania
Published: October 2022

Background and objectives: cerebral vein and dural sinus thrombosis (CVT) present a variety of non-specific clinical signs, but, due to the development of neuroimaging techniques, especially magnetic resonance imaging, their identification has increased in recent years, due to the development of neuroimaging techniques, especially of magnetic resonance imaging. The aim of our study was to identify causes and risk factors, to describe the demographic, clinical, laboratory and neuroimaging data, and to evaluate the treatment and outcome of patients with C.V.T., comparing our experience with international literature. Patients and methods: we included 30 patients (pts) with CVT, between January 1998 and September 2010. The diagnosis was based in all cases on neuroimaging features. The pts were examined at admission and after three months, using the mRS scores. Results: mean age was 37.2 years (SD 8.6), sex ratio: male/female was 1/2. 80% of women were fertile. The main clinical manifestations were headache: 22 pts (73.3%), and papilledema: 16 pts (53.3%). The most frequent neurological syndrome at onset was intracranial hypertension with subacute evolution. CT showed direct signs of dural sinuses thrombosis: (dense triangle sign in 3 pts, delta sign in 7 cases); in 12 pts, we identified a venous cerebral infarct (indirect sign of dural sinuses thrombosis). MRI identified thrombosis of SSS in 21 pts, transverse sinus in 12 cases, cavernous sinus in 3 pts, cerebral edema in 18 pts. In 12 cases, we identified a venous cerebral infarct. 7 out of 30 MRI had a normal CT. DSA revealed isolated cortical veins occlusion, without sinus occlusion in 2 cases (CT, MRI, and MR-A were normal). Risk factors were identified in 22 pts (73.3%); congenital thrombophilia being the most common (9 pts). All pts received anticoagulant therapy. After 90 days from admission, complete resolution of symptoms was seen in 14 cases, minimal neurological deficits in 7 pts, and the death rate was 16.7% (5 pts). Conclusions: CVT appear to be underdiagnosed in our region, due to low percentage of admissions for benign intracranial hypertension. CVT was common in women of fertile age, but oral contraceptive was not an important risk factor. The outcome was favorable with adequate therapy.
Diffusion tensor imaging (DTI) correlates with transcranial magnetic stimulation (TMS) findings in early ALS (Amyotrophic Lateral Sclerosis) diagnostic
Authors:   Neurology Department, University Emergency Hospital of Bucharest, Romania, Roceanu Adina , Ferastraoaru Victor ,   Neurology Department, University Emergency Hospital of Bucharest, Romania,   Jacobi Medical Center, Bronx NY, USA, Onu Mihaela ,   Radiology Department, “Prof. Dr. Th. Burghele” Hospital, Bucharest, Romania, Tarta Eugen ,   Anatomy Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Lupescu Tudor ,   Neurology Department, “Agrippa Ionescu” Hospital, Bucharest, Romania, Bajenaru Ovidiu ,   Neurology Department, University Emergency Hospital of Bucharest, Romania
Published: October 2022

The onset of ALS is insidious and symptoms may be disregarded by the patient for several months. The diagnosis of ALS is based on clinical features and EMG findings. DTI offers the advantage of the revealing in vivo macroscopic geometrical arrangement of white matter bundles that becomes apparent through diffusion measurements of water molecules. DTI findings could correlate with prolonged cortical MEP, sustaining the early diagnosis of ALS, revealing upper motor neurons involvement.
The neuroleptic malignant syndrome – a practical challenge for every practitioner
Authors:   Internal Medicine, Outpatient Clinic of “Alexandru Obregia” Clinical Psychiatry Hospital, Bucharest, Romania, Mihailescu Cristian
Published: October 2022

The neuroleptic malignant syndrome (NMS) refers to a rare but potentially life-threatening complication of the use of antipsychotic drugs, even with the newer atypical neuroleptics, that can develop with hyperthermia, rigidity and autonomic dysregulation. Even if some risk factors have been described, its actual pathophysiology remains unclear. The diagnosis represents a real challenge for every practitioner, irrespective of the medical specialty where the first presentation occurs. NMS as a whole is far from being elucidated since the manifestations are nonspecific, with atypical variants being more and more frequent and changing the overall NMS picture, the clinical course is so unpredictable, sometimes fatal, and it still represents a therapeutic dilemma which underlies its dim prognosis. This article presents 3 cases that question the classical picture of NMS, trying to broaden our understanding of this largely undefined syndrome.
Subacute demyelinating polyneuropathy. First manifestation in a case of splenic lymphoma
Authors:   Neurology Department, Pediatric Clinical Hospital, Sibiu, Romania, Gheorghe Ioan Teodor , Ungureanu Aurelian ,   Neurology Department, Pediatric Clinical Hospital, Sibiu, Romania, Catana Alina ,   Hematology Department, Pediatric Clinical Hospital, Sibiu, Romania, Rociu Ciprian ,   Neurology Department, Pediatric Clinical Hospital, Sibiu, Romania, Roman Corina ,   Neurology Department, Pediatric Clinical Hospital, Sibiu, Romania
Published: October 2022

We present a 42-year-old man, admitted in Sibiu Neurology Clinic for pain, numbness, muscle weakness in the extremities, gait disturbance. The electromyography and nerve conduction studies examinations revealed a demyelinating polyneuropathy aspect in a biochemical context of pancytopenia and hypersplenism. Further hematology and histology evaluation settled the diagnosis of splenic small B-cell lymphoma.
The need to achive a multimodal therapeutical approach in glioblastoma
Authors:   Ist Neurosurgical Clinic, “Bagdasar-Arseni” Emergency Clinical Hospital, Bucharest, Romania, Radulescu Razvan Ion
Published: October 2022

It is well-known that of all the brain gliomas the glioblastoma multiforme has always caused serious difficulties regarding its therapeutic solution by means of different methods. Glioblastoma multiforme is the most frequent primary brain tumor in adults. The average survival time after the establishment of the diagnosis varies between 12 and 14 months and less than 5% of the patients survive for longer than five years. Despite the progresses recorded in the identification of the complex biology of these tumors, the prognosis has not been substantially improved over the last three decades. Therefore an important attention has to be paid to the continuous review of the therapy of this disease (surgical treatment, radiotherapy and chemotherapy),a special place belonging to the administration of temozolomide, as well as the cell- and gene therapies.
Conception and creativity – a cognitive neuropsychology approach
Authors:   “Carol Davila” University of Medicine and Pharmacy, Neurology Clinic, “Fundeni” Clinical Institute, Bucharest, Romania, Dulamea Adriana , Dulamea Melania ,   “Ion Mincu” University of Architecture and Urbanism, Bucharest, Romania
Published: October 2022

Exploring the superior cognitive processes through cognitive neuropsychology methods, seconded by the technique offered by the functional neuroimaging, provides interesting hypotheses on the relationship between perception, abstraction and conception. The ability to form metaphors or, in other words, to synthesize information and to create a pattern is the result of a connectivity established between different cerebral areas and represents the basis of the creative process.
Prospective study on the presence of cognitive impairments in patients with brain tumors
Authors:   University of Medicine and Pharmacy, Department of Neurology, Craiova, Romania, Stanca Diana , Craitoiu Stefania ,   University of Medicine and Pharmacy, Department of Histology, Craiova, Romania, Zaharia Cornelia ,   University of Medicine and Pharmacy, Department of Neurology, Craiova, Romania, Tudorica Valerica ,   University of Medicine and Pharmacy, Department of Neurology, Craiova, Romania, Albu Carmen ,   University of Medicine and Pharmacy, Department of Neurology, Craiova, Romania, Alexandru Oana ,   University of Medicine and Pharmacy, Department of Neurology, Craiova, Romania, Pirscoveanu Denisa ,   University of Medicine and Pharmacy, Department of Neurology, Craiova, Romania, Trifan Florin ,   University of Medicine and Pharmacy, Department of Neurology, Craiova, Romania
Published: October 2022

Objective: The purpose of our study was to evaluate the cognitive decline in patients with primitive brain tumors. Material and methods: We enrolled in our study 188 patients diagnosed with brain tumors, hospitalized in the Clinic of Neurology Craiova between January 2006 and December 2010. Depending on the origin of the brain tumors the group was divided as follows: • Group A, composed of 45 patients with tumors of the meninges • Group B, composed of 105 patients with neuroepithelial tumors Each patient was evaluated by neurological and neuroimaging exam (computed tomography and/or nuclear magnetic resonance). For the evaluation of global disability we used Karnofsky Performance Status Scale. Cognitive function was assessed using: Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). The results were analyzed by Student’s T test, considering statistically significant p<0,05. Results: Statistical analysis, in terms of the average age and average years of education didn’t show significant differences between the two groups. Evaluation of the global functionality, using Karnofsky score, did not show significant differences between the two groups. On MMSE group A obtained an average score of 26,7 points, while in group B, the average score was 25,6 points. On MoCA scale there was, also, a statistically significant difference between the two groups; group A obtained an average score of 23,3 points and group B an average score of 20,3 points. Conclusion: Our study demonstrated a statistically significant cognitive decline in patients with neuroepithelial tumors compared with patients diagnosed with tumors of the meninges.
The value of the intima-media thickness as a risk factor for cerebrovascular disease in first degree relatives of diabetic type 2 patients
Authors:   School of Medicine, “Gr.T. Popa” University of Medicine and Pharmacy, Iasi, Romania, Filos Cristina , Mazilu Georgiana ,   School of Medicine, “Gr.T. Popa” University of Medicine and Pharmacy, Iasi, Romania, Popescu Cristian Dinu ,   School of Medicine, “Gr.T. Popa” University of Medicine and Pharmacy, Iasi, Romania
Published: October 2022

Cerebrovascular diseases and diabetes mellitus have become in the last years the first cause of mortality and major invalidity throughout the world. Intima media thickness is a very good marker for subclinical atherosclerosis and also for predicting future cardio and cerebrovascular events. The aim of this study is to try to fi nd out the value of the intima media thickness as a risk factor for cerebrovascular disease in first degree relatives of diabetic type 2 patients. Material and method: we evaluated two groups, selected by well defined criteria, divided into the witness group of 21 subjects and the study group of 41 subjects. The intima media thickness was measured with a standard method, by cervical ultrasound mode B, at the common carotid artery distal wall, both sides left and right. Other parameters measured were weight, height, and body mass index, arterial systolic and diastolic blood pressure. Results: Gender distribution of subjects in the study group was predominantly male (53,6%); regarding the BMI, we could notice that 57% of the study group was overweight, but with normal blood pressure. The IMT value in the study group has varied between 0,6mm and 1,3 mm with an average of 0,82mm on the right side and between 0,5mm and 1,2mm with an average of 0,87mm on the left side. Applying the t-Student test to these values we could see no statistical significance between the two groups analyzed (p>0,05). Conclusion: in this study intima media thickness had no statistical significant value as a risk factor for cerebrovascular disease in first degree relatives of diabetic type 2 patients.
Man of 81 years old with subacute installed paraparesis
Authors:   Department of Neurology, Colentina Clinical Hospital, Bucharest, Romania, Buraga Ioan
Published: October 2022

Total medullar syndrome section has multiple causes including the most common are trauma with or without bone involvement, spinal tumors, myelitis and ischemia. At various stages of clinical presentation are written plus some features of each etiology in part. Differential diagnosis often requires additional investigation and interdisciplinary consultation that could be a major emergency.
Insights in classification of seizures and epilepsies – review of key concepts throughout history
Authors:   Emergency University Hospital, Neurology Department, Epilepsy and Sleep Monitoring Unit, Bucharest, Romania, Mindruta Ioana , Dimitriu Alina ,   Emergency University Hospital, Neurology Department, Bucharest, Romania, Craciun Laura ,   Emergency University Hospital, Neurology Department, Bucharest, Romania
Published: October 2022

Since the Babylonian era up to nowadays, the large complexity of epileptic disorders made the attempt of classifying and organizing concepts one of the most challenging. The 1981 classification was a revision of the one devised by Henri Gastaut for the ILAE and published in 1970. The distinction between simple and complex partial seizures represented a significant difference. In 1989 the report of ILAE classification and terminology task force introduced the concept of epileptic syndrome. An epileptic syndrome is defined by the sum of signs and symptoms that tend to occur together, not reflecting a particular etiology and prognosis, these latter features being the hallmark not of a syndrome, but of a disease condition. Firstly, any epileptic disorder can be described as either idiopathic (primary, whose etiology is probably genetic), symptomatic (with a known or presumed cerebral pathology) or cryptogenic (with an occult cause). The epileptic diagnostic tree ramifies into four main branches in the 1989 ILAE Classification: localization-related (focal, local, or partial) epilepsies and syndromes, generalized epilepsies and syndromes, epilepsies and syndromes undetermined whether focal or generalized and special syndromes. The next important milestone in epilepsy classification was settled by ILAE in 2001, when a glossary for ictal semiology was developed and multiaxial approach of diagnosing epilepsy was proposed. The necessity of processing the new insights in epilepsy was answered by the latest ILAE Report released in February 2010, which brings awareness of and appropriately integrates the currently available data. It presents a modular approach of diagnosing epilepsy and recommends to keep a flexible vision on this topic, as every individual case requires a different prioritizing scheme.
Update on Wernicke’s: considerations on epidemiology (II)
Authors:   Department of Neurology, Colentina Hospital, Bucharest, Romania, Simionescu Oana , Dumitrescu Laura ,   Department of Neurology, Colentina Hospital, Bucharest, Romania, Oprisan Alexandra ,   Department of Neurology, Colentina Hospital, Bucharest, Romania,   University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania, Luca Dimela ,   Department of Neurology, Colentina Hospital, Bucharest, Romania, Gitman Andreea ,   Department of Neurology, Colentina Hospital, Bucharest, Romania, Ticmeanu Marina ,   Department of Neurology, Colentina Hospital, Bucharest, Romania,   University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania, Tanasescu Radu ,   Department of Neurology, Colentina Hospital, Bucharest, Romania,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,   Réseau d’Epidémiologie Clinique International Francophone (RECIF)
Published: October 2022

Wernicke Encephalopathy (WE) is frequently missed out in clinical practice. The consequences of under diagnosing WE are deleterious. WE is caused by thiamine (vitamin B1) deficiency and may occur in alcoholic and non-alcoholic patients. A better knowledge on epidemiology may shed light on the real nature of this condition. In this short review we outline epidemiological factors associated with WE.
Variation of total antioxidant status after ischemic stroke
Authors:   “Transilvania” University, Faculty of Medicine, Neurology and Psychiatry Hospital, Brasov, Romania, Varga Ioana , Ionescu Iulian ,   “Dr. Horia Radu” Centre for Neuro-Muscular Diseases, Covasna, Romania
Published: October 2022

There is strong evidence that oxidative stress appears to be a major contributor to ischemic brain injury. Objective: To study dynamic evolution of Total Antioxidant Status (TAS) and other markers of oxidative stress after ischemic stroke and to fi nd if there is any special correlation between them or with clinical status. Methods: in a prospective study we measured markers of oxidative stress – TAS, uric acid, albumin, LDL-cholesterol and CRP – as inflammatory marker, in 24 patients, initial and 2 months after the onset of stroke, and try to fi nd the evolution in time of these markers and if there is any correlation between them or with the neurologic deficit evaluated by NIHSS scale. Results and conclusions: Levels of TAS and albumin were initial significant lower than in controls and 2 months after the stroke, higher than initial but still lower than in controls. We found a correlation between TAS and uric acid stronger and for CRP weaker at the onset than 2 months after the stroke. There was no correlation between NIHSS and TAS at both determinations.
Vestibular rehabilitation outcome in patients with vestibular neuronitis
Authors:   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Stoian Sorina , Calarasu Romeo ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Georgescu Madalina ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,   Institute of Phono-Audiology and Functional ENT Surgery, Bucharest, Romania
Published: October 2022

Objectives: Our study evaluates the benefits of vestibular rehabilitation (VR) in patients with vestibular neuronitis and tries to identify appropriate assessment tools for monitoring the outcome. Material and methods: Fourteen patients with vestibular neuronitis were included in a prospective study conducted in the Institute of Phono-Audiology and Functional ENT Surgery Bucharest. All patients underwent a combined medical (betahistine 48 mg per day) and physical (VR exercises) treatment. The recovery was assessed through clinical examination (nystagmus, Romberg and Unterberger tests), computerized dynamic posturography and several physical performance tests (Berg Balance Scale, Short Physical Performance Battery, Performance Oriented Balance and Mobility Assessment and Dynamic Gait Index), both at first visit and 30 days after treatment. Results: After one month of VR, statistically significant improvements (p<0.05) were found in clinical aspects, computerized dynamic posturography, Berg Balance Scale, Short Physical Performance Battery and Dynamic Gait Index. There were no statistically significant differences of these tests by gender, age (</≥ 45 years old) or affected part. Time past before starting VR correlated significantly with the duration of VR (Spearman correlation coefficient, rho equal to 0.694). Conclusions: Recovery after vestibular neuronitis usually takes place during first weeks. Berg Balance Scale and Dynamic Gait Index are useful in identifying balance and gait impairments after vestibular neuronitis and their evolution. VR improves clinical aspects and performance tests and promotes compensation. Starting rehabilitation sooner shortens the necessary period of VR.
Tuberculous meningitis mimicking acute polyradiculonevritis
Authors:   Neurology Department, Emergency University Hospital, Bucharest, Romania, Poalelungi Alina , Nistor Raluca ,   Neurology Department, Emergency University Hospital, Bucharest, Romania, Terecoasa Elena ,   Neurology Department, Emergency University Hospital, Bucharest, Romania, Gavan Carmen ,   Neurology Department, Emergency University Hospital, Bucharest, Romania, Tiu Cristina ,   Neurology Department, Emergency University Hospital, Bucharest, Romania
Published: October 2022

Romania has the highest prevalence of tuberculosis (TB) among all the Central European countries. Involvement of the central nervous system (CNS) by the TB accounts for approximately 1% of all cases of tuberculosis. CNS TB includes two clinical categories: intracranial and spinal. We report two cases of tuberculosis meningitis with hemorrhagic CSF. Diagnosis was based on clinical signs, complementary investigations and response to early treatment with antituberculosis medication with adjunct of steroid therapy. Some mild neurological sequels persisted.
Two successive incidental findings in the same patient – What would you do?
Authors:   Emergency University Hospital, Bucharest, Romania, Laza Cristina , Popescu Dan ,   Emergency University Hospital, Bucharest, Romania, Dorobat Bogdan ,   Emergency University Hospital, Bucharest, Romania, Antochi Florina ,   Emergency University Hospital, Bucharest, Romania
Published: October 2022

Incidental findings become more frequent as health care becomes accessible and medical investigations get more efficient and effective. We report the case of a completely asymptomatic 58 year-old female referred to our service for further investigation of an incidental finding: a right carotid artery stenosis. The investigations made in our department unveiled another incidental finding: an anterior communicating artery aneurysm. This complicated vascular pathology and the particularities of the case make the long-term therapeutic decision a difficult one to make.
Suspected neurolymphomatosis in the context of a disseminated immunoblastic non-Hodgkin lymphoma and borreliosis
Authors:   Sibiu Emergency Clinical Hospital, Romania, Roman-Filip Corina , Ungureanu Aurelian ,   Sibiu Emergency Clinical Hospital, Romania, Grosu Florin ,   Sibiu Emergency Clinical Hospital, Romania, Costea Mircea ,   Sibiu Emergency Clinical Hospital, Romania, Gheorghe Ioan Teodor ,   Sibiu Emergency Clinical Hospital, Romania, Flucu Ofelia ,   Sibiu Emergency Clinical Hospital, Romania, Catana Alina ,   Sibiu Emergency Clinical Hospital, Romania, Dancu Radu ,   Sibiu Emergency Clinical Hospital, Romania, Isaila Radu ,   Sibiu Emergency Clinical Hospital, Romania
Published: October 2022

We report the case of a female patient aged 43 years with known immunoblastic gastric lymphoma admitted for progressive motor and sensory deficit with sudden onset and relatively rapid ascending up to chest level and pain in lower limbs. Lumbar puncture revealed high proteins, low CSF glucose, and pleiocytosis with atypical lymphocytes. Considering the symptoms antiborrelia antibodies were tested finding the results extensively positive, advocating for a borreliosis. MRI revealed no significant changes. The case is a feature of the associating pathologies, finding in the literature few reports alike.
Oral anticoagulation related intracerebral hemorrhage: more questions than answers
Authors:   Neurology Department, Emergency University Hospital, Bucharest, Romania, Terecoasa Elena , Tiu Cristina ,   Neurology Department, Emergency University Hospital, Bucharest, Romania, Huertas Nuria ,   Neurology Department, Severo Ochoa University Hospital, Madrid, Spain, Alonso de Leciñana Maria ,   Neurology Department, Ramon y Cajal University Hospital, Madrid, Spain
Published: October 2022

Intracranial hemorrhage (ICH) is the most feared and devastating complication of oral anticoagulant therapy. When an ICH occurs, the patient’s situation hinges on the balance between how great is the embolic risk while not receiving anticoagulants, and how big is the threat of the hemorrhage if the anticoagulant effect is not reversed promptly. Although several studies which compared the use of different reversal agents failed to demonstrate any improvement in prognosis and survival, at the present moment the consensus seem to be that anticoagulation should be rapidly reversed after an ICH. The second question to be answered is whether and when should be oral anticoagulation treatment restarted. Although the risk of thromboembolism in patients off anticoagulation seems to be higher than the risk of ICH recurrence, there is a marked paucity of prospective large studies on the real risk of ICH recurrence when OAC is resumed, paucity that probably emphasizes the ethical challenge of prescribing patients a medication to which they have an apparent contraindication. The little evidence available suggests that the optimal time for resumption is between 10 days and 30 weeks.
A complex abnormality of the circle of Willis. Case presentation
Authors:   University of Oradea, Romania, Sabau Monica , Comanescu Alexandra ,   University of Oradea, Romania, Popa Ioana ,   “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
Published: October 2022

Objective. We report a case of a patient with medium ACI stenosis and border zone infarct that occurred under normal hemodynamic conditions (normal BP, sinus rhythm), as normal supply mechanisms through the circle of Willis were absent. The circle of Willis was practically absent: the right ICA ramified in right MCA and a single ACA. Left ICA ramified in MCA and PCA. Right PCA was a branch of BA. Case presentation. A 75 year old patient was admitted in emergency with dressing apraxia. CT scan and MRI disclosed a 5/4 cm infarction in the temporo-parieto-occipital junction on the right side. Doppler ultrasonography of the precerebral vessels revealed medium stenosis of right ICA. 3D TOF MRA reconstruction disclosed a complex abnormality of the circle of Willis: absence of A1 and P1 on the left side, absence of PCoA on the right side, a single and fenestrated ACA originating in right ICA. The circle was practically absent; there was no possibility of circulatory supply. The territories of distribution of the precerebral vessels suffered severe modifications: right ICA ramified in MCA and a single ACA, left ICA ramified in MCA and PCA, right PCA was a branch of basilar artery. The infarction occurred between the boundaries of the right ICA (MCA respectively) and the posterior territory (PCA respectively). Conclusion. We report a complex and extremely rare abnormality of the circle of Willis that became clinically manifest because of a severe hemodynamic compromise.
Dystonia – as presenting symptom of HIV encephalitis
Authors:   Neurology Department, University Emergency Hospital of Bucharest, Romania, Roceanu Adina Maria , Cristian I. ,   Neurology Department, University Emergency Hospital of Bucharest, Romania, Ionita Maria ,   Neurology Department, University Emergency Hospital of Bucharest, Romania, Bajenaru Ovidiu ,   Neurology Department, University Emergency Hospital of Bucharest, Romania
Published: October 2022

Movement disorders could be a neurological complication of acquired immune deficiency syndrome (AIDS) and may be sometimes represent the initial manifestation of HIV infection. We present the case of a 16 years old male admitted in our department with dystonia – as presenting symptom of HIV encephalitis. In this case, we didn’t disclose any opportunistic infections, but basal ganglia lesions and their connections damage are revealed by cerebral imaging.
Comparative study of carotid intima media thickness in ischemic stroke subtypes
Authors:   “Lucian Blaga” University of Sibiu, Academic Emergency Hospital Sibiu, Romania, Mutu Cosmin , Minea Nicoleta ,   Academic Emergency Hospital Sibiu, Romania, Pereanu Marcel ,   “Lucian Blaga” University of Sibiu, Academic Emergency Hospital Sibiu, Romania
Published: October 2022

Ischemic stroke is a heterogeneous disease, with different subtypes, each of them presenting specific etiopathogenic aspects in which atherosclerosis and small vessel disease play a crucial role. Increased common carotid artery intima-media thickness (IMT) is a marker of atherosclerosis associated with ischemic stroke. Purpose. The aim of this study was to investigate if increased carotid IMT is related with certain ischemic stroke subtypes according to TOAST and Bamford/Oxfordshire criteria. Methods. In a prospective study 430 patients with ischemic stroke, classified in subtypes according to TOAST and Bamford/Oxfordshire criteria, were evaluated by cervical ultrasound. We measured carotid IMT bilaterally by B mode ultrasound aiming to fi nd a statistical correlation between carotid IMT and stroke subtypes. Results. All 430 patients with ischemic stroke (average age 64,67 years) were divided according to TOAST criteria as follows: 136 (31,63%) LAA, 48 (11,16%) CE, 107 (24,88%) SAA, 6 (1,4%) OE and 133 (30,93%) UE. In these patients mean ipsilateral carotid IMT varied as follows: 1,1426 mm for LAA, 1,0313 mm for CE, 1,0402 mm for SAA, 1,0167 mm for OE and 1,0647 mm for UE, with high statistical significance (p < 0,00001). According to Bamford/Oxfordshire classification the distribution of patients was as follows: 121 (28,14%) TACI, 199 (46,28%) PACI, 85 (19,77%) LACI and 25 (5,81%) POCI. In these patients mean ipsilateral carotid IMT varied as follows: 1,124 mm for TACI, 1,0955 mm for PACI, 1,0430 mm for LACI, 1,0776 mm for POCI with lower statistical significance (p <0,05). Conclusions. Highest carotid IMT value was found in LAA, respectively TACI stroke subtypes, and lowest value in SAA, respectively LACI subtypes. High carotid IMT, implicitly atherosclerosis, was better correlated with ischemic stroke due to large vessel disease and less correlated with small vessel disease.
Liver transplantation for Wilson disease: review and a case report of an unexpected neurological complication
Authors:   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Anghel Daniela ,   Department of Neurology, Fundeni Clinical Institute, Bucharest, Romania, Campeanu Ana ,   Department of Neurology, Fundeni Clinical Institute, Bucharest, Romania, Popescu Irinel ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,   Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania, Matei Emil ,   Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania, Dorobantu Bogdan ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,   Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania, Tomescu Dana ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,   Center of Anesthesiology and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania, Popa Laura ,   Center of Anesthesiology and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania, Lupescu Ioana ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,   Department of Radiology, Medical Imaging and Nuclear Medicine, Fundeni Clinical Institute, Bucharest, Romania, Tanasescu Radu ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,   Department of Neurology, Colentina Hospital, Bucharest, Romania
Published: October 2022

Wilson’s disease is a rare autosomal recessive inherited disorder of copper metabolism, which results in copper accumulation in several tissues, especially with liver injury and failure. Orthotopic liver transplantation (OLT) can be lifesaving for patients with hepatic complications of Wilson’s disease- fulminant liver failure or unresponsiveness to medical therapy in chronic liver disease, with or without neurological manifestations. We report the case of a 19-year-old woman receiving a liver transplant for acute liver failure caused by Wilson’s disease, who developed headache as the only symptom of a serious neurological complication after transplantation. The clinical course and neuroimaging demonstrating aneurismal subarachnoid hemorrhage are presented. The neurological complications and the difficulties of medical management in an immunosuppressed patient are discussed. Headache in a recently transplanted patient for acute liver failure may be a sign of a serious cerebral complication, subarachnoid hemorrhage. Early recognition and proper management may prevent life-threatening neurologic complications but chronic immunosuppression may impede a favourable outcome.
Olfactory dysfunction in Parkinson’ disease diagnosis
Authors:   Neuroscience Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania, Tohanean Nicoleta , Perju Dumbrava Lacramioara ,   Neuroscience Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
Published: October 2022

Parkinson’s disease is a common neurodegenerative disorder of unknown cause and with inevitably progressive character. The disease has a long preclinical period-premotor phase when the nonmotor symptoms are in the first plan and when is the time which neuroprotective therapy should start. One important biomarker for the premotor phase of idiopathic Parkinson’s disease is olfactory dysfunction. This deficit is frequent, significant, small-changes once motor features are evident and it is independent of motor and cognitive status and medication use. Smell loss affects all areas of olfaction and is easily measured by standard quantitative tools. The objective of this study is to evaluate the frequency and character of olfactory dysfunction among 40 patients, recently diagnosed with Parkinson’s disease, as well as to assess correlations between olfactory function and the stage, duration or type of Parkinson’s disease. Olfactory function was assessed using a 12-marker Smell Test: Sniffi n’ Sticks-Screening 12. This is a validated method of identification of sense of smell that can be used easily and quickly. The percentage summed of patients with hyposmia and anosmia at this testing was important and the study finds no correlation between olfactory function and duration or stage of Parkinson disease. Hyposmia is one of the cardinal early symptoms of Parkinson’s disease and can be evaluated as marker of the premotor state.
Safety and outcome of intravenous thrombolysis with rtPA in patients with atrial fibrillation
Authors:   Stroke Unit, Department of Neurology, Emergency University Hospital, Bucharest, Romania, Terecoasa Elena , Tiu Cristina ,   Stroke Unit, Department of Neurology, Emergency University Hospital, Bucharest, Romania, Guillan Marta ,   Stroke Unit, Department of Neurology, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain, Sanchez-Gonzalez Victor ,   Stroke Unit, Department of Neurology, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain, Alonso de Lecinana Maria ,   Stroke Unit, Department of Neurology, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain, Masjuan Jaime ,   Stroke Unit, Department of Neurology, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
Published: October 2022

Background and purpose. Intravenous administration of recombinant tissue plasminogen activator (rtPA) is approved for the treatment of patients with acute ischemic stroke. It is still controversial if in patients with ischemic stroke due to atrial fibrillation this treatment has the same efficacy as in patients with ischemic stroke due to other etiologies. The present study aimed to compare the safety and outcome of intravenous thrombolysis with rtPA between patients with stroke due to atrial fibrillation, due to other cardiac sources of emboli and due to large-vessel disease. Methods. Retrospective analysis of 463 patients treated with rtPA in the Stroke Unit of Ramon y Cajal University Hospital, Madrid, between January 2004 and December 2011. Patients were divided in three subgroups according to stroke etiology: cardioembolic stroke due to atrial fibrillation, cardioembolic stroke due to a cardiac disease other than atrial fibrillation, stroke due to large-vessel disease. The outcome measures of the study were: symptomatic intracranial hemorrhage transformation, modified Rankin score and mortality at three months. Results. The results of the multivariate analysis showed that stroke etiology has no influence on functional outcome (p = 0.181), symptomatic intracranial hemorrhage (p = 0.093) and mortality at three months (p = 0.091). Age and baseline NIHSS scores are independent predictors for both functional outcome and mortality. Conclusion. Stroke outcome after intravenous thrombolysis with rtPA is not influenced by the stroke etiology.
Rare cause of cardioembolic stroke in former athlete with dilated cardiomyopathy
Authors:   Department of Neurology, Emergency University Hospital, Bucharest, Romania, Laza Cristina , Mergeani Athena Cristina ,   Department of Neurology, Emergency University Hospital, Bucharest, Romania, Popescu Damian ,   Department of Neurology, Emergency University Hospital, Bucharest, Romania, Rata Andrei Valentin ,   Department of Neurology, Emergency University Hospital, Bucharest, Romania, Florescu Maria ,   Department of Cardiology, Emergency University Hospital, Bucharest, Romania, Antochi Florina Anca ,   Department of Neurology, Emergency University Hospital, Bucharest, Romania
Published: October 2022

We present the case of a 50 year-old male, a former athlete with important cardiologic history who presented to our emergency department with sudden onset left side hemiparesis and dysarthria. The cerebral computed tomography showed a recent ischemic lesion in the right temporo-insular area and a spontaneously hyper-dense right middle cerebral artery. The Duplex ultrasound examination of the cervico-cerebral vessels showed significantly enlarged jugular veins, with intraluminal hyperechogenic images. The echocardiography showed severely dilated cardiac cavities, especially left atrium and auricle with many mobile hypoechogenic thrombi. The final diagnosis was cardioembolic stroke due to dilated cardiomyopathy. We chose to present this case in order to raise awareness of this low incidence diagnosis.