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Presents a case of women with slightly mental retardation and epilepsy. Evidence of diffuse subependymal heterotopia; Maintenance of the electric properties of normal neurons; Genetic etiology of subpendymal neuronal migration disorders.

Background: Episodic non-ketotic hyperglycaemia in patients with diabetes may be responsible for a syndrome characterised by hemichorea-hemiballism associated with unique radiological features. Objective: To investigate whether factors other than hyperglycaemia may be responsible for the neurological involvement. Methods: Three patients who developed a persistent choreaballism syndrome triggered by a hyperglycaemic crisis were investigated. In these patients, the persistence of the involuntary movements required neuroleptic medication. Results: Ti weighted magnetic resonance imaging revealed bilateral hyperintense lesions involving the striatum. Surprisingly, in these patients, the laboratory investigations revealed peripheral red blood cell acanthocytosis in a significant proportion of cells. Conclusion: Compared with the large population of patients with diabetes who do not show abnormal involuntary movements, unrecognised acanthocytosis in diabetes might render patients prone to develop hemichorea-hemiballism. [ABSTRACT FROM AUTHOR]

Aim: To describe different referral strategies for acute ischemic stroke (AIS) patients in a Hub-Spoke emergency stroke network with their incidence, time metrics and related outcomes. Methods: Referral paradigms were defined as follows: primary transfer to the comprehensive stroke center (CSC) from a remote region, called mothership (MS); secondary transfer to the CSC from a primary stroke center where intravenous thrombolysis was available, called drip and ship (DS); secondary transfer to the CSC from a community hospital where no reperfusion therapy was available, called ship and drip (SD); primary transfer to the CSC from its catchment area, called direct CSC (dCSC). Results: Among 517 anterior circulation AIS patients treated with mechanical thrombectomy between 2015 and 2020, 16.6% of them were SD, in addition to the well-known referral paradigms of MS (21.8%) and DS (18.1%). This rate grew to 30% when only patients whose place of onset was outside the CSC catchment area were considered. In the SD group, onset to CSC and onset to groin were significantly longer (178±80 min vs. 102±60 min, p<0.001, and 277±77 min vs. 211±61 min, p<0.001, respectively), and the risk of any intracranial hemorrhage (ICH) was significantly higher (OR: 2.514; 95%CI: 1.18–5.35, p=0.017) compared to MS. Conclusion: In this hub-spoke stroke network, a high proportion of SD paradigm was found, which was associated with longer times to treatment and higher rates of any ICH. A closer cooperation between hospital stroke physicians, national health system staff, and paramedics is warranted to identify the most appropriate referral strategy for each patient. [ABSTRACT FROM AUTHOR]

Background. It is uncertain whether Helicobacter pylori (H. pylori) is associated with ischemic syndromes and whether this association is mediated by the induction of atherosclerosis. In this study, we tested the hypothesis that atherosclerotic stroke shows a selective association with virulent H. pylori strains. Methods and Results. The seroprevalence of infection by H. pylori and by strains bearing the cytotoxin-associated gene-A (CagA), a strong virulence factor, was assessed by enzyme-linked immunoadsorbent assay in 138 patients with large vessel stroke (group A), 61 with cardioembolic stroke (group B), and in 151 healthy controls. The three groups had a similar socioeconomic status. Serum levels of C-reactive protein (CRP) were also measured by enzyme immunoassay. The prevalence of infection was 71% in group A, 63.9% in group B, and 70.2% in controls (P = NS), whereas the prevalence of Cag-A positive strains was higher in group A than in group B patients (42.8% vs 19.7%; odds ratio [OR]: 3.04, 95% confidence intervals [CI6.49; P < 0.001) and controls (42.8% vs 17.9%; OR: 4.3, 95% CI, 2.12 to 8.64; P < 0.001), after adjusting for main cardiovascular risk factors and social class. A trend toward a difference in CRP (mg/dl, mean ± SD) was observed among patients with stroke, between CagA positive (2.00 ± 3.43) and CagA negative ones (1.31±1.72), (P = 0.072, Mann-Whitney U test). Conclusions. The association between H. pylori and acute cerebrovascular disease seems to be due to a higher prevalence of more virulent H. pylori strains in patients with atherosclerotic stroke. [ABSTRACT FROM AUTHOR]

Objectives – The aim of our study was to evaluate possible changes in nocturnal sleep, daytime somnolence and cognitive functions induced by add‐on therapy with lamotrigine (LTG). Material and methods – Thirteen patients affected by seizures resistant to common antiepileptic drugs (AEDs) underwent nocturnal polysomnographic monitorings, daytime somnolence evaluations and a neuropsychological battery before and after 3 months of treatment with LTG. Results – With LTG therapy we observed a significant increase in REM sleep and a significant reduction in the number of entries into REM and stage shifts. No significant correlation was observed between the decrease in nocturnal epileptiform activity and the increase in REM sleep. Other sleep parameters were unmodified. No significant changes were observed in daytime somnolence and in cognitive performances. Conclusion – LTG may produce positive effects on epileptic seizures and interictal abnormalities without interfering negatively on REM sleep, with improvement of sleep stability and without changes in daytime somnolence and neuropsychological performances. For these reasonsit could be an important drug for improving epileptic patients'quality of life. [ABSTRACT FROM AUTHOR]

Background and purpose: Patients with acute ischemic stroke are at high‐risk for contracting COVID‐19 infection. Additionally, healthcare professionals including neurovascular ultrasound providers are also at risk of being infected by SARS‐CoV‐2 virus. Yet, preparedness to continue to guarantee hyperacute treatment is vital for patients outcome. In light of this situation, the European Society of Neurosonology and Cerebral Hemodynamic (ESNCH) appointed a task force to provide consensus recommendations for the performance of neurovascular ultrasound investigations in acute ischemic stroke during the COVID‐19 pandemic with the aim of protecting both patients and ultrasound providers. Methods: The "ultrasound in acute stroke working group" of the ESNCH examined literature articles and reviews using the following key words: "corona virus" or "COVID‐19" or "SARS‐CoV‐2 virus", and "acute stroke" or "cerebrovascular disease", and "ultrasound". Thereafter, a thorough discussion was conducted with the "education and guidelines working group" of the ESNCH. Results: We propose rapid up‐to‐date recommendations for healthcare personnel involved in the pre‐hospital and intra‐hospital assessment of stroke patients, with a particular attention to neurovascular ultrasound performance. Conclusion: The ESNCH provides a guidance summary for the performance of neurovascular ultrasound investigations in acute ischemic stroke in the time of COVID‐19. [ABSTRACT FROM AUTHOR]

We have investigated the prolactin response to bromocriptine (BRC), a D2 dopamine receptor agonist in migrainous women before and after treatment with flunarizine. We evaluated whether this test was predictive of therapeutic efficacy of flunarizine treatment and whether the therapeutic response to flunarizine treatment was related to its effect on dopaminergic system at tuberoinfundibular level. Ten migrainous women underwent a BRC test in the late follicular phase before and after 1 and 3 months of treatment with flunarizine 10 mg at bedtime. Blood samples of prolactin (PRL), growth hormone, follicle-stimulating hormone, luteinizing hormone, estradiol and progesterone were taken at basal condition. PRL was also evaluated 1 and 2 h after BRC (2.5 mg) administration. Each patient kept a daily headache diary for 1 month prior to the test and throughout the study. The level of PRL inhibition after BRC administration, observed before flunarizine treatment, was not predictive of the therapeutic response observed after 1 and 3 months of treatment. The effect of flunarizine on PRL level was not related to the therapeutic efficacy of the drug. These data suggest that flunarizine does not attenuate the activity of dopaminergic neurons in migrainous patients, and that the antimigraine effect of flunarizine does not seem related to its action on dopaminergic system at least at tuberoinfundibular level. [ABSTRACT FROM AUTHOR]