Abstract: Described here is a case of topiramate-induced reversible erectile dysfunction in which possible pathogenetic mechanisms were excluded by use of appropriate psychological, neurophysiological, ultrasound, and laboratory tests.
Abstract: We report the case of a patient with vertebrobasilar steno-occlusive pathology associated with ischemic brainstem symptomatic lesions related to abnormal decrease in blood pressure (BP). A 63-year-old man presented vertigo and persistent gait impairment as a result of a posterior cerebellar infarction and, during hospitalization, experienced a new episode of cerebral ischemia in the territory of the anterior cerebellar artery. Cerebral angiography showed occlusion of the left vertebral artery and two severe stenoses of the right vertebral artery, and 24-hour dynamic BP monitoring evidenced severe postprandial hypotension. Medical treatment was not effective so he underwent an endovascular procedure. This report documents the importance of BP monitoring for a better understanding of the pathophysiology of posterior ischemic strokes and, above all, for a more reliable prognosis and therapy.
Abstract: Ischemic stroke is a complex multifactorial disease and approximately 30%, especially in the young, are cryptogenic. In some of the patients with cryptogenic ischemic stroke the underlying risk factor may be a prothrombotic state. We studied 101 patients with ischemic stroke under 55 years of age. All the patients underwent an extensive diagnostic evaluation to determine the cause of stroke. Common variations in the genes encoding factor V, prothrombin, 5,10-methylenetetrahydrofolate reductase, plasminogen activator inhibitor-1, and human platelet alloantigens-1 were evaluated. Of the 101 patients with ischemic stroke, 28 patients had cryptogenic ischemic stroke. At least one of the different genetic polymorphisms investigated was present in 44% patients in the total group and in 48% of patients with cryptogenic ischemic stroke. In this study population under 55 years of age there was no significant difference in the prevalence of various genetic polymorphisms, factor V, prothrombin, 5,10-methylenetetrahydrofolate reductase, plasminogen activator inhibitor-1, and human platelet alloantigens) in patients with cryptogenic ischemic stroke and in patients with ischemic stroke of determined cause.
Abstract: BACKGROUND: Only a restricted number of population studies based on long-term prognosis after a stroke have been published. We analyzed long-term survival and outcome in insular first-ever stroke population from the Aeolian Archipelago. SUBJECTS AND METHODS: From 1 July, 1999 to 30 June 2002, 62 patients with first-ever stroke were recruited to evaluate short-term incidence and outcome. Information for every patient was collected by phone interviews after 3 months, 1 year, and 4 years. RESULTS: 30 days case fatality rate was 24.2% (95% C.I. 14.22 to 36.75). Fifty-one percent (95% C.I. 35.8 to 66.3) of patients died before last survey and 39.1% died during the first year of follow-up. Annual approximate death risk amounted to about 10%. The cerebrovascular causes were the most frequent causes of death (65.2%). A high level of invalidity at 4 years was present in many survivors (40%). None of the deceased had followed physio-kinesitherapy, or applied for equipment or services. CONCLUSION: More attentive medical care for stroke patients could help improve outcome, reducing mortality for patients from the Aeolian island, who already showed a low incidence.
Abstract: Trigeminal neuralgia (TN) is paroxysmal, lancinant pain often described as an "electric wave" by patients, with involvement of the divisions of the fifth cranial nerve. Demyelinating, compressive, ischaemic diseases are involved in the physiopathology of TN, but there are some cases without explanation. Familial TN (FTN) is a rare condition, about 1%-2% of all TN cases, while sporadic cases are the most common. To date, there have been about 126 reports of FTN. We describe the case of a 66-year-old man who had been complaining for 3 years of right-side paroxysmal lancinating pain in the second division of the fifth cranial nerve. A brain MRI with angiographic sequences did not show neurovascular conflicts or other pathological conditions. The patient had a family history of TN, which had been diagnosed in 3 other family members (father, sister and first cousin), who had undergone medical or surgical treatment for TN. There was no family history of hypertension, metabolic disorders, neurological or traumatic diseases. Animal studies have shown a probable involvement of genes codifying for calcium channels as the starting alterations in trigeminal excitability. Our FTN could be a good model to investigate the role of gene mutations in this condition.
Abstract: A 76-year-old patient, since the age of 45, presented with frequent attacks often triggered by emotional stimuli and characterised by forward head drop and a fall to the ground without loss of consciousness. Clinically these episodes were misinterpreted as pseudoseizures and treated with clomipramine for more than 20 years. In spite of this chronic therapy, during the last year, the attacks presented with a daily recurrence and, moreover, after arbitrary clomipramine withdrawal, they increased in frequency until they became subcontinuous. Videopolygraphic analysis, multiple sleep latency test (MSLT) and human leukocyte antigen (HLA) association studies were suggestive of narcolepsy and the recurrent episodes, diagnosed as status cataplecticus, recovered after citalopram administration.
