Acute onset of Lambert Eaton myasthenic syndrome in prostate adenocarcinoma: a case report.

Lambert Eaton myasthenic syndrome (LEMS) is a rare disorder of the neuromuscular junction. The representative clinical triad consists of proximal muscular weakness, areflexia and autonomic dysfunction. The diagnosis is based on the clinical findings confirmed by voltage-gated calcium channels antibody titer and neurophysiology. We present a 69 year old male with prostate adenocarcinoma and 30 years history of smoking, referred for muscle weakness in the lower limbs and difficulty to climb the stairs.

Theta-burst stimulation as a therapeutic tool in neurological pathology: a systematic review.

TBS (theta-burst stimulation) is a novel therapeutic approach in a wide range of neurological diseases. The present systematic review aims to identify the various protocols used in the last years, to assess study quality and to offer a general overview of the current state of the literature. The systematic review was conducted according to the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines. We applied the following inclusion criteria: (1) population over 18 years old with diagnosed neurological disorders, (2) patients treated with sessions of theta-burst stimulation, (3) randomized-controlled clinical trials, (4) articles in the English language, and (5) studies that report response and score reduction on a validated scale of the investigated disorder or remission rates. We included in the final analysis 56 randomized controlled trials focusing on different neurological pathologies (stroke, Parkinson`s disease, multiple sclerosis, tinnitus, dystonia, chronic pain, essential tremor and tic disorder), and we extracted data regarding study design, groups and comparators, sample sizes, type of coil, stimulation parameters (frequency, number of pulses, intensity, stimulation site etc.), number of sessions, follow-up, assessment through functional connectivity and neurological scales used. We observed a great interstudy heterogenicity that leads to a difficulty in drawing plain conclusions. TBS protocols have shown promising results in improving various symptoms in patients with neurological disorders, but larger and more coherent studies, using similar stimulation protocols and evaluation scales, are needed to establish guideline recommendations.

Multiple strokes and cerebral microangiopathy in a patient with Churg-Strauss syndrome.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic disease that mainly affects the lungs and skin. It is considered to be a small and medium-vessel vasculitis. Although neurologic manifestations of EGPA are reported, usually consisting of peripheral neuropathy, central nervous system manifestations are quite rare, those described being cerebral infarctions or hemorrhages. We present the case of a 79-year-old woman diagnosed in 2016 with EGPA, being treated with Prednisone and Azathioprine, who presented to the Neurological Emergency Department with right hemiplegia, dysmetria in the left arm and right hemi-hypoesthesia. CT (computed tomography) and MRI (Magnetic resonance imaging) findings on admission described lacunar strokes. The patient presented with low creatinine clearance on admission (positive for chronic renal disease), grade III hypertension, ischemic cardiomyopathy and right calf deep vein thrombosis. The patient was started on neuroprotective and neurotrophic treatment associated with parenteral hydration, anticoagulant and hypotensive drugs. The patient's symptoms partially improved, with possibility of independently maintaining a sitting position and upright stance with unilateral sustenance at discharge. Patients suffering from vasculitides must be carefully observed in order to prevent or treat complications that may emerge.

The economic burden of stroke: a systematic review of cost of illness studies.

Stroke is one of the leading causes of morbidity and mortality worldwide. As the number of stroke cases is rising from one year to another, policymakers require data on the amount spent on stroke to enforce better financing policies for prevention, hospital care, outpatient rehabilitation services and social services. We aimed to systematically assess the economic burden of stroke at global level. Cost of stroke studies were retrieved from five databases. We retrieved the average cost per patient, where specified, or estimated it using a top-down approach. Resulting costs were grouped in two main categories: per patient per year and per patient lifetime. We extracted information from forty-six cost of illness studies. Per patient per year costs are larger in high income countries and in studies conducted from the payer perspective. The highest average per patient per year cost by country was reported in the United States ($59,900), followed by Sweden ($52,725) and Spain ($41,950). The highest per patient lifetime costs were reported in Australia ($232,100) for all identified definitions of stroke. Existing literature regarding the economic burden of stroke is concentrated in high-income settings, with very few studies conducted in South America and Africa. Published manuscripts on this topic highlight substantial methodological heterogeneity, rendering comparisons difficult or impossible, even within the same country or among studies with similar costing perspectives.