5^th World Congress on Neurology and Therapeutics March 14-16, 2016 London, UK

Carla Perna has been working as Locum consultant in Clinical Oncology at Royal County Surrey Hospital, Guildford, Surrey. She is also a Clinical Research Fellow at University College of London Hospital in Clinical Oncology. Besides she is a Clinical Oncologist in training at “Villa Santa Teresa diagnostica per immagini”, Bagheria (Palermo,IT) (University of Palermo, IT)

Background
High-grade glioma is characterizes by increasing intracranial pressure and consequent neurological deficit related to the tumour site. Radiotherapy with concomitant chemotherapy may themselves complicate these issues, involving also metabolic, hematologic and electrolytic imbalances. On the other hand, a diagnosis of brain tumour with his poor prognosis, is classically accompanied by sentiment of suffer, loss of dignity, disability, thoughts of death. This can make diagnostic and therapeutic management more complex for patient and relatives. Aim of the study was to investigate the possible relation between cognitive impairment and radiotherapy treatment. Also we wanted to determinate quality of life of patients analysed before and after treatment.

Methods
47 patients underwent psychological testing before and after chemo-radiotherapy, between December 2011 and July 2013, but only 30 truly analysed (13 females and 17 males). Tests used were MMSE (Mini Mental State Examination ); Clock design; Phonemic Verbal Fluency Test and semantics; Tokens Test; AAChener Aphasia Test; Span Verbal Words; Rey’s Words; Prose Memory; Figure of Rey-B; Trial Making Test; Raven's Progressive Matrices (C.P.M.); EORTC QLQ C30; EORTC QLQ -BN20; HAD (Hospital Anxiety and Depression Scale).

Results
In our finding radiotherapy does not cause in itself cognitive deficits. Unexpectedly, the analysis showed that the neuropsychological assessment and counselling have helped to increase the compliance of the patients. In particular they improved their mood, their coping strategies and also their personal assessment about their mental and physical health.

Conclusions
Not evidence in our finding that radiotherapy causes cognitive deficits. Neuropsychological assessment and counselling improved patients mood and coping with a benefit in term of quality of life.

Prof. Magda Ahmed Eldomiaty has completed his PhD at the age of 37 years from Tanta University and postdoctoral studies from Tanta University College of Medicine Egypt. She is prof. Of Anatomy and embryology in Taibah University Saudi Arabia, Tanta University Egypt. She is international reviewer in many international journals. She has published more than 25 papers in reputed journals and has been serving as an editorial board member of Edorium Journal of Anatomy and Embryology.

The study demonstrated the expression of muscle-derived myokines in the dentate gyrus (DG), medial frontal cortex (mFC) and cerebellum during depression and after voluntary exercise. Depression was developed by forced swimming (15 minutes/day) for 2 weeks and evaluated by automatic monitoring of the locomotor activity. Voluntary exercise was performed through accessing voluntary rat wheel for 3 weeks. Brain sections were processed and immunostained with antibodies against BDNF, MIF, VEGF and IL6. Light microscopic study and measuring the integrated optic density (IOD) of the photographs using ImajeJ software were performed to evaluate the myokines’ expression. Microscopically; BDNF was expressed in the cytoplasm and nuclei of nearly all neurons of DG, mFC and in granular and Purkinje cells of the cerebellum. MIF expression was mainly cytoplasmic in neurons of subgranular zone of DG, neurones of mFC and in Pukinje cells of cerebellum. VEGF showed cytoplasmic expression in many neurons of DG, mFC and in purkinje cells. IL6 was also cytoplasmic but expressed more in the glial cells, endothelial cells and purkinje cells. After voluntary running protocol; the IOD of BDNF increased significantly in upper and lower limbs of DG (P= 0.005 and p<0.001 respectively), mFC (P=0.001) and cerebellum (P=0.001). IOP of MIF significantly increased in both limbs of DG (p<0.001), mFC (p=0.001) but not in the cerebellum (P=0.052). IOP of VEGF and IL6 showed significant increase of in both limbs of DG (p<0.001), mFC (p<0.001) and cerebellum (p=0.001). The study could re-define the muscle derived myokines that might help in managing depression.

Dr. Ramel Carlos has been working as a neurologist in the Island of Guam for the past 13 years. He completed his Neurology residency and Epilepsy and Clinical Neurophysiology fellowship training at Wake Forest University, Winston Salem, North Carolina, USA. Noel Bien Carlos is currently a Neuroscience student at the University of Southern California in Los Angeles, California. He is actively involved in clinical and laboratory research.

Emerging evidence suggests that silent strokes or lacunar infarctions, leukoaraiosis, and vascular diseases may be associated with cognitive impairment including dementia. We assessed the occurrence of these risk factors among various spectrum of cognitive dysfunction. A retrospective review of patients evaluated in Guam with the diagnosis of Memory Loss, Mild Cognitive Impairment (MCI) and Dementia from August 2006 to December 2014 was conducted. The history of stroke and comorbid vascular diseases was identified. The neuroimaging studies were reviewed to determine the presence of silent strokes and leukoaraiosis in patients without history of a clinical stroke. There were 585 patients included in the analysis. One hundred forty two patients have a diagnosis of memory loss, 95 have MCI and 348 have dementia. A history of stroke was present in 29% of patients with Memory Loss, 20% of patients with MCI and 30% of patients with dementia. Silent strokes without a history of clinical stroke were present in 10% of patients with memory loss and MCI, and 15% of patients with dementia. The presence of Leukoaraisosis was present in 50% of patients with memory loss, 56% of patients with MCI, and 60% of patients with dementia. Occurrences of vascular diseases were higher in patients with dementia than patients with Memory Loss and MCI. In conclusion, silent strokes, leukoaraisosis, and vascular diseases are found to be more prevalent in patients with Dementia than those with Memory Loss and MCI.

Natalia Vérez Cotelo has completed his PharmD from Santiago de Compostela University and postdoctoral studies from Universidad Nacional de Educación a Distancia (UNED) School of Phsycology. She is member of Berbés Group, a Pharmaceutical Research and Education organization. She has published more than 25 papers in reputed journals and has been serving as Pharmacist in Nathional Health Service in Spain.

In Spain, as in other Mediterranean countries, family caregivers play an essential role in caring for patients with Alzheimer’s disease (AD). Given the high demands on caregivers of AD patients, they may experience physical, psychological or social consequences as a result of caregiving. Several factors are associated with the onset of caregiver burden, including the social support available, AD patient’s health, and the place where they live. A cross-sectional study with 175 family informal caregivers was conducted at a community pharmacy and in family caregivers associations in Galicia (Spain). Demographic variables were collected, and the following questionnaires were administered: the Beck Depression Inventory-II, STAI-Anxiety Questionnaire, Zarit Burden Scale, family APGAR scale, and the Duke-UNC questionnaire. The typical caregiver profile consists of a 56-year old women with a primary education who belongs to a functional family. Nearly a half (48%) of caregivers had a high perception of burden, with anxiety in 37% of caregivers and symptoms of depression in 25%. Family caregivers usually went to the same pharmacy (93%), were treated with psychotropic drugs (39%), and interacted with the pharmacist (90%). The caregivers from cities of The Atlantic Ocean zone presented a major level of overload and anxiety that those of the interior of Galicia. The caregiver members of family caregivers associations showed major overload and anxious symptoms that those who aren´t members of any association. The cultural standard, a good familiar function and the social received support act as "protective" factors. This study confirmed that pharmacists can help caregivers finding signs of psychopathology in order to improve their psychological health.

Syeda Nadia Nadeem is 24 years old and completing final year of medical school at University of Liverpool. She is has a strong interest in neurology, especially stroke medicine and most recently worked alongside acclaimed stroke consultants at the Walton Centre, Liverpool. She is also a representative of the Neurology Society in Liverpool and has taught numerous medical students on the topic of stroke and neurology

Background: Acute ischaemic stroke is the second leading cause of death worldwide. It creates a massive burden not only on the patients’ life but society as a whole. There has been many advancement in stroke management over the past few decades but 2015 has shown giant leaps in this. Up till now, thrombolysis was the main stroke treatment but recently several randomised controlled trials have emerged to demonstrate the efficacy behind using thrombectomy and how it will lead us into the future by treating ischaemic stroke quicker and more effectively than ever before. Aim: To perform a systematic review of the new trials, which compare thrombectomy to best medical care. Furthermore, to critically analyse the current thrombectomy guidelines across UK and Europe in order to develop a thrombectomy best practice protocol, which can be used as a guide worldwide. Method: Numerous articles which highlight the use of thrombectomy compared to thrombolysis alone in acute ischemic stroke were reviewed. Most recent UK and Europe guidelines for thrombectomy use were compared and critically appraised. Results and Conclusion: Results show that thrombectomy used with thrombolysis reduces mortality rates, and improves patients’ functional independence and vessel reperfusion rates significantly from 37% to 100% compared to thrombolysis alone. Current European recommendations complies with these results and forms relevant guidance, whereas, the UKs guidelines are incompatible, lacking structure and recent evidence. As a result, this review has created a new protocol which encompasses the trial results and European recommendations, in the hope to assist physicians worldwide.

Prof. Magda Ahmed Eldomiaty has completed his PhD at the age of 37 years from Tanta University and postdoctoral studies from Tanta University College of Medicine Egypt. She is prof. Of Anatomy and embryology in Taibah University Saudi Arabia, Tanta University Egypt. She is international reviewer in many international journals. She has published more than 25 papers in reputed journals and has been serving as an editorial board member of Edorium Journal of Anatomy and Embryology.

The study investigated the impact of voluntary exercise on; depressive behaviour, serum and hippocampal levels of myokines and hippocampal formation of rats. After developing depression, the depressed rats were allowed to voluntary wheels for 3 weeks to study; the locomotor activities through forced swimming test, the serum and hippocampal levels of myokines through ELISA and the hippocampal structure and neuronal count. Voluntary exercise produced significant increase in the distance moved by rats and significant decrease of the immobility duration. Also, significant increase of serum and hippocampal brain-derived neurotrophic factor and macrophage migration inhibitory factor, significant increase of the hippocampal vascular endothelial growth factor and significant decrease of serum interleukin 6. Significant correlations were detected between serum levels of brain-derived neurotrophic factor and that of macrophage migration inhibitory factor and interleukin 6, whereas hippocampal levels of this myokin was correlated with that of macrophage migration inhibitory factor and vascular endothelial growth factor. The hippocampal formation showed preserved neurons and well-formed dendritic extensions with significantly decreased number of degenerated neurons in hippocampal areas, and significantly increased number of the healthy neurons in the upper limb of dentate gyrus. The study proved the improving effect of voluntary exercise on depressed behaviour in rats. It demonstrated the relation of myokines to the development and/or relief of depression, and the correlation of serum and hippocampal myokines' levels. . Interest should be given for diagnosing and treating depression using myokines and to study the specified parts of hippocampal formation that could respond differently to treatment.

Nicoleta Dumitrescu, 2nd year medical student, “Gr. T. Popa” University of Medicine and Pharmacy (UMF), Iasi, Romania, presented papers to several national and international medical congresses and participated to Student Surgical Society Romania workshops.

Worldwide are registered annually about 9 million cases of tuberculosis, Romania being the first in the EU, with an incidence of 87 cases /100.000 inhabitants (2013, World Health Organization). Aim: to report a very rare case of a 27 years-old man diagnosed with a cerebral intraventricular tuberculoma, after he had been treated two months for pulmonary tuberculosis with Mycobacterium tuberculosis - negative sputum smear. Case Report: The patient was brought on August 2015 to “Prof. dr. N. Oblu” Emergency Clinical Hospital, Iasi, by his family because of a confusional syndrome, somnolence and sphincter disorders. Cerebral magnetic resonance imaging showed asymmetrical hydrocephalus and a small homogenous enhanced lesion that was located in the lateral right cerebral ventricle and foramen of Monro. A surgical intervention by endoscopic approach was made. A white-yellowish, soft tumor located in the right lateral ventricle and extended into the third ventricle was seen. Cerebrospinal fluid (CSF) examination revealed leukocytes (8 cells/mm3) and intact red blood cells (340 cells/mm3). Histopathological examination of the biopsy showed rare Langhans giant cells, epithelioid histiocytes, and lymphocytes, but no caseous necrosis. A final diagnosis of an early intraventricular tuberculoma was established. The patient's evolution was favorable under the tuberculostatic treatment and corticoids. Conclusions: This case is customized by the acute development of the intraventricular tuberculoma (while the patient had already been treated with tuberculostatic therapy for two months for active pulmonary tuberculosis), low number of white blood cells in CSF, and negative bacterioscopic exam of sputum.

Muhammad Nauman amin completed his MBBS in 2011 . He is currently working as medicine trainee in United Kingdom and has completed his MRCP in 2015.

Case Presentation:

A 30 years old male was referred by primary care physician to Emergency department with one day history of acute frontal headache, left retro-orbital pain, Neck pain and drooping of Left eyelid. He was experiencing photophobia but denied any other symptoms. All of this followed a weekend of heavy exercise at a Boot camp His past history included Migraine, Splenectomy following a motorcycle accident and previous fracture of scapula, arm and thoracic vertebrae. Clinical examination revealed miosis and ptosis of the Left eye. Rest of the clinical examination was normal. CT Head was requested which was reported as normal. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) revealed a left Internal Carotid Artery Dissection. The patient was started on oral anticoagulants. Spontaneous resolution occurred three months later was confirmed with repeat MR Angiogram.

Summary:

Horner syndrome presents with classical triad of ptosis, meiosis and anhydrosis. There are many possible etiologies along the three neuron pathway . However Internal Carotid Artery Dissection is one of the life threatening causes of acute onset Horner syndrome sooner to prevent any catastrophic consequences.

Zohaib Tariq graduated in 2011 and in medicine training program at CT1 level. He is very keen and presented various posters and delivered oral presentations at various national conferences.

The purpose of writing this case report is to share this interesting and rare functional disorder comprised of symptoms caused by excessive stretch of spinal cord in someone who has tethered cord congenitally. Causes include excessive flexion of spinal cord that can happen in pregnancy. Symptoms mimic cauda equine syndrome and include urinary/fecal incontinence, saddle anesthesia. MRI spine is investigation of choice and urgent surgical de-tethering may be required in some cases. This case is about a 24 years old female who was delivered with forceps under spinal anesthesia 4 days before. Since delivery she was double incontinent and complaining of pain and heaviness on buttocks and left thigh. Initially it was thought, could it be a complication of spinal anesthesia but anesthetists were pretty confident that it was not the case. MRI L/S spine was arranged to look for ongoing symptoms which showed congenital spina bifida occluta with intradural lipoma and tethered cord. Based on symptoms provided radiologist raised the suspicion of acute adult tethered cord syndrome. At this point neurology team was involved for further management. O/E she had decreased anal tone, absent left ankle jerk and decreased pain and touch sensations of buttocks, perianal area and left L2,L3,L4 dermatomes. Power, rest of reflexes, cranial nerves and higher mental functions were intact. Urgent neurosurgical opinion was sought which recommended conservative management initially and repeat MRI L/S and whole spine in 3-4 days. Patient's symptoms are improving gradually. Repeat MRI spine is again consistent with previous findings. Patient will be re discussed with neurosurgeons if symptoms does not resolve fully.

Waqas Ilyas completed his MBBS in 2011 from the renowned University of health and sciences and is currently working as core medical trainee in East Cheshire NHS Trust.

A 24 year female presented with on and off worsening headache 2 weeks and vomiting X2 episodes 1 day. Physical examination,pregnancy test and routine blood tests were normal and patient was discharged home on analgesia after CT scan and L.P (CSF exam) normal & negative for xanthochromia. Patient readmitted in ICU next day with lethargy, irritable, and witnessed seizure. Fundoscopy revealed mild blurring nasal margin left optic disc. Neurological examination mild right arm weakness but hemodynamically stable. Patient started on phosphenytoin, Acyclovir and PCR virology requested. CT venogram was done and reported as normal. Patient discussed with neurotertiary centre for advice and possible transfer who advised MRI/MRV which was not possible due to patient irritability, agitation and no facility of sedation available in radiology department. Scans were looked again and discussed with radiologist and noted to have sagittal sinus thrombosis with positive delta sign in previous CT venogram which was reported as normal. Patient was started on treatment for that and repeated non-contrast CT scan showed hemorrhagic infarct and confirmed previous diagnosis.

Conclusion:
Fundoscopy is part of neurological examination/assessment to rule out secondary causes of headache as recommended by Nice guidelines.Measuring Opening pressure is important part of LP as it helps to narrow down differential. Opening pressure is high in Idipathic I.C hypertension and venous thrombosis ( which were top most d/d in this case).