Despite advances in applied sciences, myasthenia gravis (MG) remains a challenging disorder to diagnose and treat. The clinical presentation results in either transient or persistent painless weakness and abnormal fatigability of any (ocular, bulbar, limbs, trunk, respiratory) or all voluntary (skeletal) muscles; however, it is usually not to the same extent. Several scoring systems of MG signs or the global state of the patient have been proposed in an attempt to provide a standard scheme for use by all investigators. Some patients may have non-muscle-related complaints due to different disorders which may be associated with MG (thymoma, thyroid disorders, other autoimmune diseases, etc.).

Vascular cognitive impairment (VCI) is a heterogeneous group of cognitive disorders that share a presumed vascular cause, and it is the second most common cause of cognitive impairment in the elderly after Alzheimer’s disease. Its prevalence is estimated to double over the next 30 years. Vascular cognitive impairment encompasses cases related to multiple cortico-subcortical infarcts, silent infarcts, strategic infarcts, small vessel disease, as well as mixed pathology. It is important to emphasize that some of the risk factors for vascular dementia are the same as for stroke, including high blood pressure, diabetes, heart disease and cigarette smoking. Compared with Alzheimer’s disease, vascular dementia has a higher rate of mortality and a slower rate of cognitive decline. The aim of the treatment in vascular cognitive impairment is mainly to identify and reduce the effect of the vascular risk factors. This article aims to resume the most important data regarding VCI.

Vascular cognitive impairment AbstrActVascular cognitive impairment (VCI) is a heterogeneous group of cognitive disorders that share a presumed vascular cause and it is the second most common cause of cognitive impairment in the elderly after Alzheimer's disease.Its prevalence is estimated to double over the next 30 years.Vascular cognitive impairment encompasses cases related to multiple cortico-subcortical infarcts, silent infarcts, strategic infarcts, small vessel disease, as well as mixed pathology.It is important to emphasize that some of the risk factors for vascular dementia are the same as for stroke, including high blood pressure, diabetes, heart disease and cigarette smoking.Compared with Alzheimer's disease, vascular dementia has a higher rate of mortality and a slower rate of cognitive decline.The aim of the treatment in vascular cognitive impairment is mainly to identify and reduce the effect of the vascular risk factors.This article aims to resume the most important data regarding VCI.

Cerebral venous thrombosis (CVT) is an uncommon disorder in the general population. At least 1 risk factor can be identified in 85% of patients with CVT. Because of the high frequency of thrombophilia among patients with CVT, screening for hypercoagulable conditions should be performed. Two pathophysiological mechanisms contribute to their highly variable clinical presentation. Four major syndromes have been described: isolated intracranial hypertension, focal neurological abnormalities, seizures, and encephalopathy. Cavernous sinus thrombosis represents the single CVT which produces a characteristic clinical syndrome. Head Computed Tomography is the most frequently performed imaging study, but Magnetic Resonance Imaging of the head combined with Magnetic Resonance venography are the most sensitive studies. Acute phase therapy for CVT focuses on anticoagulation, management of seizures, increased intracranial pressure, and prevention of cerebral herniation. The majority of patients have a complete or partial recovery, however they have an increased incidence of venous thromboembolism. Clinical and imaging follow-ups 3–6 months after diagnosis are recommended to assess for recanalization.

The congenital anomalies of the supra-aortic arteries and their branches as potential risk factors for cerebrovascular insufficiency are not yet fully investigated and clarified. This report describes the case of a 68-year-old man who was admitted in our Clinic for an acute ischemic stroke in the vertebrobasilar territory. Extracranial color-coded duplex sonography (CCDS) and computed tomography angiography revealed a combination of congenital anomalies of the neck arteries: left internal carotid artery hypoplasia, left common carotid artery hypoplasia, right vertebral artery hypoplasia and the emergence of the left vertebral artery directly from the aortic arch. The aim of this article is to emphasize the value of CCDS as an accurate, non-invasive method of assessing the neck arteries and, also, the importance of the morphological anomalies of the carotid and vertebral arteries in the cerebral hemodynamics.

Agenesis, aplasia and hypoplasia of the internal carotid artery are rare congenital malformations. They are usually asymptomatic and incidentally discovered through ultrasound or imagistic tests. The aim of this study is to improve their management in our Departments. We report here the case of a 39-year-old woman addressed to our ambulatory in 2013 for benign symptoms like dizziness and headache. Imagistic findings (magnetic resonance imaging of the brain, and cervical spine, and magnetic resonance angiography of the head and neck) indicated a very rare condition: left internal carotid artery agenesis accompanied by the absence of the pre-communicant part of the left anterior cerebral artery and of the right posterior communicating artery. Internal carotid artery agenesis is an uncommon congenital anomaly and it could be misdiagnosed as stenosis/occlusion of this artery. This condition is important to be recognized due to the associated hemodynamic changes and in order to discover and evaluate other accompanying vascular malformations (aneurysms, collateral channels) and their life threatening potential risks (subarachnoid hemorrhage or ischemia). Also, it has a special importance in case of planning carotid or trans-sphenoidal hypophyseal surgery.

Thrombophilia is characterized by an increased tendency to arterial and venous thrombus formation. Inherited thrombophilia can be secondary to protein S deficiency. Concomitant use of oral contraceptive pills increases the risk of venous thromboembolism and arterial thrombosis. We report a case of a 34-year-old female who used oral contraceptive pills for many years, who developed acute ischemic stroke of right occipital lobe with secondary left superior homonymous quadrantanopia. We have run several tests to establish the ischemic stroke etiology: unenhanced brain and cervical spine computed tomography, brain magnetic resonance imaging and magnetic resonance angiography (including MR venography), computed tomographic angiography, echocardiography, extracranial duplex ultrasound and laboratory data (including thrombophilia testing). The laboratory investigations confirmed that the ischemic stroke of our patient resulted from a severe inherited thrombophilia secondary to protein S deficiency.