Impact of Depression on Cognitive Function and Disease Severity in Idiopathic Cervical Dystonia Patients: One-Center Data in Cross-Sectional Study.

Background: Cervical dystonia is a highly disabling hyperkinetic movement disorder with a lot of nonmotor symptoms. One symptom with a high prevalence is depression, which may negatively affect dystonia patients. The aim of the study was to investigate the impact of depression on disease severity and cognitive functions in cervical dystonia patients. Methods: Patients with cervical dystonia were interviewed and divided into two groups, based on the Patient Health Questionnaire-9: those with no depression or mild depressive features and those with moderate, moderately severe, and severe depression. The severity of dystonia and cognitive functions were assessed and compared in both groups. Results: A total of 52 patients were investigated. Self-assessment of the disease was more negative in clinically significant depressive signs group (p = 0.004), with a tendency for patients with clinically significant depressive features to have a slightly higher score on objective dystonia scales (TSUI and TWSTRS), but without statistically significant differences (p = 0.387 and p = 0.244, respectively). Although not statistically significant, a slightly higher MoCA scale score was registered in cervical dystonia patients with clinically insignificant depressive signs. There was a tendency for worse results in the abstraction category in patients with clinically significant depression (p = 0.056). Conclusions: Patients with clinically significant depression have a more negative self-assessment of the disease and perform worse in abstraction tasks.

Neurosyphilis Mimicking Herpes Simplex Encephalitis on Magnetic Resonance Imaging: A Case Report.

BACKGROUND Neurosyphilis is a central nervous system infection caused by Treponema pallidum, that can develop at any time after the initial infection. The clinical signs of neurosyphilis are very variable, as well as its radiological features, and it is a diagnostic challenge. Knowledge of clinical symptoms and correct laboratory diagnostics, combined with routine radiological examination and additional diagnostic tools, such as high-resolution, three-dimensional FLAIR sequence, T2-weighted, and T1-weighted contrast-enhanced magnetic resonance imaging (MRI) are key to making an accurate diagnosis of neurosyphilis. CASE REPORT We present the clinical case of a patient who presented a 1-year history of vague clinical symptoms and was misdiagnosed with herpes simplex virus (HSV) encephalitis. Initial head MRI revealed extensive cerebral white matter lesions with cortical contrast enhancement, mainly of anterior and medial parts of the left temporal lobe, as typically seen in HSV encephalitis. Empirical therapy with acyclovir was started until a diagnosis of syphilis was confirmed with laboratory findings. Later, the therapy was changed to penicillin G. The patient's condition improved after receiving targeted treatment. A control MRI scan was performed, and previously detected changes in the brain had decreased significantly. CONCLUSIONS MRI is the imaging of choice to support the diagnosis of neurosyphilis. Our findings suggest that neuroimaging can play an important role in indicating suspicion of syphilitic encephalitis. Enhancement of the anterior and medial parts of the temporal lobe is an atypical imaging finding, and it can simulate an infection with HSV. Early treatment is critical to a positive outcome.

Use of High-Resolution Magnetic Resonance Imaging (MRI) for Radiological Diagnosis of Neurovascular Conflict: A Case Report.

BACKGROUND Neurovascular conflict (NVC) or neurovascular compression syndrome is a pathoanatomical phenomenon that puts the vessel and the cranial nerve in direct contact, resulting in mechanical irritation to the nerve. Several clinical syndromes in which abnormal activity spreads in the nerve innervation zone are known to be associated with neurovascular compression syndrome. Radiological examination and precise diagnostic measures are the cornerstones for successful diagnosis, but a precise diagnosis of NVC is not always easily achievable. Apart from routine radiological examination, additional diagnostic tools should be used, including high-resolution, three-dimensional (3D), T2-weighted (T2W) magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and precise diagnostic radiological criteria. CASE REPORT We present the cases of 2 patients diagnosed with trigeminal neuralgia V2/3 and severe facial pain for more than 5 years for whom treatment with medication was unsuccessful. Their primary MRI scans did not show specific signs of possible NVC. For clarification, additional high-resolution, T2W MRI scans were performed. Radiological evidence of NVC was found. During neurosurgery, an NVC was confirmed among the trigeminal nerve, the roots of the cerebellum, and the petrosal vein. The procedure was successful in both patients. CONCLUSIONS High-resolution, T2W MRI sequences together with 3D MRA (TOF-MRA) are the most sensitive tools available for detection of cranial nerve root entrance area vascular compression. The best way that radiologists can increase the accuracy of diagnosis of NVC is to take a systematic approach to evaluation and to apply the recommended criteria to images from patients suspected of having the condition.

Lack of Accredited Clinical Training in Movement Disorders in Europe, Egypt, and Tunisia.

BACKGROUND: Little information is available on the official postgraduate and subspecialty training programs in movement disorders (MD) in Europe and North Africa. OBJECTIVE: To survey the accessible MD clinical training in these regions. METHODS: We designed a survey on clinical training in MD in different medical fields, at postgraduate and specialized levels. We assessed the characteristics of the participants and the facilities for MD care in their respective countries. We examined whether there are structured, or even accredited postgraduate, or subspecialty MD training programs in neurology, neurosurgery, internal medicine, geriatrics, neuroradiology, neuropediatrics, and general practice. Participants also shared their suggestions and needs. RESULTS: The survey was completed in 31/49 countries. Structured postgraduate MD programs in neurology exist in 20 countries; structured neurology subspecialty training exists in 14 countries and is being developed in two additional countries. Certified neurology subspecialty training was reported to exist in 7 countries. Recommended reading lists, printed books, and other materials are the most popular educational tools, while courses, lectures, webinars, and case presentations are the most popular learning formats. Mandatory activities and skills to be certified were not defined in 15/31 countries. Most participants expressed their need for a mandatory postgraduate MD program and for certified MD sub-specialization programs in neurology. CONCLUSION: Certified postgraduate and subspecialty training exists only in a minority of European countries and was not found in the surveyed Egypt and Tunisia. MD training should be improved in many countries.