Vlad Tiu

• Medical doctor at Elias Emergency Hospital of Bucharest

Introduction Evidence regarding the benefit of endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (c-ICA-O) is lacking. We assessed the outcomes and safety of EVT in patients with isolated c-ICA-O. Methods Retrospective multicenter cohort study of patients with an AIS...

Background Widespread use of ocrelizumab, an anti-CD20 monoclonal antibody, for treating patients with multiple sclerosis (MS), has led to an increase in reported adverse events following real-world observation. Among these, drug-induced colitis is a rare, but severe side effect, prompting a recent FDA statement regarding this safety concern. Objec...

Introduction Neurosonology is a vital paraclinical investigation in modern neurology. However, access to education and certification in neurosonology for neurology residents and young specialists in Europe is challenging, and comprehensive data regarding this topic are scarce. Information regarding difficulties in neurosonology training across Euro...

BACKGROUND The association of COVID-19 with higher bleeding risk and worse outcomes in acute ischemic stroke (AIS) undergoing revascularization may be related to the presence of infection symptoms. We aimed to assess the safety and outcomes of revascularization treatments in patients with AIS with asymptomatic COVID-19 (AS-COVID) or symptomatic COV...

(1) Background: Early disability accrual in RRMS patients is frequent and is associated with worse long-term prognosis. Correctly identifying the patients that present a high risk of early disability progression is of utmost importance, and may be aided by the use of predictive biomarkers. (2) Methods: We performed a prospective cohort study that i...

Background and objectives COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower efficacy of revascularization treatments in patients with acute ischemic stroke. We aimed to evaluate the safety and outcomes of revascularization treatments in patients with acute ischemic stroke and COVID-19....

(1) Background: Cognitive impairment (CI) begins early in the evolution of multiple sclerosis (MS) but may only become obvious in the later stages of the disease. Little data is available regarding predictive biomarkers for early, active cognitive decline in relapse remitting MS (RRMS) patients. (2) Methods: 50 RRMS patients in the first 6 months f...

Romania has one of the highest incidences of stroke and one of the highest mortality rates in Europe. The mortality rate due to treatable causes is also very high and is associated with the lowest public spending on healthcare in the European Union. Nonetheless, significant achievements in acute stroke care have been made in Romania in the last 5 y...

Background: Previous studies suggest that the mechanisms and outcomes in COVID-19-associated stroke differ from those with non-COVID-19 strokes, but there is limited comparative evidence focusing on these populations. Therefore, we aimed to determine if a significant association exists between COVID-19 status with revascularization and functional...

Background and Objectives: In this critical review, we explore the potential use of MRI measurements as prognostic biomarkers in multiple sclerosis (MS) patients, for both conventional measurements and more novel techniques such as magnetization transfer, diffusion tensor, and proton spectroscopy MRI. Materials and Methods: All authors individually...

IntroductionMyasthenia gravis is an autoimmune disorder affecting neuromuscular transmission, and its hallmark is fluctuating muscular weakness affecting the ocular, bulbar, respiratory, or limb muscles. Our objective is to highlight the difficulties encountered in diagnosing this disorder in patients lacking this characteristic phenomenon.Methods...

Background and purpose Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hos...

Peduncular hallucinosis is a rare syndrome that develops with upper brainstem and diencephalon lesions. Patients complain of vivid hallucinations that usually occur in hypnagogic states but maintain critical appraisal. Pathological disruption of the reticular activating systems partially explains this clinical phenomenon. We report the case of a 47...

Spontaneous intracranial hypotension is a rare clinical entity caused in most cases by a cerebrospinal fluid leak occurring at the level of the spinal cord. Cranial dural leaks have been previously reported as a cause of orthostatic headaches but, as opposed to spinal dural leaks, were not associated with other findings characteristic of spontaneou...

Background and Objectives: Neutrophil-to-lymphocyte ratio (NLR), a very low cost, widely available marker of systemic inflammation, has been proposed as a potential predictor of short-term outcome in patients with intracerebral hemorrhage (ICH). Methods: Patients with ICH admitted to the Neurology Department during a two-year period were screened f...

Background COVID-19 infection has been known to predispose patients to both arterial and venous thromboembolic events such as deep venous thrombosis, pulmonary embolism, myocardial infarction, and stroke. A few reports from the literature suggest that Cerebral Venous Sinus Thrombosis (CVSTs) may be a direct complication of COVID-19. Objective To...

Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aims: To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods: Retrospective observational cohort of consecut...

Background: The burden of stroke is high in Romania and data regarding access to post – stroke rehabilitation are almost non– existent. We aimed to determine the percentage of patients who benefited from post–stroke rehabilitation and to describe the most common rehabilitation settings. Methods: A structured telephone-based questionnaire regarding...

Background Ginkgo biloba is a commonsymptomatic treatment for cognitive impairment, although data on its efficacy are controversial. Objective The aim of the current study was to evaluate the effectiveness of standardized Ginkgo biloba extract EGb761® (Tanakan®) on the improvements in cognitive functions over 24 months in a local cohort of patient...

Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aims: To summarize the findings of a multinational observational cohort of patients with SARSCoV-2 and cerebrovascular disease. Methods: Retrospective observational cohort of consecuti...

Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is u...

Cardiac abnormalities are frequently reported in acute subarachnoid hemorrhage (SAH) patients. However, frank ST-elevation and myocardial dysfunction mimicking acute coronary syndrome is a rare occurrence. Systemic and local catecholamine release mediate myocardial injury and may explain raised troponin levels, concordant regional wall motion abnor...

Intracerebral hemorrhage is a significant public health problem, as it is a disease associated with overwhelming mortality and disability. We performed a retrospective feasibility study of patients admitted with acute intracerebral hemorrhage in our department for four months. Our aims were to identify peculiarities of the risk factors, demographic...

Introduction: Despite the availability of prevention and therapies of stroke, their implementation in clinical practice, even of low-cost ones, remains poor. In 2015, the European Stroke Organisation (ESO) initiated the ESO Enhancing and Accelerating Stroke Treatment (EAST) program, which aims to improve stroke care quality, primarily in Eastern E...

Background and aim: Romanian national level stroke mortality data is relatively scarce. The current study investigated stroke mortality rates and trends in Romania. Methods: All individual deaths registered in Romania during 1994-2017 were analyzed using an anonymized database, based on death certificates. Stroke crude mortality rates (CMR) and...

Background: The risk of ischemic stroke (IS) is significant within 6-12 months from the myocardial revascularization for an acute cardiac event. Consequently, we can expect to have patients with an acute IS occurring right in the time frame of dual antiplatelet therapy (DAPT) imposed by the coronary heart disease (CHD). Areas of uncertainty: Unt...

Objectives: The carotid-cavernous fistula (CCF) represents an abnormal communication developed between the internal and/or the external carotid artery (ICA, ECA) or their branches and the cavernous sinus (CS). We report this case in order to highlight the course and an alternative to treatment of a CCF. Material and methods: A 47-year old male pa...

Aims: To study the age and sex-dependent mortality rates and causes of death in a large Romanian diabetes cohort as compared with the general population. Methods: All adult patients aged 20–64 years, receiving a free diabetes prescription in a major urban area during 2001–2008 were included and followed-up for death until December 31, 2011. Crude m...

Opsoclonus-myoclonus syndrome (OMS) is a very rare condition with different autoimmune, infectious and paraneoplastic aetiologies or in most cases idiopathic. We report the case of a 75-year-old woman who was admitted in our department in early fall for altered mental status, opsoclonus, multifocal myoclonus, truncal titubation and generalized trem...

Multiple sclerosis (MS), neurologic disease affecting young population, may cause cardiovascular dysfunction, due to autonomous nervous dysfunction, physical invalidity, increased oxidative stress, and systemic inflammatory status. However, cardiovascular function is rarely evaluated in these patients. We assessed left and right ventricular (LV and...

Delta-aminolevulinic acid dehydratase porphyria (ADP) is a rare cause of acute polyneuropathy. It should be part of the differential diagnosis in every patient presenting with polyneuropathy and elevated liver enzymes. Genetic, acquired and environmental factors can play a role in the clinical manifestations and there are several steps in reaching...

CLOSE and Gore-REDUCE trials have recently changed the way we approach patients with stroke and patent foramen ovale. We present the case of a young patient with an Embolic Stroke of Undetermined Source (ESUS) and an atrial septal defect causing a large right-to-left shunt, with an ample discussion on evidence-based decision making.

Despite major technological advances in ischemic stroke diagnostic techniques, our current understanding of stroke mechanisms and etiology continues to remain unclear in a significant percent of patients. As a result, several etiological ischemic stroke classifications have emerged during the last two decades but their reliability and validity is f...

Objectives. The aim of our study is to determine whether cerebral vasomotor reactivity is impaired in patients with arterial hypertension and cognitive impairment and how this hemodynamic parameter is associated with different functions of cognition. Materials and methods. We included 87 patients with arterial hypertension divided into two groups,...

Material and methods: We included in the study 32 healthy subjects and 32 MS patients: 10 naive, 10 early treated and 12 late treated with INF-β1a. Serum determination of cytokines and brain MRI were performed at the beginning of the study, after 6 and 12 months. Rio score was calculated at the end of the study. Results: MS patients had initiall...

Transient global amnesia is now considered a very rare complication of cerebral angiography. Various etiological mechanisms have been suggested to account for this complication, but no consensus has been reached yet. This case report documents one of the few reported cases of cerebral angiography-related transient global amnesia associated with mag...

Although considerate progress was obtained by adding imagistic and laboratory test, clinical examination remains the core of the diagnosis for Alzheimer`s disease. After 20 years of experience with anticholinergic drugs we know that only one third of the patients respond to the treatment; the treatment is more efficient in the initial stages of the...

Stroke is one of the leading causes of disability in Europe. Central and Eastern European countries have the highest incidence and mortality rates through Europe. The improvements in stroke prevention and treatment in Central and Eastern European countries did not completely reach the quality parameters present in Western European countries. We pre...

Background. Rheumatoid arthritis comes with a 30% higher probability for cardiovascular disease than the general population. Current guidelines advocate for early and aggressive primary prevention and treatment of risk factors in high-risk populations but this excess risk is under-addressed in RA in real life. This is mainly due to difficulties met...

Endocarditis is an important, although less common, cause of cerebral embolism. All forms of endocarditis share an initial common pathophysiologic pathway, best illustrated by the non-bacterial thrombotic form, but also a final potential for embolization. Stroke associated with endocarditis has signifficant mortality and morbidity rates, especially...

The authors present the data of a medical registry which evaluated if the physicians assess VTE risk in stroke patients, during hospitalization period and at hospital discharge and if the thromboprophylaxis is used according to National Guidelines for VTE Prophylaxis. 884 patients with acute ischemic stroke patients were enrolled between June 2010...

The electroencephalographic examination (EEG) records spontaneous electrical activity generated in the cerebral cortex. The EEG is abnormal in almost all conditions associated with impairment of the level of consciousness. When consciousness is impaired the EEG becomes slowed (episodic or continuous), unresponsive to afferent stimuli, amplitude dim...

Background and purpose. There are conflicting data in the literature regarding the safety of intravenous thrombolysis in patients with ischemic strokes receiving prior treatment with vitamin K antagonists. We aimed to assess the safety, short term outcome and mortality after rt-PA administration in patients with atrial fibrillation related strokes...

To monitor the long-term cognitive function evolution of patients undergoing carotid artery stenting (CAS), using detection of embolic signals (ES) as a potential marker of cognitive decline. This is an ongoing prospective nonrandomized single-center study of patients undergoing carotid artery angioplasty and stenting using standard techniques. Neu...

Spontaneous dissection of the internal carotid artery is a leading cause of stroke and TIA, particularly in young patients. The antithrombotic treatment with or without an interventional procedure is a unanimously accepted indication for the prevention of the ischemic events in these patients. Whether anticoagulants or antiplatelets as antithrombot...

Background and purpose. Intravenous administration of recombinant tissue plasminogen activator (rtPA) is approved for the treatment of patients with acute ischemic stroke. It is still controversial if in patients with ischemic stroke due to atrial fibrillation this treatment has the same efficacy as in patients with ischemic stroke due to other eti...

The actual criteria for diagnosis of dementia have many shortages, due to the fact that both DSM 4 and ICD 10 criteria are essentially based on the typical evolution of Alzheimer's disease, which is the most frequent, but not the only one cause of dementia in the general population. In the new project of DSM-5, proposed for public debate by the Ame...

Dysgenesia of the internal carotid artery (ICA) is a rare vascular congenital anomaly with a variety of different grades (agenesia, aplasia and hypoplasia). We report a case of 46 year old Caucasian women with history of asthma, who presented, 1 month after a neck trauma in a car accident, headache and blurred vision in the left eye. Also, she desc...

Intracranial hemorrhage (ICH) is the most feared and devastating complication of oral anticoagulant therapy. When an ICH occurs, the patient’s situation hinges on the balance between how great is the embolic risk while not receiving anticoagulants, and how big is the threat of the hemorrhage if the anticoagulant effect is not reversed promptly. Alt...

Romania has the highest prevalence of tuberculosis (TB) among all the Central European countries. Involvement of the central nervous system (CNS) by the TB accounts for approximately 1% of all cases of tuberculosis. CNS TB includes two clinical categories: intracranial and spinal. We report two cases of tuberculosis meningitis with hemorrhagic CSF....

To investigate the historical changes in survival with diabetes in adult type 2 diabetes patients. We analyzed 9066 deaths, 54.2% males, registered at "I. Pavel" Bucharest Diabetes Centre, aged 40-64 years and deceased between 1943 and 2009. We split the analysis in three time periods according to year of death: 1943-1965, 1966-1988 and 1989-2009....

Among the patients with cognitive vascular impairment, a particular group is represented by those who have concomitant cerebrovascular and coronary heart disease (CHD). The clinical evolution of some of these patients is dominated apparently by the progressive cognitive impairment and sometimes psychotic episodes and not by evident clinical stroke...

Aims. We investigated the prevalence of micro and macro-vascular complications and how these patients perform with respect to current treatment goals. \r\nMethods. We performed a cross-sectional study in type 2 diabetes subjects treated with biguanides in monotherapy, attending a standard diabetes outpatient clinic during 2008-2009. We used the lat...

The purpose of the study was to investigate the efficacy and safety of Cerebrolysin in patients with hemorrhagic stroke. The primary objective of this trial was to assess the clinical efficacy and safety of a 10-days course of therapy with a daily administration of Cerebrolysin (50 mL i.v. per day). The trial had to demonstrate that Cerebrolysin tr...

Optic neuropathy (ON) is defined as the reduction of vision due to inflammatory lesion of the optic nerve. The patient with ON has to be evaluated clinically but also with complex techniques (magnetic resonance imaging, visual evoked potentials, cerebrospinal fluid examination) because ON could be the presenting symptom in multiple sclerosis patien...

To investigate the survival with diabetes in patients treated with insulin from diagnosis. We analyzed 845 subjects, 55.9% males, registered at "I. Pavel" Bucharest Diabetes Centre, insulin-treated from diagnosis, aged <40 years and deceased between 1946 and 2005. We divided the subjects in two groups by age at diagnosis: group A <18 years and grou...

Magnetic Resonance Diffusion Tensor Imaging (DTI) is a neuroimaging method for detecting and representation of water diffusion properties of nervous tissues. Fiber tracking technique uses DTI data and reconstructs nervous fibers and significantly enhances the knowledge about the in vivo configuration of white matter. Using sophisticated algorithms...

Quantitative sensory testing (QST) is a potentially useful tool for measuring sensory impairment for clinical and research studies but there is still no consensus regarding the place of this evaluation in every day clinical practice. Our study included 15 patients previously diagnosed with neuropathic pain due to small fiber sensory polyneuropathy...

The authors present two cases of subarachnoid hemorrhage, both women, middle aged who developed almost the whole spectrum of complications of this type of intracranial bleeding. We briefly review the management of the subarachnoid hemorrhage and we emphasize the importance of the interventional therapy (treatment of the aneurysm by endovascular coi...

The neurological complications are frequent in patients with hematological syndromes such as: myeloproliferative diseases, malignant diseases of lymphoid cells, plasmocytic diseases, transfusion biology and therapy, bone marrow and stem cell transplantation, disorders of the platelet and vessel wall, disorders of coagulation and thrombosis, hypopro...

Objectives: To compare plasma concentrations of soluble P-selectin (sP-selectin) in patients with rheumatoid arthritis and healthy controls and to explore the relationship between clinical and serological measures of disease activity and endothelial dysfunction. Methods: 24 patients with rheumatoid arthritis (RA) and 21 age and sex matched controls...

We report the case of a 61 years old man, with Waldenstrom's macroglobulinemia, who was hospitalized for paresthesias and weakness in lower and upper extremities; during hospitalization he developed acute ischemic stroke for which he received fibrinolytic therapy with rtPA with complete remission of his symptoms; six hours later he developed a new...

We present the case of a 32-years-old female who was admitted to the Neurology Clinic for occipital headache and severe cervical pain. Based on the first investigations (cerebral CT scan, cerebral MRI and cerebral angiography) the diagnose was intraventricular hemorrhage. One year later the patient was hospitalizad again for left cervical and left...