Razvan Adrian Bertici

Cerebral venous sinus thrombosis (CVST) is an uncommon cerebrovascular disorder with heterogeneous manifestations and may occasionally precede the diagnosis of an underlying malignancy. We report the case of a 24-year-old man who presented with recurrent fever, headache, pharyngodynia, and systemic inflammation initially attributed to a sinonasal or odontogenic infectious process. He subsequently developed binocular horizontal diplopia, left abducens nerve palsy, papilledema, severe headache, and nausea. Neuroimaging demonstrated extensive CVST involving the left internal jugular vein, bilateral transverse sinuses, and superior sagittal sinus, without ischemic, hemorrhagic, or tumoral brain parenchymal lesions. Thrombophilia testing identified heterozygous prothrombin G20210A as the only established inherited thrombophilic factor. Despite initial neurological stabilization, the patient developed a rapidly recurrent frontal calvarial, epicranial, and cranio-dural lesion extending toward the superior sagittal sinus, without brain parenchymal involvement or imaging evidence of leptomeningeal disease. Initial morphological assessment suggested Langerhans cell histiocytosis. However, comprehensive histopathological and immunohistochemical reassessment demonstrated diffuse strong CD30 expression, nuclear and cytoplasmic ALK positivity, CD43 expression, and focal epithelial membrane antigen and granzyme B positivity, while CD1a and S100 were negative. These findings established the diagnosis of systemic ALK-positive anaplastic large cell lymphoma with secondary extra-axial cranio-dural involvement. Systemic staging demonstrated disseminated nodal disease and a noncontiguous cranio-dural extranodal lesion, consistent with stage IV disease. Treatment with anticoagulation and six cycles of brentuximab vedotin combined with cyclophosphamide, doxorubicin, and prednisone resulted in a favorable neurological and oncological outcome, with no metabolically active or residual enhancing disease on follow-up imaging. This case emphasizes the importance of continued etiological investigation in young patients with extensive CVST and an atypical clinical course, even when plausible infectious and inherited thrombotic risk factors coexist.

Background: The coexistence of systemic prothrombotic disorders, chronic thromboembolic pulmonary hypertension (CTEPH), chronic hypoxia, and cerebrovascular thrombosis creates complex diagnostic and therapeutic challenges. Case summary: We report the case of a 52-year-old woman with JAK2V617F-positive polycythemia vera, inherited thrombophilic abnormalities, recurrent pulmonary thromboembolism progressing to severe CTEPH, chronic hypoxemia, cerebral venous sinus thrombosis, and right vertebral artery occlusion. Management challenge: The case illustrates persistent thrombotic risk despite anticoagulation, the need for disease-directed cytoreduction, limited access to CTEPH-directed interventional treatment, neurological vulnerability despite preserved brain parenchymal integrity, and the narrow therapeutic margin created by the combined use of anticoagulant, cytoreductive, and pulmonary vasodilator therapy. Particular emphasis is placed on the competing risks of recurrent thrombosis and hemorrhagic complications, especially in the cerebrovascular territory. Conclusion: This case highlights the need for repeated multidisciplinary reassessment in patients with overlapping hematological, pulmonary, and neurological vascular disease. Improved survival in patients with severe multisystemic conditions may increase the clinical relevance of complex presentations requiring coordinated management. Further evidence is needed to support safer, more standardized treatment strategies for patients requiring simultaneous control of thrombosis, pulmonary vascular disease, myeloproliferation, hypoxia, and treatment-related bleeding risk.

Aphasia is a complex neurological syndrome that includes a multitude of signs and symptoms that describe a patient’s inability to use language (understanding and producing spoken and/or written language) after it has already been acquired, which is caused by cerebral lesions situated in the dominant (left) cerebral hemisphere in right-handed people. Aphasia has a prevalence of 25–30% in acute ischemic stroke (especially in arterial infarcts). In patients who suffered cerebral venous and dural sinuses thrombosis (CVST), aphasia has been noticed in almost 20% of cases, its presence being considered a negative predictive factor. We report the case of a 22-year-old right-handed woman with obesity and active smoking (10 cigarettes/day), undergoing treatment with oral contraceptives who presented to the Emergency Department with an intense headache, resistant to usual analgesic treatment, accompanied by language disorders onset within 24 h. The neurological examination was normal, except for language assessment, which revealed the severe impairment of the repetition domain (she was unable to repeat simple words), and difficulty in naming objects with some hesitations and mild comprehension difficulties (especially in complex orders). She underwent neuroimaging examinations at admission. Native Head Computed Tomography revealed spontaneous hyperdensity (parenchymatous hematoma) in the left temporal lobe. Cranial magnetic resonance imaging (MRI) confirmed venous infarction in the left temporal area and a hypointense signal on MRI T2*SW (susceptibility-weighted) in the region of the left lateral sinus and left jugular vein bulb, which confirmed the thrombosis at this level. Associated cortical vein thrombosis was diagnosed on indirect radiological grounds, since hemorrhagic transformation obscured the direct visualization of the adjacent cortical veins. MR venography was not performed at that time, but instead at the 1-month follow-up, MR venography confirmed the chronic, partial thrombosis of the left lateral sinus and left jugular vein bulb. Laboratory data demonstrated an elevated D-dimer and the presence of homozygosity for MTHFR C677T and PAI-1 4G/4G. Anticoagulation in the form of low-molecular-weight heparin was immediately started, followed by chronic treatment with oral anticoagulant (apixaban) and folic acid. The headaches resolved within three days, and her neurological examination was almost normal: the repetition continued being altered for complex phrases. We did not observe any left lateral sinus thrombosis recurrence, or other extra-cerebral embolic events (deep vein thrombosis or pulmonary embolism) during the follow-up year. The immediate anticoagulation since the admission resulted in a favorable outcome. Taking into consideration our interest in monitoring patients with aphasia secondary to CVST, we also analyzed data from the literature regarding the incidence of conduction aphasia and other aphasic syndromes in this CVST. Due to the limited number of articles identified in the last 21 years (2005–2026) in the literature, we concluded that conduction aphasia is an extremely rare clinical presentation in this kind of pathology and further studies should be conducted in order to identify significant statistical data.

Cerebral venous sinus thrombosis (CVST) is a rare form of stroke with heterogeneous clinical presentation and etiological profile. This study aimed to evaluate the demographic, clinical, imaging, etiological, treatment, and outcome characteristics of CVST in a Romanian population. We conducted a retrospective monocentric cohort study including 55 patients diagnosed over a six-year period in a tertiary neurological center. CVST accounted for 1.2% of all stroke cases, with an incidence of 13.75 per million per year. Gender distribution was relatively balanced, differing from international cohorts, and traditional female-specific risk factors were less prominent. Thrombophilia (68.6%) and infections (38.2%) were the most frequent etiologies. Younger patients were more frequently associated with thrombophilia, while a higher inflammatory response was observed in older individuals; additionally, female patients showed a higher prevalence of the MTHFR C677T mutation. Transverse and sigmoid sinuses were the most affected, while cavernous sinus involvement was more frequent than typically reported and associated with infections. At discharge, long-term anticoagulation was recommended in 67.3% of patients, tailored to underlying etiology and risk profile. Outcomes were favorable, with 70–80% achieving a modified Rankin Scale score ≤2 at discharge and over 90% at 90-day follow-up, despite inconsistent correlation with imaging findings. These results highlight the heterogeneous nature of CVST and the need for comprehensive, individualized evaluation and management.

Vascular cognitive impairment (VCI) includes any degree of cognitive impairment, from subjective cognitive decline to mild cognitive impairment, to dementia that shares a presumed vascular cause (stroke and/or vascular risk factors) alone or in combination (additive or synergistic interactions) with neurodegenerative pathology. The vascular contribution to dementia represents at least 20–40% of all dementia cases. On one hand, cognitive decline produced by an acute stroke is the most well-known type of VCI; on the other hand, different cerebrovascular diseases, especially subclinical cerebral white matter lesions and subclinical microinfarcts (representing types of cerebral small-vessel diseases), can determine insidious cognitive decline. The most important mechanism of VCI is chronic age-related dysregulation of cerebral blood flow. If vascular risk factors are detected in midlife, they envisage cognitive impairment later in life. In this chapter, we present recent data concerning the epidemiology, mechanisms, diagnostic criteria, neuroimaging features, and vascular risk factors of VCI.

Estrogens are cholesterol-derived hormones, with four endogenous estrogens being presented in the scientific literature, namely, estradiol, estrone, estriol, and estetrol. In this study, we aim to obtain a complete thermoanalytical profile for the three most important endogenous estrogens: estradiol, estriol, and estrone. To achieve this, the TG/DTG were registered in non-isothermal conditions at five different heating rates (β = 2, 4, 6, 8, and 10 °C min⁻¹). To describe the mechanisms of the degradation processes, a complex kinetic analysis was performed by applying a preliminary method (ASTM E698), two isoconversional methods (Flynn–Wall–Ozawa and Friedman), and the non-parametric kinetic method. The results indicate that estradiol undergoes a single-step degradation process, while estriol and estrone present a complex degradation process. The determination of the shelf life of pharmaceutical products represents a critical factor in ensuring their safety and efficacy. This parameter can be estimated from the activation energy derived from non-isothermal experiments through the application of the Arrhenius equation and appropriate kinetic models.

Estrogens represent a class of cholesterol-derived female sex hormones, essential in the regulation of numerous physiological processes. On the basis of their origin, they can be classified into endogenous (synthesized within the body) or exogenous (introduced from external sources) compounds. In humans, four types of endogenous estrogens have been identified, namely estrone, 17-β-estradiol, estriol, and estetrol. Despite their similarities in chemical structures, they have distinct receptor affinities and functional roles at different life stages. This review presents, in addition to an overview of their diverse physiological functions, a discussion of the three estrogen receptors (ERα, ERβ, and GPER1) currently investigated as possible targets in the development of new therapeutic strategies for hormone-dependent breast cancer.

Background/Objectives: In the past two decades, the primary therapeutic use of sildenafil has shifted significantly, from the treatment of angina to managing erectile dysfunction, and since the early 2000s it has been used in the treatment of pulmonary hypertension, particularly pulmonary arterial hypertension. Sildenafil is used as a citrate salt; after oral administration, it presents an absorption of ~90% and an absolute bioavailability of 38%, due to the first-pass effect, such that it belongs to class II of the Biopharmaceutics Classification System. Currently, studies are seeking to obtain new pharmaceutical formulations with an optimized biopharmaceutical profile. In this study, an inclusion complex of sildenafil citrate and 2-hydroxypropyl-beta-cyclodextrin in a molar ratio of 1:1 was obtained and its pharmaceutical compatibility with six pharmaceutical excipients was assessed. For three of these excipients, the presence of chemical interactions with sildenafil citrate has been presented in the literature, and for the other three, compatibility has not been evaluated. Methods: To certify the stoichiometry of the obtained inclusion complex molecular modeling, Job’s method and the Benesi–Hildebrand method were employed. Furthermore, we have described the inclusion complex and the obtained binary mixtures via ATR-FTIR and thermal (TG/DTG and DSC) analysis. Results: The results indicated a lack of chemical interactions between the inclusion complex and the six pharmaceutical excipients at ambient temperature (confirmed by ATR–FTIR investigations) and the presence of chemical interactions between the inclusion complex and three of the excipients when the mixture was heated under non-isothermal conditions (TG/DTG and DSC investigations). Conclusions: This study describes the inclusion complex between sildenafil citrate and 2-hydroxypropyl-beta-cyclodextrin in a molar ratio of 1:1 and its compatibility with several pharmaceutical excipients, results with further applications in the preformulation stage of novel delivery systems.

Tuberculosis and parasitic infections, including Toxocara, frequently coexist in many regions worldwide, yet their interaction remains poorly understood. Tuberculosis triggers a type 1 immune response characterized by IL-12, IFN-γ, and TNF-α production, while toxocariasis elicits a type 2 response, mediated by cytokines such as IL-4, IL-5, IL-13, and IL-33. The coexistence of these divergent immune pathways can disrupt immune regulation and impair the host’s ability to control both infections, potentially leading to persistent hypereosinophilia. We illustrate this complex interplay through a real-world case involving a heavy smoker in whom Toxocara infection likely reactivated latent tuberculosis, resulting in severe, unexplained hypereosinophilia and late-onset asthma with recurrent exacerbations. After excluding other causes and completing full antituberculosis therapy along with three courses of antiparasitic treatment and systemic corticosteroids, hypereosinophilia persisted. The introduction of benralizumab, a biologic therapy targeting IL-5Rα, led to a rapid reduction in eosinophils to normal ranges and significant clinical improvement. This case underscores the diagnostic and therapeutic challenges posed by the intersection of common infections and highlights that even a neglected parasitic infection such as toxocariasis can underlie severe respiratory complications with eosinophilia, where paradoxically biologic therapy may ultimately provide a very effective intervention.

Angiotensin II receptor antagonists are tetrazole derivatives used in the treatment of high blood pressure, and are also indicated for the treatment of heart failure (NYHA class II-IV). They are used alone or in combination with other classes of antihypertensives or diuretics for the effective management of high blood pressure. In this study, we aim to evaluate the thermal stability and degradation kinetics for the principal compounds used in therapy from this class, namely telmisartan, valsartan, olmesartan medoxomil, and losartan potassium. To obtain the thermoanalytical data for the kinetic investigations, the TG and DTG curves were registered at five different heating rates (β = 2, 4, 6, 8, and 10 °C min⁻¹). The kinetic methods used were a preliminary ASTM E698 method and two isoconversional methods: Flynn–Wall–Ozawa and Friedman. For each molecule, the results showed complex decomposition processes consisting of complex reaction sequences.