Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment in advanced Parkinson’s Disease (PD). However, the effects of STN-DBS on freezing of gait (FOG) are still debated, particularly in the long-term follow-up (≥5-years). The main aim of the current study is to evaluate the long-term effects of STN-DBS on FOG. Twenty STN-DBS treated PD patients were included. Each patient was assessed before surgery through a detailed neurological evaluation, including FOG score, and revaluated in the long-term (median follow-up: 5-years) in different stimulation and drug conditions. In the long term follow-up, FOG score significantly worsened in the off-stimulation/off-medication condition compared with the pre-operative off-medication assessment (z = −1.930; p = 0.05) but not in the on-stimulation/off-medication (z = −0.357; p = 0.721). There was also a significant improvement of FOG at long-term assessment by comparing on-stimulation/off-medication and off-stimulation/off-medication conditions (z = −2.944; p = 0.003). These results highlight the possible beneficial long-term effects of STN-DBS on FOG.

Objective: Nonconvulsive status epilepticus (NCSE) is misdiagnosed in >50% of cases in the emergency department. Computed tomographic perfusion (CTP) has been implemented in the hyperacute setting to detect seizure‐induced hyperperfusion. However, the diagnostic value of CTP is limited by the lack of thresholds for hyperperfusion and high interrater variability. This pilot case–control study aims at identifying the diagnostic value of reverse Tmax (rTmax) in differentiating NCSE from acute ischemic stroke in the hyperacute setting.Methods: We enrolled patients with NCSE (Salzburg criteria‐based diagnosis) and stroke cases 1:1 matched for clinical features and time of presentation. CTP standard maps (mean transit time [MTT]–cerebral blood volume–cerebral blood flow [CBF]) and rTmax maps were elaborated and rated by two experts in CTP blinded to the final diagnosis. Hyperperfusion was adjudicated for standard CTP maps as an increase in CBF and a decrease in MTT, and for rTmax as the presence of a black area on 3‐, 2‐, and 1‐s threshold maps. Cronbach alpha was used for interrater agreement; receiver operating curve analysis was run to measure accuracy with area under the curve.Results: Overall, 34 patients were included (17 NCSE, 17 stroke; time from onset to imaging = 2 h for both groups). People with NCSE were older and more frequently had a history of epilepsy. NCSE patients had hyperperfusion on rTmax maps in 11 of 17 cases versus zero of 17 in stroke. Intra‐ and interrater reliability was higher for rTmax than for standard CTP maps (κ = 1 vs. κ = .6). rTmax was 82% (95%CI = 67–97%) accurate in predicting NCSE versus stroke in the hyperacute setting. Agreement between neuroimaging and electroencephalography (EEG) was limited at a hemispheric level for standard CTP maps, whereas rTMax had agreement with EEG largely reaching the sublobar level.Significance: rTmax mapping might represent a reliable tool to spot NCSE‐induced hyperperfusion with a threshold‐based reproducible approach. Further studies are needed for validation and implementation in the differential diagnosis of focal neurological deficit in the hyperacute setting.

Thoracic outlet syndrome (TOS) is frequently caused by bone abnormalities and congenital or acquired soft-tissue alterations. Among these, isolated Subclavius Muscle (SM) hypertrophy represents a rare condition that could lead to a reduction in costoclavicular space and brachial plexus compression. A 47-year-old forest ranger with a history of gun shooting during animal hunting and training sessions of skeet shooting for 20 years developed TOS due to ultrasonography-detected isolated SM hypertrophy, successfully treated with an ultrasound-guided Botulinum Toxin (BTX)-A injection. In our patient, ultrasonography of the brachial plexus has allowed SM hypertrophy to be recognized and to perform BTX-A injection just in the muscle, with a complete resolution of the symptoms.

Background: To investigate the relevance of hyperperfusion on computerised perfusion imaging (CTP) in the emergency setting in people with non‐convulsive status epilepticus (NCSE) and previous stroke, to derive relevant aspects on the epileptogenic focus and the network recruited for NCSE propagation.Methods: We enrolled consecutive adult patients with acute‐onset NCSE and a previous stroke at a single institution undergoing CTP and EEG during symptoms. All patients underwent standard imaging including CT, CTP, CT angiograms and standard EEG within 30 min from hospital arrival. Age‐/sex‐matched NCSE without previous stroke cases and recurrent ischaemic stroke cases were included to test for accuracy of hyperperfusion rates.Results: Overall, 15 patients had a previous stroke and developed NCSE (mean age 78 years, 46.7% female). All patients had hyperperfusion on CTP imaging (mean onset‐to‐CTP 184 min). Only one case showed hyperperfusion limited to the previous stroke lesion, and one had a combination of lesional and peri‐lesional hyperperfusion. All remaining cases (n = 13) had exclusive extra‐lesional involvement. Five cases had multiple separated hyperperfused areas, and five had ipsilateral intra‐thalamic hyperperfusion. No correlation emerged between onset‐to‐CTP timing and hyperperfusion (p value for CTP = 0.66, CBV = 0.28, MTT = 0.28, reverse T_max = 0.66). Hyperperfusion was present in NCSE cases only and in none of age‐/sex‐matched ischaemic stroke cases (n = 18).Conclusions: Hyperperfusion involves cortical areas external to the previous lesion site during NCSE, supporting the relevance of networks for the spatial evolution of epileptic activity and limited relevance of the lesion site for the propagation of the epileptiform activity.