Bacterial infections and international travel

Having to undertake a trip, whether for business or leisure, it is necessary to gather detailed information about the places one intends to visit, considering the map of countries where the risk of exposure to "traveler's diseases" is highest.

Stroke: ischemic and hemorrhagic

Stroke is a serious disease that occurs as a result of the reduction, or interruption, of blood flow to the brain (by which we mean the brain, cerebellum, and brainstem

Morton’s neuroma

Morton’s Neuroma is a neuropathy consisting of a swelling of a nerve in the foot located between the third and fourth toes. The condition is named after the American surgeon

DEPRESSION: the end of the supremacy of drugs

From the myth of happy pills to integrated care “Like most people I thought antidepressants worked”-so begins the book by Irving Kirsch, professor of psychology at Harvard and Plymouth, now

Family life and obsessive compulsive disorder

Obsessive compulsive disorder is a disease capable of disrupting those affected, completely changing their habits, activities and quality of life, but it extends its consequences to the patient's family causing a difficult and challenging living condition.

Parkinson’s disease: Symptoms, causes and treatment


Parkinson’s disease is a chronic progressive disease; it was first described by James Parkinson in 1817. After dementias, it is the most common neurodegenerative disease.


The condition is equally prevalent worldwide; the average age of onset is between
55 and 60 years of age
and affects
1-2% of the entire population over 65 years of age
; 5% of those affected are under 40 years of age.

In Italy there are about
220 thousand
people affected.


Various risk factors for Parkinson’s disease have been identified, including age, family history, male gender, environmental exposure to herbicides, pesticides, metals (manganese, iron), well water, residence rural, mental and physical trauma, emotional stresses.

A protective factor, on the other hand, is cigarette smoking.

The cause of the disease is unknown, but it is probably the result of an interaction between environmental toxins, genetic susceptibility, and senescence.
Mitochondrial dysfunction and oxidative stress
are now considered among the main mechanisms underlying the disease.

In a .small percentage
of the cases a genetic cause
. Major mutations include those affecting genes coding for
and for

is related to the
degeneration of most of the dopaminergic neurons in the black substance
(nerve structure located at the level of the midbrain). This results in the reduced production of
, a key neurotransmitter in the
regulation of movement
. Symptoms of the disease become apparent
When more than 70 percent
of dopaminergic neurons were lost.

The main alterations involve the
black substance
which appears paler than normal; within it there is a reduction in the number of neurons and in surviving neurons inclusions of a substance called
are the so-called
Lewy bodies
, which are not specific to Parkinson’s disease, as they can also be found in
Lewy body dementia
and in
Alzheimer’s dementia.


The onset is sneaky
with tremor in one hand
, but also often with
joint pain
, depression of mood, easy fatigability.

The cardinal symptoms are
resting tremor
, the
slowness of movement
, also called bradykinesia,

and the
. To these symptoms must be added postural instability. PD is a
asymmetric pathology
in that, especially in the early stages, it affects one half of the body more than the other .

Let us go on to illustrate the basic symptoms.

The resting tremor, present in about 70% of cases, has a frequency of 4-6 shocks per second and at onset affects only one hand and, in particular, the first three fingers, giving the impression of “count coins“; tremor is accentuated under conditions of emotional tension, fatigue, o When the subject feels observed, while it is absent during sleep.

is characterized by an
increased muscle tone
constant resistance
to mobilization. There may be the so-called
cogwheel phenomenon
, in that the presence of resistance to passive mobilization is alternated with
sudden failures
, brings to mind the
clicks of a gear

slowness of movement
(bradykinesia) is the third cardinal sign of the disease, also accompanied by reduced motility. During the march, the subject with PD gives the impression of having the
upper limbs attached
to the body
without the characteristic
pendular movements

Also observed are
difficulties such as using a knife or fork
, buttoning up or
, shave. The writing becomes trembling and uncertain and you shrinks (microgra phy), the facial expressions is reduced (amimia) (Figure 8). The subject, over time, assumes a prone posture with
Head flexed forward and knees and elbows flexed

Postural instability
is the difficulty in maintaining upright station in response to external thrusts; it can be the cause of disastrous falls and is present in about 40% of cases.


Autonomic nervous system involvement is characterized by the presence of
orthostatic hypotension, constipation, sialorrhea, seborrhea, increased sweating
At the level of the head and neck. Urinary disorders may be present such as urinary urgency
and increased
urinary frequencyI

cognitive impairment
, usually moderate, is present in up to 60 percent of cases; there may be impairment of attention, concentration and memory and slowness in performing executive tasks. Unfortunately in some cases until the
in 20%
may be present a
frank dementia
subcortical type

depression of mood tone
is often present but under-diagnosed and under-treated. I sleep-wake rhythm disorders are very common being able to affect up to 90% of people with PD. They can consist of
excessive daytime sleepiness
or in
difficulty in initiating or maintaining sleep
, or in
poor sleep quality with frequent awakenings
and reductions in stages III and IV sleep and REM sleep.


It is mainly based on the recognition of the three main signs
, resting tremor, rigidity and bradykinesia with unilateral onset, and the response to L-DOPA.

CT or MRI scans of the brain are normal or at most can demonstrate the presence of some degree of brain atrophy, which is otherwise highly variable.

The following can be used to assess presynaptic dopaminergic pathways
the SPET-DaT SCAN, which s
erve to show alteration of dopaminergic pathways, but is not always superior to clinical diagnosis.

To assess the degree of disability, the use of Rating Scales is useful. The most widely used are the UPDRS and the Hoehn and Yahr Scale.


Initially there is a good drug response; later, as the disease worsens, the response to drugs worsens and fluctuations appear especially in the area of motor symptoms. These include the on-off phenomenon, sudden lack of response to medication with no relation to the timing of intake; wearing-off, predictable reappearance of parkinsonian symptoms after a number of years due to the shorter duration of response to medication; and freezing of gait or simply freezing, sudden motor blockage that occurs at the onset of walking, or in crossing narrow passages, or in changes of walking direction; in the latter case, the subject reports having his or her feet as if glued to the floor.



Meniere’s Syndrome

Meniere’s syndrome is a balance disorder characterized by recurrent and unpredictable “attacks” involving the onset of intense dizziness, associated with reduced hearing, whistling and buzzing. Each attack is heralded by

Sleep and mood disorders

Sleep disorders and mood disorders are linked by a double thread and articulately affect each other. Decades of studies and clinical-practical experience, both in the field of Sleep Medicine and

Major depression

Major depression (or “major depressive disorder,” as stated in the “Statistical Diagnostic Manual of Mental Disorders – DSM 5”), is a mood disorder that is characterized by the presence of


The term syncope refers to an episode of fainting, that is, a sudden loss of senses, which can affect people of any age and can be induced by a variety


Anxiety or, more precisely, “generalized anxiety disorder,” as stated in the “Statistical Diagnostic Manual of Mental Disorders-DSM 5.” It is a psychiatric illness characterized by: intense and persistent worry and

Spinal canal stenosis

Spinal canal stenosis consists of the narrowing of a section of the canal present along the entire spine (formed by the aligned succession of small holes in the center of

Shock, medical emergency

It may happen that the circulation of blood through the body undergoes a sudden change giving rise to a condition of physiological shock, with decreased flow and crisis on the

Cerebral aneurysm

A cerebral aneurysm is a vascular malformation that presents as a small spherical protrusion or bulge along the wall of an artery present in the brain. Its presence is risky

Ischemic stroke

According to the official definition of the World Health Organization (WHO), stroke corresponds to a “sudden onset of signs and/or symptoms referable to local and/or global deficits in brain function,


Glaucoma is a serious eye disease that can cause blindness, mainly due to increased pressure inside the eye that damages the optic nerve. The disease can occur at any age,

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