Parkinson’s disease (PD) is the second commonest neurodegenerative disorder in the older adult and is characterized by progressive disabling motor symptoms of bradykinesia, tremor, rigidity, postural instability and also non motor symptoms that affect quality of life. The pharmacotherapy of PD consists of oral, transdermal, and subcutaneous medications, as well as invasive advanced therapies at later stages of the disease. PD medications are often started as monotherapy but with the progression of the illness often there is a need to add more medications and frequently comprises of a challenging polypharmacotherapy. Adverse effects of pharmacotherapy often add to the problems of adequate treatment. Patients and physicians have to prioritize treatment goals on the most disabling symptoms and the safest and most effective treatments. Almost every year newer medications and modes of delivery continue to be researched and added to the therapeutic armamentarium. This review article outlines existing and emerging pharmacotherapies for motor symptoms in PD.

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A 51-year-old male with a past medical history of bicuspid aortic valve, hypertension, and anterior cerebral artery stroke of unclear etiology three months earlier, presented to the Emergency Department with progressive shortness of breath, hemoptysis, and night sweats. The patient's echocardiogram revealed a mobile mass greater than 1.0 cm in diameter on the bicuspid aortic valve, which was not present on the echocardiogram three months prior, during his stroke workup. Per modified Duke's criteria, this patient was found to have 'definite' infective endocarditis despite persistently negative blood cultures. The patient underwent urgent surgical aortic valve replacement and a ventricular septal defect was noted that was not seen on prior imaging. The patient was discharged on intravenous antibiotics and warfarin. The patient was able to return to his normal functional status weeks after surgery, and is continuing to exercise without limitation. This case provides an example of patients with bicuspid aortic valves having an increased propensity for developing infective endocarditis. While also highlighting the interesting intra-operative images and presentation of acute culture-negative endocarditis with vegetation, and the subsequent repair, treatment, and recovery.

Ofatumumab is a monoclonal antibody used in the treatment of recurrent and progressive chronic lymphocytic leukaemia (CLL) and was recently approved for the treatment of multiple sclerosis. We describe the case of a 68-year-old man who presented with complaints of irregular pulse readings while undergoing ofatumumab treatment for recurrent CLL. Electrocardiograms (ECGs) demonstrated premature ventricular contractions (PVCs) which eventually caused cardiomyopathy and failed to resolve despite ablative therapy. Ofatumumab-induced PVCs are confirmed in this case by the existence of documented PVCs on ECGs and the disappearance of these PVCs after the completion of ofatumumab treatment. To the best of our knowledge, there have been no previously reported cases of PVCs associated with ofatumumab in the literature.

Introduction : Obtaining serial head computed tomography (CTH) imaging for patients with spontaneous intracerebral hemorrhage (sICH) is commonly utilized to monitor for hematoma expansion (HE), defined as an increase in ICH volume by 33%. Obtaining recurrent CTH in the ICU setting may burden nursing and transport staff, expose patients to radiation, and inflate healthcare costs. It remains unclear whether utilizing scheduled CTH for sICH patients is more advantageous than targeted CTH, which is prompted by a decline in neurological status. We reviewed clinical factors and imaging studies in patients with and without HE. Methods : This retrospective cohort study conducted over two years identified 171 sICH patients. Patient demographics, clinical and neuroimaging data were recorded (including the reason for repeat imaging). These variables were then compared and analyzed in relation to HE using SPSS version 26, chi‐square tests for categorical variables, and independent‐samples t‐tests were used for continuous variables. Results : Patients were predominantly male (65%), with a mean age of 65±14 years, a median GCS of 14, a median ICH score of 1, and a median ICH volume of 12.1 ccs. Repeat CTH was obtained within 14 hours after the initial imaging on average. Admission blood pressure (BP), BP‐lowering interventions, pre‐admission use of anticoagulant and antiplatelet therapy, GCS on admission, ICH volume, ICH score, and presence of spot signs were similar between the two groups. 15% of total patients (26/171) had HE. In the group that underwent scheduled repeat CTH, only 7% (9 patients) had HE, while the remaining 93% (119 patients) did not. Patients who underwent a second scan following a change in the neurologic assessment included 39% (17 patients) who had HE, compared to 61% (26 patients) that did not. HE detection was significantly lower in patients that underwent scheduled CTH (p < 0.0001). Conclusions : In patients with a stable exam, scheduled head CT only showed HE in 6% of patients; thus, the excess burden, radiation, and costs may not be necessary for these patients. Hematoma expansion is significantly lower in patients who underwent scheduled imaging than those prompted by a decline in neurologic status. However, our sample size is small and additional studies with larger population sizes are required to validate our findings.