Background and purpose Impulse control disorders (ICDs) in Parkinson's disease (PD) are associated primarily with dopamine agonist (DA) use. Comparative surveys of clinical occurrence of impulse control behaviours on longer acting/transdermal DA therapy across age ranges are lacking. The aim of this study was to assess the occurrence of ICDs in PD patients across several European centres treated with short‐ or long‐acting [ropinirole (ROP); pramipexole (PPX)] and transdermal [rotigotine skin patch (RTG)] DAs, based on clinical survey as part of routine clinical care. Methods A survey based on medical records and clinical interviews of patients initiating or initiated on DA treatment (both short‐ and long‐acting, and transdermal) across a broad range of disease stages and age groups was performed. Results Four hundred and twenty‐five cases were included [mean age 68.3 years (range 37–90), mean duration of disease 7.5 years (range 0–37)]. ICD frequencies (as assessed by clinical interview) were significantly lower with RTG (4.9%; P < 0.05) compared with any other assessed DAs except for prolonged release PPX (PPX‐PR). The rate of ICDs for PPX‐PR (6.6%) was significantly lower than for immediate release PPX (PPX‐IR) (19.0%; P < 0.05). Discontinuation rates of DA therapy due to ICDs were low. Conclusion Our data suggest a relatively low rate of ICDs with long‐acting or transdermal DAs, however these preliminary observational data need to be confirmed with prospective studies controlling for possible confounding factors.

Introduction: Consultation of hospitalized patients under the responsibility of other specialties is a very demanding work. However, it is often under-recognized and poorly documented. The aim of the present study was to assess the burden of the inpatient neurology consultation in a Portuguese hospital and to evaluate the performance of our Neurology department regarding this issue. Material and Methods: A retrospective study was conducted during 2013, reviewing clinical and demographic data. Results: Over one year, the neurologists of our department evaluated 632 inpatients. The commonest reasons for consultation were altered mental state/behavior, focal neurological deficit and seizures. Requests came mainly from medical departments but also from Intermediate and Intensive Care Units. Neurologists suggested further investigation in almost one half of patients and management changes in a similar proportion of patients. A new diagnosis could be established in 63% of cases and the most frequent diagnosis were neurological manifestations of systemic disorders, epilepsy and cerebrovascular disease. Our intervention had impact on the care of 68% of patients. Discussion and Conclusion: Different studies in the literature support our findings and highlight the economic and patient care benefits of this activity. Our results suggest that neurological inpatient observation generates useful interventions for the clinical management of these patients.

Background: The assessment of ophthalmic artery flow direction by transcranial Doppler sonography has become part of the cerebrovascular routine examination in stroke patients. It provides helpful information for the investigation of collateral circulation and can evaluate the hemodynamic significance of high-grade internal carotid artery (ICA) stenosis. Our aim was to determine the value of assessing the direction of ophthalmic artery blood flow in the setting of routine color flow duplex ultrasonography examination of patients with ipsilateral carotid disease.

Introduction: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADA-SIL) is a heritable small-vessel disease of the brain characterized by subcortical ischaemic events, cognitive impairment and leukoencephalopathy. The clinical presentation of the disease varies substantially between and within families and might be modulated by gender and common vascular risk factors. Case Report: We present the clinical case of a 57-year-old patient initially misdiagnosed with multiple sclerosis. The case illustrates how important it is to re-evaluate family history and imaging features in clinically non-progressive patients and demonstrates the substantial diversity of CADASIL within family members. In this setting, the approach of minimally symptomatic patients with white matter changes can present some diagnostic challenges. Discussion: This case illustrates the diagnostic challenge of minimally symptomatic CADASIL. The need to reassess the diagnosis in such patients is of uttermost importance, since it has implications for disease management and genetic counseling.

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