Worldwide, stroke represents one of the first causes of death and disability, as well as reduction in the average quality of life (QoL).

In the last 20 years, the incidence of stroke has significantly increased by more than 70% due to multifactorial causes.

There are two primary types of strokes: ischemic stroke, which is caused by a blood vessel blockage, and hemorrhagic stroke, which is brought on by brain bleeding.

Recognizing the symptoms is crucial for prompt medical intervention. In fact, within minutes, brain cells start to die, potentially resulting in long-term disability or even death.

If you experience any stroke symptoms, think "FAST":

• Face: sudden numbness or weakness in the face. Does one side drop?
• Arms: can both arms be lifted up? Is one dropping?
• Speech: difficulty speaking or understanding speech
• Time: call emergency medical assistance if you notice any of these symptoms.

Strokes can affect anyone, but certain risk factors, such as high blood pressure, smoking, obesity, and diabetes, increase the likelihood.

Immediate medical care is vital to minimize damage and improve outcomes, requiring emergency treatment.

Whether the two types of strokes may have similar symptoms, treatment is different.

For ischemic stroke, a wide range of treatments are offered to patients: medical, endovascular, or surgical therapies.

• Medical therapies range from the administration of clot-busting drugs like tissue plasminogen activator (tPA), which aim to dissolve clots and restore blood flow, to treating some other diseases like atrial fibrillation, which is the main cause of cardioembolic ischemic stroke.
• Endovascular treatments, such as mechanical thrombectomy, involve the removal of blood clots from blocked arteries using devices (catheters).
• Surgical treatment consists of removing potential causes of stroke (carotid endarterectomy to remove atherosclerotic plaques) or increasing brain blood flow with a cerebral bypass.

For hemorrhagic stroke, treatment is aimed at surgical removal of the hematoma and treatment of eventual underlying vascular malformations that caused the bleeding (aneurysms, arteriovenous malformations, cavernomas, etc.).

Cerebral aneurysms can be treated microsurgically (clipping) or endovascularly (coiling or stenting).

Arteriovenous malformations (AVM) can be treated surgically (removal of the AVM), endovascularly (excluding the AVM from the circulation), or with radiotherapy. A combination of the three techniques in some cases can also be indicated.

Cavernomas can be removed with microsurgical intervention.

Following the acute phase, neurorehabilitation plays a crucial role in stroke recovery. Physical therapy, occupational therapy, and speech therapy are often employed to restore mobility, regain independence in daily activities, and address communication difficulties.

In order to advance stroke prevention, treatment, and rehabilitation, research is essential.

Brain tumors account for 85-90% of all primary central nervous system (CNS) tumors. Worldwide, an estimated 308,102 people were diagnosed with a primary brain or spinal cord tumor in 2020.

It is also estimated that 5,230 children under the age of 20 will also be diagnosed with a CNS tumor in the United States in 2023.

Brain tumors differentiate into primary and secondary (metastases), which originate from other parts of the body and then spread intracranially.

Symptoms of brain tumors can vary depending on the location, size, and growth rate of the tumor. Common symptoms include persistent headaches, seizures, changes in vision or hearing, difficulty with coordination and balance, cognitive impairment, and personality changes. However, the manifestation of symptoms can differ from person to person, making diagnosis and treatment challenging.

The impact of such a disease extends beyond the patients themselves, affecting their families, caregivers, and communities.

Treatment opportunities depend on many variables. Surgery is of great importance, with the purpose of removing the mass from the brain and avoiding further growth and complications. Complementary are also radiotherapy and chemotherapy, often used in combination to achieve the best possible outcome.

New frontiers are currently being explored:

• targeted therapies, that focus on specific genetic alterations in tumor cells
• immunotherapy, which stimulates the immune system to fight against cancer
• focused ultrasound and laser interstitial thermal therapy, which are showing promising results in minimizing damage to healthy brain tissue.

Traumatic Brain Injuries (TBI) are severe medical conditions resulting from external forces impacting the head, leading to potential long-term cognitive, physical, and emotional impairments.

They are considered a major source of disability and death worldwide. 

In fact, the annual incidence of TBI with diverse causes such as motor vehicle accidents, falls, sports-related injuries, and violent assaults is variably estimated at 27 to 69 million worldwide.

Because of the life-threatening consequences, a high number of deaths are reported, and survivors very often live with significant disabilities.

Surgical techniques such as craniotomy, decompressive craniectomy, and intracranial pressure monitoring play a crucial role in the management of severe TBI, aiming to alleviate intracranial pressure caused by bleeding or swelling within the brain, thus preventing further damage.

These procedures not only reduce the risk of secondary brain injury but also provide an opportunity for subsequent interventions during the recovery phase.

Following surgical intervention, patients with TBI require specialized care in neurological intensive care units (NICUs), which closely observe intracranial pressure, cerebral perfusion, and vital signs.

Multidisciplinary teams consisting of neurosurgeons, neurologists, neurointensive care specialists, anesthesiologists, nurses, and rehabilitation professionals collaborate to manage complications and optimize patient outcomes.

Thereafter, the importance of neurorehabilitation, which is a fundamental step for patients after a TBI. The goal of rehabilitation is to promote functional recovery, improve independence, and enhance the overall quality of life.

Dementia and Alzheimer's disease are intricately linked conditions that have garnered significant interest from researchers, medical practitioners, and society.

Worldwide, more than 55 million people are living with Alzheimer's and other forms of dementia. If breakthroughs are not discovered, this number will almost double every 20 years, reaching 78 million in 2030 and 139 million in 2050.

According to the Swiss Federation of Public Health (FOPH), in Switzerland, the number of patients with dementia is estimated at around 150.000. Every year, around 32.200 new cases are diagnosed (2022), with a tendency to increase. 

The term "dementia" dates back to ancient times, appearing in medical texts as early as 2000 BCE. However, it was not until the late 19th century that advancements in medical knowledge allowed for a more systematic understanding of the condition.

Significant advancements have been achieved in our understanding of the mechanics and causes of dementia throughout the past century. Beta-amyloid plaques and tau protein tangles in Alzheimer’s disease have been linked to disruptions in brain function, according to recent research. Genetic factors have also been explored, such as mutations in the presenilin genes, which contribute to early-onset familial Alzheimer's disease.

Furthermore, improvements in neuroimaging methods have made it possible for researchers to see the structural and functional changes in the dementia-related brain. Cerebrospinal fluid analysis, positron emission tomography (PET), and magnetic resonance imaging (MRI) have all helped with earlier detection and more precise diagnoses.

The first symptoms may vary and occur after a long time, usually with an individual experiencing periodic disorientation, slight amnesia, and verbal difficulty. Memory loss worsens with the progression of the illness, making it difficult to recall recent events or identify familiar faces.

Impaired judgment, personality changes, and trouble solving problems are frequently tied to dementia progression. Simple things like managing money or adhering to instructions become more difficult, as does communication impairment, which makes it harder to articulate ideas or follow conversations.

Patients with dementia need assistance with basic everyday tasks as the disease progresses to its final stages, when they might get extremely disoriented, forget where they are and when they were there, and modify their behavior to become agitated or aggressive. In the end, it becomes harder to identify loved ones and have meaningful conversations.

Parkinson's disease (PD) is a chronic neurodegenerative disorder that affects millions of individuals worldwide. It is prevalent globally, with estimates suggesting that approximately 60 million patients are currently affected.

The prevalence of PD increases with age, making it more common among the elderly. It is reported that almost 2% of individuals over the age of 60 are affected.

The typical symptoms include:

• bradykinesia (slowness of movement)
• resting tremors
• rigidity
• postural instability

Additionally, individuals may experience non-motor symptoms such as depression, sleep disturbances, cognitive impairments, and autonomic dysfunction.

Early diagnosis is therefore challenging due to the diverse range of symptoms.

Currently, several treatment approaches aim to manage symptoms and improve quality of life.

Medical therapy, such as Levodopa, a precursor of dopamine, remains the gold standard for motor symptom management. Other medications, like dopamine agonists, MAO-B inhibitors, and COMT inhibitors, complement levodopa therapy.

Surgical interventions are also used, especially in cases where advanced Parkinson’s disease compromises patients’ quality of life. In these cases, deep brain stimulation (DBS) is indicated, which involves placing small electrodes in particular areas of the brain responsible for the symptomatology.