Clinical Neuroscience - 1996;49(11-12)

Clinical Neuroscience

NOVEMBER 20, 1996

[Cluster headache and its treatment]

JELENCSIK Ilona

[Cluster headache, one of the most painful conditions known, is encountered infrequently in clinical practice. It is characterized by recurrent, unilateral attacks of severe intensity, brief duration and often accompanied by signs and symptoms of autonomic dysfunction. The actual cause of the pain has not been fully elucidated, but most authors believe that the pain arises as a result of a local vasodilatation with a release of certain neuropeptides to the perivascular tissues, resulting in sterile neurogenic inflammation and oedema. Aetiology is absolutely unknown. Treatment can be given as prophylaxis and/or as a symptomatic acute therapy for individual attacks. In the prophylaxis of episodic cluster headache ergotamine, calciumentry blockers, serotonin inhibitors and steroids are used. In chronic cluster headache lithium is the drug of choice, but verapamil may also be tried. Acute therapy has included ergotamine, oxygen inhalation and sumatriptan. Rarely, surgical intervention may be considered.]

HUN 1996;49(11-12)

Clinical Neuroscience

NOVEMBER 20, 1996

[Experiences with sumatriptan in the treatment of Cluster headache]

JELENCSIK Ilona, BOZSIK György, ÁFRA Judit, ERTSEY Csaba

[Subcutaneously administered sumatriptan 6 mg is rapid, effective and well-tolerated for the acute treatment of cluster headache. Efficacy is maintained in long-term use. The authors report the results of the 5HT1 receptor agonist sumatriptan autoinjector in the treatment of 350 attacks in 20 cluster patients. After 20 minutes post injection the complete dissolution of headache was reported in 95% of the attacks. Slight and transient side-effects were experienced therefore non of the patients were discouraged from using the autoinjector device again. It is essential in the improvement of the quality of life of patients suffering from cluster headache.]

HUN 1996;49(11-12)

Clinical Neuroscience

NOVEMBER 20, 1996

[Quantitative monitoring of EEG variability following subarachnoid hemorrhage]

JUHÁSZ Csaba, VESPA Paul, NUWER R. Marc, MARTIN Neil

[Cerebral vasospasm causing focal ischemia is a frequent complication following subarachnoid hemorrhage. Monitoring of EEG may help to reveal hemispheric dysfunction in the postoperative period. Continuous monitoring of EEG was performed on 8 bipolar channel in 30 patients with subarachnoid hemorrhage during the first two weeks after aneurysm rupture. Computerized trend analysis of 8–16 hours long periods was made. Variability of relative alpha power was evaluated visually on a 4 grade scale and it was also measured quantitatively. EEG data were compared with daily transcranial Doppler values and clinical state. Symptomatic vasospasm was detected in 16 patients while other neurological complications developed in a further 4 cases during monitoring. Significant decrease of variability was observed in all of them. This change developed 1-2 days before other signs of vasospasm in 10 patients. The onset of variability decrease was unilateral in 4 cases. No remarkable decrease of variability was found in patients without neurological complication. Our data confirm that EEG monitoring is a useful tool for sensitively detecting deterioration of brain function. Relative alpha variability is an indicative EEG parameter that can signify hemispheric dysfunction caused by ischemia in an early subclinical stage, when still no Doppler signs of vasospasm or deterioration of clinical symptoms occur.]

HUN 1996;49(11-12)

Clinical Neuroscience

NOVEMBER 20, 1996

[Intravenous perfusion anaesthesia in neurosurgey part two]

HUDVÁGNER Sándor, SZENOHRADSZKY Katalin, VIDA Gabriella, DÓCZI Tamás

[A retrospective analysis of 1300 neurosurgical perfusion narcoses performed by means of intravenously administered propofol-fentanyl-vecuron proved the advantage of this technique over traditional procedures. It decreased the recovery time, the incidence of postoperative nausea and vomiting, and muscle fibrillation. Propofol did not elevate either raised or normal intracranial pressures. Moreover, a trend reduction of raised ICP was observed. The incidence of cardiovascular complications was also reduced. Patients, especially the elderly, had a quick, subjectively well-tolerated induction of sleep and recovery. Comparison of parameters of propofol general anaesthesia with those of "combined balanced narcosis" and "perfusion ataranalgesia” statistically proved the significantly advantage of this new method. The conclusion has been drawn that propofol was a most appropriate drug for neurosurgical anaesthesia. ]

HUN 1996;49(11-12)

Clinical Neuroscience

NOVEMBER 20, 1996

[Post-traumatic ischemic stroke in childhood]

VELKEY Imre, LOMBAY Béla

[A report is given about two children with post-traumatic ischemic stroke. In the first case a blunt head injury, in the second case a minor cervical trauma caused the ischemic cerebrovascular episodes. The diagnosis was made after repeated CT scans by the help by sonography. The possible traumatic origin of acute hemiparesis due to ischemic stroke in children is emphasized. ]

HUN 1996;49(11-12)

Clinical Neuroscience

NOVEMBER 20, 1996

[Repeated stroke, psychotic episode - primary antiphospholipid syndrome?]

CSIBRI Éva, FARKAS Márta

[The antiphospholipid syndrome described some 10 years ago is characterized by a predisposition to arterial and venous thrombosis and the presence of antiphospholipid antibodies. It is often associated with systemic lupus erythematosus, but its primary forms are also well known. Its clinical features are well known in neurology as well as in psychiatry. In this paper we present a case report with therapeutic implications. We discuss the importance of reccurent stroke at a young age in association with the possibility of a rare manifestation of antiphospholipid syndrome: organic brain disease, appearing in the form of schizoaffective psychopathological symptoms.]

HUN 1996;49(11-12)

Clinical Neuroscience

NOVEMBER 20, 1996

[Left median thalamic infract and complex plasy]

VASTAGH Ildikó, FOLYOVICH András, ARÁNYI Zsuzsanna, BODROGI László, TÁRCZY Miklós

[The authors present the case history of a 68-years­ old female patient. The patient, who is known to have hypertension, developed on the day of her admission a short lasting loss of consciousness. Upon recovery the following neurological symptoms were observed: gaze paresis upward and to the right, skew deviation, partial gaze paresis downward, slight right sided hemipares is, ataxia of the right extremities and trunk, right sided hemihypesthesia. Short neuropsychological examination disclosed a speech disorder and the disturbance of abstract thinking. CT scan of the brain showed a congenital arachnoidal cyst in the region of midline cerebellar structures, ischemic infarcts in the right cerebellar hemisphere and in the medial part of the left thala­mus. MRI in addition revealed a 2-3 mm large infarct in the mesencephalon. MR angiography showed a tortuous basilar artery. Neuro-ophthalmological examination and acoustic evoked potentials indicated a functional disturbance at the right side of the brainstem at the level of the pons and midbrain. The authors present a case with a thalamic infarct accompanied by a complex eye movement disorder and cerebellar symptoms. They wish to indicate the role of thalamic infarcts in the development of a sud­den loss of consciousness with successive neuropsy­chological disturbance and gaze palsy.]

HUN 1996;49(11-12)

Clinical Neuroscience

NOVEMBER 20, 1996

[Rehabilitation of communication by computer controlled synthesized speech]

FOLYOVICH András, VASTAGH Ildikó, PATAKI László, CSÜRKI Mária, PATAKI Klára

[A method of speech rehabilitation by computer aided synthesized speech is reported. This method is useful in patients with severe dysarthria, dysphonia and motor aphasia, when agraphia and alexia are not present. The improved communication helps the patients to adapt to their milieu and decreases social isolation. A case history is given of a patient who uses this method successfully during her daily activities. The speech therapy was significantly supported by the use of computer for synthesized speech. The 48-year old woman underwent a cardiac operation (implan tation of artificial valve) due to previous myocarditis and mitral insufficiency before the present neurological complication. She suffered multiple ischemic attacks leading to the loss of motor performance of speech.]

HUN 1996;49(11-12)

Clinical Neuroscience

NOVEMBER 20, 1996

First experiences with MR-compatible implants in the management of Aneurysmal subarachnoid haemorrhage

DÓCZI Tamás, KÖVÉR Ferenc, HORVÁTH Zoltán, MÉSZÁROS István, VADON Gábor

Aneurysm clips made of titanium alloy were considered to be useful for clinical application due to the expected reduction in artifact formation on postoperative CT and MR. First, the behaviour of the new titanium clip (Aesculap) was investigated in phantom experiments in CT and MR scanners. After the in vitro tests had proved the applicability of the new implants, a series of operations was performed employing the new clip in 21 patients and the traditional phynox clip in 17 patients. All patients with a titanium implant had postoperative 11, T2 and proton-weighted MR scans. In 12 cases pre- and postoperative; in 9 cases only postoperative MR angiographies were carried out. In 4 patients both control MR- and catheter angiographies were performed. Clinical results as analysed at least 6 months following the operation were not different from those of 1992 and 1993 of the same team and were comparable to recently published data in the literature. The study has shown that ability to effectively diagnose clip-adjacent brain structures can be improved considerably by employing clips of titanium alloys. Concerning the value of postoperative MR angiography either with or without contrast material to control the effectiveness of aneurysm occlusion, the following conclusion was drawn: while the postoperative potency of the parent artery was clearly visualized in every case, it was impossible to define whether occlusion of the aneurysm had been complete.

ENG 1996;49(11-12)

Clinical Neuroscience

NOVEMBER 20, 1996

[Hungarian Society of Neurologists and Mental Physicians SZOTE neurological round table]

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HUN 1996;49(11-12)