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Clinical Neuroscience - 1997;50(05-06)
Content
Clinical Neuroscience
MAY 20, 1997
[Effects of Propofol and Thiopental on median nerve somatosensory evoked potentials and cerebral blood velocity]
[Effects of induction doses of thiopental and propofol on median nerve somatosensory evoked potentials and cerebral blood flow velocity were investigated in 50 patients suffering from degenerative lumbar spine diseases before operation and during anaesthesia. The propofol influences the cerebral electric activity and the blood flow velocity to a less extend than thiopental. Based on our results we prefer to employ propofol during neurosurgical procedures when using intraoperativ somatosensory evoked potentials and/or transcranial Doppler monitoring. ]
Clinical Neuroscience
MAY 20, 1997
[Three dimensional time of flight magnetic resonance imaging in trigeminal neuralgia]
[The purpose of our study was to evaluate the role of three dimensional time of flight magnetic resonance angiography in detection of neurovascular compression in patients with trigeminal neuralgia. 53 patients (26 males, 27 females mean age 57 years) with trigeminal neuralgia underwent 3D TOF MRA. Examinations were performed on 0.5 T Elscint Gyrex V Dlx equipment. The imaging parameters were 33-38/9/25 TR/TE/flip angle with 30-50 mm slab thickness and 1-1.5 mm slice thickness. Contrast material was administered in every case. Maximum intensity projection and thin slice reconstruction (pixel by pixel) were performed in three standard directions (axial, coronal and sagittal). To evaluate the presence or absence of vascular contact, we used both the source slices and reconstructed pictures. Vascular contact with the trigeminal nerve in the entry zone was identified on the symptomatic side in 26 cases (superior cerebellar artery in 20, superior cerebellar artery and vein in one, anterior inferior cerebellar artery in 2, basilar artery or a vein in 1-1 case) and on the asymptomatic side in 3 cases (superior cerebellar arteries). No contact was detected in 24 patients. The examination was not of diagnostic value in three cases, because of head motion artefacts. Veins were better visualized on the contrast pictures. Microvascular decompression sec. Janetta was performed in 9 cases. The surgical and neuroradiological findings were identical in every case. Complete pain relief or significant diminshing of the symptoms were achieved following surgery in all patients. 3D TOF MRA is a useful method in demonstration of vascular contact with the trigeminal nerve at the entry zone, which is valuable information in planning surgical treatment for patients with trigeminal neuralgia.]
Clinical Neuroscience
MAY 20, 1997
[Uremic polyneuropathy - clinical and electrophysiological analysis]
[Uremic polyneuropathy is a consequence of chronic renal failure, and is one of the symptoms of the uremic syndrome. Its etiology is not well known, several neurotoxins are presumed as pathogenic factors. Both axonal lesions and demyelinization are involved in the development of neuropathy 66 electrophysiological studies (EMG, ENG) in 57 uremic patients were performed in our department between 1978 and 1988. The correlation between clinical and electrophysiological findings are discussed. Clinical or neurographic and myographic signs of neuropathy were found in 50/57 of the patients. The number of electrophysiological signs changes parallely with the severity of uremic neuropathy. There was significant correlation between the decreased plasma calcium levels, the elevated plasma phosphate levels, and the severity of neuropathy. The electrophysiological symptoms are more frequent in cases of rapidly progressive neuropathy. Peripheral nerve pathophysiology reveals a combination of segmental demyelinization and axonal degeneration.]
Clinical Neuroscience
MAY 20, 1997
[Mental disorders after stroke (treatment of post-stroke depression with moclobemide)]
[Post-stroke states are usually characterized by residual neurologic symptoms and movement performance, while psychological disturbances remain hidden. Stroke patients frequently present mood disturbances, cognitive decline, anxiety disorders, sometimes serious schizophorm and paranoid states. Among them, post-stroke depression is the most common and possibly amenable form to therapeutic intervention. Depression has negative effect on rehabilitation, quality of life and even long term survival. Biological, psychological and social factors play an important role in the etiology of post stroke depression. The psychotherapeutic approach is so far undeveloped; considering drug therapy, in the past decade tricyclic drugs have been replaced by newly developed second generation antidepressants with lower side-effects profile. In our experience 6-week treatment with moclobemide in 33 patients resulted in symptom reduction in 80%. Appropriate therapy extends the possibilities of rehabilitation, improves the quality of life, and reduces mortality.]
Clinical Neuroscience
MAY 20, 1997
[The genetic diagnosis of leber's hereditary optic neuropathy]
[We observed the occurence of Leber's hereditary optic neuropathy associated mitochondrial point mutations in patients with bilateral optic neuropathy. DNA samples isolated from peripheral venous blood by the phenol/chloroform method were tested with the help of PCR for the pathogenic Leber's hereditary optic neuropathy associated mitochondrial point mutations. From 14 patients suffering from bilateral visual impairment Leber's hereditary optic neuropathy associated mitochondrial point mutations were found in 5 cases. The patients were previously treated with optic neuritis or with toxic optic neuropathy. By testing the relatives of the patients some asymp tomatic Leber positive cases were observed, too. The diagnosis of Leber's hereditary optic neuropathy is based on the occurence of mitochondrial point mutations. To test for these mutations can help in the clinical practice in diagnosing bilateral optic neuropathies. In patients with the pathogenic Leber mutations the development of the clinical symptoms does not occure necessarily, however the other mechanisms determining the clinical picture are not known so far.]
Clinical Neuroscience
MAY 20, 1997
[Anatomical basis of endoscopic ventriculostomy - clinical application of the free hand technique]
[The anatomical basis of the "free hand” technique in treatment of occlusive internal hydrocephalus, viz. endoscopic ventriculostomy, is discussed. In 25 cadavers the cella media of the lateral ventricle was endoscopically approached through a frontoparietal (15 cases), frontal (5) and biportal coronal (5) burr hole. Using the identified structure of the choroid plexus the foramen of Monro was investigated. Via this route, the endoscope advanced into the 3rd ventricle, then the localization of ventricular perforation was determined by first visualizing the mamillary bodies and the infundibular recess. Ventricular anatomy was also investigated in 50 fixed human brains. Between October and December 1995 endoscopic ventricular fenestration using a frontoparietal burr hole was performed on 3 patients without stereotactic localization. In one case the serious condition of the patient, in the other two cases the enormous supratentorial hydrocephalus required the application of the free hand technique. ]
Clinical Neuroscience
MAY 20, 1997
[Analysis of the EEG changes caused by subcortical stroke based on chaos theory ]
[The conventional electrophysiological methods used to analyse the functional characteristics of the nervous system are not able to grasp its non-linear and random features. Of the methods based on chaos theory, correlation dimension analysis can be used to quantify the complexity of the analysed signal, such as the elektroencefalogram. The new version of this method - developed by the authors -, the point correlation dimension is more accurate than other currently used algorithms. The purpose of the present paper is to compare the sensitivity of the conventional electrophysiological methods with those developed on the basis of chaos theory in a case where a small subcortical stroke was present. By mapping the scalp distribution of the point correlation dimension of the electroencephalogram, recorded when the patient had no neurological symptoms, a significantly low dimensional area - as compared to the contralateral side - was seen in the parietal region, ipsilateral to the stroke. Only modest changes were seen in the corresponding frequency power spectra, however. The authors suggest that the two different methods of analysis may well complement each other. ]
Clinical Neuroscience
MAY 20, 1997
[Hungarian Society of Neurologists and Mental Physicians SZOTE neurological round table]
[Extrapyramidal diseases. The activity of SZOTE Neurology "Extrapyramidal Outpatient Clinic" (diagnostic and therapeutic principles). Autonomic nervous system disorders and their treatment in Parkinson's disease. Options for neuroprotective treatment in Parkinson's disease. Therapy for epilepsy. Strategy for the use of antiepileptic drugs. Relationship between antiepileptic drugs and the endocrine system. Teratogenic effects of antiepileptic drugs. Difficulties in caring for patients with epilepsy in some cases. Cases of untyped leukodystrophy in the setting of symptomatic focal epilepsy. Evaluation of surgical outcome of epilepsy using quality of life measurement. Interactions between antiepileptics and oral anticoncipients: the experience of a survey.]
Clinical Neuroscience
MAY 20, 1997
[Report on Parkinson's Disease XII. international symposium]
[A major scientific meeting on this topic was held in London from 23 to 26 March 1997 at the Queen Elizabeth II Convention Centre, near Westminster. Two of the symposia held prior to the Congress should be highlighted: a round table on the role of the glutamate system in the treatment of Parkinson's disease, organised by Merz (Frankfurt), and a press conference on the issue of multisystem atrophies (MSA). ]
Clinical Neuroscience
MAY 20, 1997
[Hungarian branch of the International Antiepileptic League]
[Eyelid myoclonia with absences. Dysplasias of cerebral cortex and epilepsy.]
Clinical Neuroscience
MAY 20, 1997
[Horányi Béla klinikai idegtudományi társaság]
[Lecture given at the unveiling of the bronze statue of Professor Béla Horányi, 28 November 1996, in the classrooms of the Departments of Neurology and Psychiatry and Psychotherapy of the SOTE. ]
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