Clinical Neuroscience

[8th Hungarian Congress on AlzheimerAbstracts]

OCTOBER 10, 2004

Clinical Neuroscience - 2004;57(09-10)

[Despite of the now well-recognised importance of trace elements in medical field - it is established that several diseases of the central nervous system, like Alzheimer’s disease are connected to alterations of trace elements levels - reliable data on their concentrations in normal and pathological human brain are still rare. Correlation studies are even more scarce in the literature, especially in case of Alzheimer’s disease.]

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Clinical Neuroscience

[Functional imaging of cerebrospinal fluid pathology]

BORBÉLY Katalin

[The most common problem addressed by dynamic radionuclide imaging of cerebrospinal fluid (CSF) abnormalities is differentiating patients with normal-pressure hydrocephalus (NPH) from those with other forms of degenerative brain disorder who would clearly not benefit from surgical treatment by ventricular shunting. Radionuclide cisternography (RC) SPECT and regional cerebral blood flow (rCBF) SPECT are critically important for the diagnosis and therapy management of patients with chronic hydrocephalus. However, radionuclide imaging is helpful not only in identifying patients with NPH showing improvement after shunting. RC reveals tracer activity outside the intracranial cavity, indeed. The importance of establishing the diagnosis arises from the fact that untreated leaks can be followed by meningitis in up to one quarter of patients. CSF collections may communicate with the subarachnoid space. RC SPECT has proved useful in assessing the communication of the arachnoid cysts (CSF collection) with the ventricular or subarachnoid compartment. Improved anatomical detail revealed by SPECT imaging is helpful in solving problems of the CSF pathology. Sensitive and accurate assessments of normal and disordered CSF dynamics can be obtained with RC SPECT.]

Clinical Neuroscience

[Traumatic prepontine tension pneumocephalus (in English language)]

KUNCZ Ádám, ROOS Arne, LUJBER László, HAAS Daniella, REFAI Al Mohamed

[Objective - A case of prepontine tension pneumocephalus after temporal bone fracture is presented. Case report - An 8-year-old girl suffered a head injury due to a fall off her bicycle. She lost her consciousness, and when she was admitted to the local hospital the Glasgow Coma Score (GCS) was 8/15 (eye opening: 2; verbal answer: 2; motor response: 4) and there was bleeding from the right ear. The patient's condition deteriorated rapidly and she needed intubation and ventilation. CT of the brain revealed large amount of air in the prepontine region, displacing the brainstem posteriorly. Patient was kept ventilated, meanwhile cerebrospinal fluid (CSF), as otorrhea appeared on the right side. CT was repeated 36 hours later, showing significantly less air in the prepontine area. The patient was weaned off the respirator, extubated and the level of consciusness improved. Later the patient developed meningitis, which was treated by systemic antibiotics with lumbar CSF drainage applied for five days. A high resolution CT scan of the petrous bone revealed a fracture crossing the middle part of the pyramid. Patient showed a full recovery except a right-sided mixed hearing loss. Conclusion - Rapid neurological deterioration following head injury can be a consequence of tension pneumocephalus. Prepontine pneumocephalus can be caused by minor fracture of petrous bone. High resolution CT is necessary to visualize minor fracture of the petrous bone. Conservative treatment may be satisfactory to treat tension hydrocephalus.]

Clinical Neuroscience

[“From brain - through mind - to society” 13th International Semmelweis Symposium Abstracts]

Clinical Neuroscience

[“From brain - through mind - to society” 13th International Semmelweis Symposium]

Clinical Neuroscience

[Dysexecutive syndromes]

SZIRMAI Imre

[Executive function is a higher order cognitive capacity that involves memory, perception and performance of complex tasks. Disorders of the executive functions are sign of lesions in the praefrontal cortex, involving the praefrontal-striatal-thalamic networks and the parietal association areas. According to signs and localization, five basic praefrontal syndromes are recognised. 1. Damage in posterior dorsolateral praefrontal cortex and subcortical nuclei causes the dorsolateral syndrome with impaired decision making, working memory and planning. 2. The ventromedial-orbitofrontal syndrome: if lesion spares the basal forebrain, memory can be preserved, but poor social decision making developes. 3. The dorsomedial syndrome consists of attention disorder, akinesia, mutism and apathy. 4. The bilateral ventrolateral praefrontal regions serve perception of self and environment. 5. The ventral lateral (verbalizer) area of the dominant hemisphere coordinates language. Executive impairments can be found in cerebrovascular, Parkinson's and other diseases of basal ganglia, and in frontotemporal lobar degeneration. The dorsolateral syndrome can be examined by the use of Wisconsin card sorting test, self ordered pointing task and the delayed response task. Praefrontal-basal function can be assessed by Gambling-, Faux Pas-, and Emotion identification tasks. Conclusions: 1. A dysexecutive syndrome does not fulfil the criteria of dementia. 2. A "frontal syndrome" is an indefinite eponym. Focal lesions in prefrontal systems lead to localization- specific symptoms, which can be defined by psychometric tests. 3. In neurological diseases associated with multifocal damage of the brain neuropsychologic tests may help to determine strategical lesions, which are responsible for the actual syndromes.]

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