Clinical Neuroscience

[About "aseptic" meningitis]

MOLNÁR Sándor1

JULY 01, 1965

Clinical Neuroscience - 1965;18(07)

[Worming in aseptic meningitis should be considered in the presence of varying degrees of eosinophilia in the blood and CSF, especially in the presence of ascaris lumbricoides, cysticercosis and trichinellosis which may have spread to the nervous system. Meningitis tends to be partly toxic and partly neuroallergic. The CSF pattern of so-called sympathetic or concomitant meningitis, maintained by inflammatory foci, mainly purulent, of the body or brain, is always dependent on the development of the underlying disease. Changes in the latter are followed by changes in both the quantitative and qualitative cellular picture of the CSF and, to a lesser extent, in the protein levels. ]

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  1. Budapesti Orvostudományi Egyetem Neurológiai Klinika

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[Recording of pulsus-frequency and amplitude variation and its significance during posterior scala surgery]

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[The most delicate neurosurgical interventions are those involving manipulation of the midline structures, supratentorially near the hypothalamus and infratentorially near the pons, medulla oblongata. Not only direct damage to these structures, but also temporary circulatory disturbances caused by pressure or traction may result in consequential oedema or atony, which may lead to a very serious condition of the patient, possibly death. While there are little or no signs of hypothalamic injury during surgery, even minor lesions of the posterior scala of the brain stem are immediately apparent in the form of vegetative reactions (in the anaesthetised patient), changes in pulse, blood pressure and respiration. It is the anaesthesiologist's task to monitor these very carefully and report them to the surgeon.]

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[Data for the isolation of midline subfrontal meningiomas]

HULLAY József

[The author, reviewing the surgical descriptions of 20 cases of meningiomas with midline subfrontal and praesellar localization, found that in 5 cases the tumor was located on the lamina cribrosa and crista galli, in 3 cases it was located in the tuberculum sellae but also spread to the limbus sphenoidalis, and in 12 cases, the most frequent, it was located on the planum (jugum) sphenoidalis. He found the striking frequency of meningiomas adherent to the planum remarkable because in the publications on meningiomas this variant is not listed as a separate group, but is classified with the two former variants. - The correct analysis of the anamnesis, the osteo-, angio- and pneumographic images, and the justification for this is that while the site of adhesion of olfactory meningiomas is the os ethmoidale, that of planum meningiomas is the os sphenoidale, and while the former tends to destroy the base of the anterior scala, the latter tends to cause bone outgrowth. Although the tuberculum meningioma and planum meningioma are attached to the same bone and the limbus may be blurred, the former may show at most a slight bone lesion at the site of attachment, whereas the latter usually shows marked hyperostosis and specific bone outgrowth. On these grounds, he considers it justified to include planum meningioma as a separate variant alongside tuberculum meningioma and olfactory meningioma.]

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[Four out of 20 neurological patients (2 Friedreich's, 1 Wilson's, 1 gargoylism) were found to have abnormal overall iron metabolism by isotope analysis. In contrast, the general iron turnover of our Hallervorden-Spatz patients was found to be normal despite abnormal iron metabolism in the pallidum and substantia nigra. Iron storage in these formulas is continuous. These findings can be used in the pathogenesis of Hallervorden-Spatz disease. ]

Clinical Neuroscience

[Use of Nuredal (Niamide) in neuropsychiatry]

NAGY A. Tibor, ZSADÁNYI Ottó

[Authors report their experience with Nuredal (Niamide) in 52 patients. The effect on psychomotor inhibition, a core symptom of depression, was found to be indisputable and primary, and they suspect this to be an extension of the scope of psychotherapy. This potential is seen in the possibility of transforming reactive depressive disorders into neurotic depression.]

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Clinical Neuroscience

[Pneumococcal meningitis in children - 9 1/2-year-experience at Szent László hospital, Budapest, Hungary ]

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Clinical Neuroscience

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[Introduction - The removal of hypophyseal tumor by transsphenoidal pituitary surgery using microsurgical instruments was first performed over 100 years ago. Operating techniques for this surgery are constantly being renewed, first by using a microscope and later on with the use of an endoscop. The authors provide an overview of the minimal invasive posterior transseptal-transsphenoidal aproach with the combined utilization of classical techniques with the assistance of the endoscop. Method - Sixty-one patients (33 female, 28 male, 21-84 yrs) were treated for sellar region tumor resection using an endonasal transsphenoidal aproach with the help of an endoscop. Follow ups were performed within 2-21 months. Results - Total tumor resection was successful in 91.8%, and partial resection in 8.2% of the patients. The rate of complications using the endoscop method was not higher compared to that of the classical microscopic method. There was no major bleeding in any of the cases. Adverse events such as minor epistaxis occurred in 4.9%, transitional diabetes insipidus in 6.5%, inraoperative CSF leak in 16.67%, postoperative CSF leak in 11.5% and meningitis in 8.2% of the patients. After the operation the pathological hormonal production stoped in all patients except in two patients who were acromegalic. However their GH level normalized and they did not require further treatment, the IGF-1 still remained high. Conclusion - The success of the surgical treatment is based on both, the proficient pre- and postoperative endocrinological care, and the minimal invasive surgical technique. The endoscop was used partially or continuously during the operation for better visualization of the operation field in multiple angles (30°, 45°). It was useful in differentiating between normal and tumorous glandular tissue, and also offered an enhanced view of the intrasellar (via hydroscopy) and parasellar region. Moreover the endoscopic method is able to decrease the operating time, reduce blood loss. In different stages of the surgery, depending on the anatomical and pathological situation, switching back and forth from microscope to endoscop technique, gives us the benefit of a clearer view in each situation.]