Clinical Neuroscience

[About Lissauer's apperceptive blindness]

SIMONYI Gusztáv1

MAY 01, 1959

Clinical Neuroscience - 1959;12(05)

[A 59-year-old patient with Alzheimer's disease slowly developed object agnosia, prosopagnosia, spatial disorientation, and apraxia of dressing over five years. There is evidence of visual analyser disability, left hemianopsia, visual loss. In projection at distance and angle of tachystoscopic examination, paralysis of the Bálint gaze. In addition, progressive dementia. None of the usual symptoms of colour agnosia or colour naming disorder, and no aphasia in any other way. These are the symptoms analysed by the author, who does not yet see any justification for dropping the traditional concept of agnosia, which has been a matter of debate in the literature in recent years.]

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  1. Budapesti Neurológiai Klinika

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Clinical Neuroscience

[Central nervous system metastases from malignant melanoma ]

LEEL-ŐSSY Lóránt, TÖRÖK Pál

[The authors provide a clinicopathological description of five CNS m. m. metastases and, in their assessment, conclude : 1. CNS metastases of m. m. occur in 8-12% of other malignant tumour metastases. 2. They draw attention to the danger of removing naevi and melanomas. 3. The most common clinical presentation is subarachnoid haemorrhage. Symptoms of multiple metastasis are often difficult to recognise. 4. The need for neurosurgical intervention is emphasized in the presence of symptoms suggestive of a nodule. The tissue picture suggests a neuroectodermal origin of melanoma. They seek to explain the pathomechanism of the frequent subarachnoid haemorrhage and address the mode of metastasis.]

Clinical Neuroscience

[Structural analysis of Wahnstimmung]

IRÁNYI Jenőné

[In our cases, we provided a psychopathological analysis of Wahnstimmung in the light of a structural approach. The regression symptoms of the relational structure are prominent in the state picture. The emotional polarization disorder due to the lack of differential inhibition results in total perplexity, anticipatory uncertainty, ambivalence that generally colours psychic events. The symptoms are accompanied by phenomena triggered by a reduction in psychic energy and regression of cognitive and adaptive structures. In cases where the structural regression symptoms are accompanied by an energetic insufficiency, the condition is stuck in a state of pathological imbalance constituting the delirium. The striving for a new pathological state of equilibrium manifests itself in the personality's effort to correct itself in the face of pathological symptoms. In such cases, new dynamic stereotypes are seen to develop in the form of secondary pathological cognitive structures, in the form of positive or negative misconceptions. ]

Clinical Neuroscience

[Effect of vasomotor reflexes on abnormal electroencephalogram]

HASZNOS Tivadar

[A review of our data and a comparison with the literature shows that in our patient population, only a relatively small percentage of activation procedures described by others have been successful. The large number of patients included in our study precludes us from explaining negative cases by statistical variance. In particular, it is difficult to explain the ineffectiveness of apnce, because while in carotid compression it is conceivable that the pressure was not applied in the right place and with the right force, in the patient who underwent apnce we were able to check in all cases that the patient complied with our request. Based on the negative results, the activation methods listed were no longer used indiscriminately in all patients. Carotid artery compression and oculo-cardiac reflex are performed in patients where it is necessary to differentiate between syncope and sacer. In vascular pathologies, amyl nitrite inhalation will continue to be performed. This is a relatively difficult EEG diagnostic problem and the small number of positive cases justifies the use of this test. Evipan is routinely used in combination with hyperventilation. This has the distinct advantage, in our opinion, of achieving the same effect with a relatively low dose of Evipan, which is therefore harmless, as compared to deeper anaesthesia, which requires a higher dose, or other more prolonged methods that are more likely to have complications.]

Clinical Neuroscience

[Formation of an ophthalmo-otoneurology working group]

[The author reports on the ophthalmo-otoneurological working group established on 25 March 1959 at the headquarters of the Medical-Health Trade Union, within the framework of the "Pavlov" Neurological Specialist Group.]

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[The aim of this study was to evaluate the prevalence of albuminuria in patients under age 60 with insulin dependent diabetes mellitus (IDDM) complicated by hypertension. Among 469 patients regularly being followed for IDDM 76 were found with treated/un treated hypertension (16.2%). 62 patients from this group were investigated for urinary albumin excretion rate (AER) (24-hour timed urine collection, three times, immunoturbidimetric method). Microalbuminuria (AER 30–300 mg/day) was detected in 15 cases (24%), macroalbuminuria (AER>300 mg/day) in 11 patients (18%), whereas in 36 cases no abnormal albuminuria (AER<30 mg/day) was found. No significant differences have been found in age, duration of diabetes or metabolic control (HbA1c) among the investigated groups. The longest duration of hypertension though not statistically significant, was observed in the normoalbuminuric group. The ratio of treated/untreated patients with hypertension in normo-, micro- and macroalbuminuric groups were as follows: 23/13, 12/3 and 11/0 respectively. The maximal systolic and diastolic blood pressure values in the macroalbuminuric group, however, significantly surpassed that of the normoalbuminuric group (p<0.01). One third of normoalbuminuric patients with hypertension had no alteration in their eye-fundi. The prevalence of proliferative retinopathy and blindness rose with increasing albuminuria. These results suggest that hypertension developing in IDDM is pathogenetically heterogenous. In a significant number of IDDM patients, hypertension does not follow but rather preceeds development of incipient nephropathy. Hypertension without micro albuminuria in IDDM probably represents essential hypertension with a better prognosis related to the late complications of diabetes.]

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[The diagnosis of giant-cell arteritis is a real challenge for clinicians. There are several reasons for the difficulties in establishing the diagnosis. This disease is associated to rare conditions, therefore most physicians lack clinical experience. This condition shows very heterogeneous manifestation, the intensity of the symptoms vary in time. Early diagnosis is of great importance in order to prevent ischemic complications. Among these complications one should emphasise the role of anterior ischemic optic neuropathy that may result in abrupt blindness. In this case report, we show a rare socalled large vessel manifestation of giant-cell arteritis. This form of the disease needs different approach in diagnosis where color duplex ultrasonography may have distinguished importance. The final verification of the diagnosis is based on histology. However the lack of all histological criteria do not exclude the presence of giant-cell arteritis.]

Clinical Neuroscience

[Symposium on current encephalitis]

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