Clinical Neuroscience

[Adult onset panencephalitis nodosa with retinal nodule and unusual course]

POHL Ödön1, REMENÁR László1, HAITS Géza1

MAY 01, 1966

Clinical Neuroscience - 1966;19(05)

[The authors describe the case of a 20-year-old man whose pathological findings showed a typhoid picture of panencephalitis nodosa. A clinically remarkable atypical course was noted. The first symptom, 3 years before death, was severe visual loss in the right and then in the left eye. Retinal oedema, haemorrhages, very marked retinal vasoconstriction, vascular tympanic visual field loss, later papillary decolorization and chorioretinitis foci were observed. Psychiatric features were a slow intellectual decline and a great lack of motivation in the weeks preceding death, reminiscent of catatonic stupor. From a neurological point of view, it is emphasised that the abnormal movements appeared only in the terminal stage, and then only in an abortive form. The authors hypothesise the possibility of an atypical ocular onset in panencephalitis nodosa on the basis of early ocular signs and attribute permeability-pathological and anoxia-vascular mechanisms for the development of both ocular and cerebral lesions.]

AFFILIATIONS

  1. BOTE Psychiatriai klinika és az Országos Idegsebészeti Tudományos Intézet szemészeti osztálya

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

[The state of rehabilitation of the mentally ill in Hungary ]

DUBOVITZ Dénes

[There is a long tradition of rehabilitation and one of its most important tools, occupational therapy, in the care of the mentally ill, both in our country and around the world. Nevertheless, the rehabilitation of the mentally ill and the use of occupational therapy in mental wards have not developed sufficiently.]

Clinical Neuroscience

[Catheter-based method of vertebral angiography]

FÉNYES György

[The author describes a catheter-based method of vertebral angiography performed through the brachial artery without complications in 110 cases. ]

Clinical Neuroscience

[A kortikoszteroid-pszichózisokról]

POHL Ödön, HAITS Géza

[The authors describe three cases of corticosteroid depression and typologically separate these pictures from the major depressive forms in the psychiatric literature.]

Clinical Neuroscience

[Differential diagnostic problems of debilitas and imbecillitas]

KLEININGER Ottó

[Oligophrenia is a persistent intellectual and personality development disorder with a deficit of mental decline, caused by organic damage to the central nervous system between about the ages of 0 and 3 or 4. Therefore, we wanted to differentiate debilis from imbecilis not only by differences in intellectual level but also by differences in personality traits. Thus, the debilis are characterized by: being teachable in basic operations, being formally well spoken, being emotionally infantile, having a formal sense of community, being attached to their families until puberty, lacking intellectual emotions. They are motivated in their tantrums, are emotionally unstable, and are easily neuroticised due to their reduced tolerance skills. Their instinct for species preservation is characterised by a drive for convention, self-preservation tends to occur only at puberty. Their egotism makes them incapable of serious friendship. Their willpower is reduced and they need more control when encouraged. They have active, even focused attention, but need more and more stimuli to maintain it. Their ability to remember is characterised by an inability to remember dependencies, and they are therefore self-conscious. In general, we can speak of the reproductive intellect of the retarded. Their thinking is primitive and stereotyped. IQ: between 0.85 and 0.7, according to W. Stern. They are capable of stereotypical work independently. Imbecilic: movement is characterised by inhibition or staggering and they cannot be taught to write continuously. Speech: speech disorders of a grammatical nature (speech without verbs or formulas). No sense of community. Generally attached to the family, no intellectual sense of course. Affect lability, lack of motivation in outbursts of anger. Persistent depression is rare. Self- and species-preserving instincts may be satisfied at the cost of aggression. They have no need for mates. Their will life is abnormally diminished, they are incapable of sustained activity and are highly suggestible. They have only passive attention. Their memory for words and numbers is so poor that they have difficulty learning words and confuse their meanings. They cannot be taught the four basic operations. We cannot even talk about reproductive intelligence at school age. They have some elements of objective thinking in their thinking. IQ: between 0.7 and 0.4 according to W. Stern. They are capable of stereotyped work only under constant control and guidance. We wish to emphasise once again that we do not consider it possible to separate the debilitated from the imbecilic on the basis of age of intelligence alone, but that this can only be done by taking into account all personality traits. ]

Clinical Neuroscience

[Comment]

ZSAKÓ István

[The author reports on the Hungarian medical history of family care of the mentally ill.]

All articles in the issue

Related contents

Clinical Neuroscience

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]