Clinical Neuroscience

[Amnesticus syndrome due to Härtel's alcohol injection ]

PAP Zoltán1, ADLER Péter1

MARCH 01, 1963

Clinical Neuroscience - 1963;16(03)

[We reported a patient with severe trigeminal neuralgia in whom, by Härtel's method, part of the alcohol given into the Gasser's duct was presumably introduced into the cisterna chiasmatis and caused sterile meningitis, with encephalitis in the infundibulum area and severe damage to the mammillary bodies. This resulted in acute unconsciousness, febrile delirium, a slowly recovering foggy state of consciousness and a permanent amnestic syndrome. However, neuralgia - except for the unpleasant sensation of phonia, which still exists in branch I, has disappeared. The case is interesting not only from a psychological point of view, because of the memory disturbance, but also because of the lessons to be drawn from it. Although Dandy and Frazier-Spiller's trigeminal surgery cannot be said to be completely without risk, not to mention Sjöquist's intramedullary tractotomy, the situation is really different today from what it was in Fedor Krause's time. Härtel's confident statement, quoted above, made in 1924, has lost much of its legitimacy today. His proposal for surgical interventions, like Kirschner's electrocoagulation, was restricted to a narrower field. Despite the undoubtedly positive results, its use must always be accompanied by undesirable consequences. Its recommendation should therefore be limited to patients who are not suitable for or do not agree to intracranial surgery and who cannot be made painless by other means. ]


  1. Hajdú-Bihar Megyei Tanács Kórháza Idegosztálya és a Debreceni Orvostudományi Egyetem Stomatológiai Klinikája



Further articles in this publication

Clinical Neuroscience

[Reactivity, pharmacological influence and association with respiration of the periodic eeg complex in subacute panencephalitis]


[1. The stimuli we used could not influence the shape or periodicity of the periodic complexes. It appears that periodic eeg phenomena in penencephalitis can no longer be provoked by external stimuli when periodicity is stable. 2. No rapid activity typical of the initial stage of barbiturate anaesthesia was seen in any of our patients after intravenous Evipan. The lack of rapid activity in response to Evipan is associated with panencephalitic cortical lesions. 3. After Megimide injection, spasm potentiation initially occurred only in the section corresponding to the periodic complex. On this basis, it seems reasonable to conclude that the periodic complex represents a state of increased excitability that facilitates the appearance of spasm potentials. 4. There is a statistically highly significant difference between the number of eeg complexes occurring with increased frequency during the inspiratory and expiratory phases. If we assume that the firing of inspiratory and expiratory bulbopontine neurons facilitates the emergence of the panencephalitic eeg complex, it is reasonable to conclude that the primary anatomical lesion responsible for the emergence of the periodic complex may be the bulbopontine phase of the formatio reticularis, or at least a system intensely related to it. 5. In some cases, intravenous Relaxil G caused the characteristic periodicity of the curve to disappear and the diffuse polymorphic deltaic activity characteristic of end-stage panencephalitis to develop. The Relaxil effect suggested that the structure controlling the autorhythmicity of the periodic complex may be the diffuse thalamic system. Thus, the presence of a periodic complex implies the relative integrity of the diffuse thalamic system. 6 We have discussed the differences between the panencephalitic periodic complex, the K-complex and the Forbes' secondaerial response and, on the basis of these differences, we believe that the periodic complex cannot be identified with either the Forbes' secondaerial response or the K-complex.]

Clinical Neuroscience

[Text analysis of the diary of a schizophrenic patient ]

KUNCZ Elemér, THORDAI István

[Authors examine the diaries of 33-year-old female patients - 70 handwritten pages spanning a year - which can be used to track phases of immersion in a world of closed, autistic experience and self-medication tendencies. They find that, on the one hand, the diary as a form corresponds to a written monologue by which the patient, isolated from the outside world, deceives his own solitude, and, on the other hand, a certain striving for autonomy and the role of self-preservation tendencies can be discerned in the bizarre turns of phrase and conceptual changes.]

Clinical Neuroscience

[Dr. Adolf Juba]


[The author gives an account of the life and work of Dr. Adolf Juba.]

Clinical Neuroscience

[Glioma behaviour in tissue culture]

PÁLYI Irén, TÓTH Géza, CSÁKY László, ÁFRA Dénes, ZOLTÁN László

[1. In tissue cultures of gliomas after a single high dose of 6000 r., phosphorus metabolism was investigated 6 and 22 h after irradiation. 2. After irradiation, glioma cultures showed higher activity in the acid-soluble phosphorus fraction than controls. The lipid and DNA fractions, on the other hand, had lower activity compared to controls. 3. Normal tissues show no consistent changes in their phosphorus metabolism after a single high dose of radiation. ]

All articles in the issue

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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

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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

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

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Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]


[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Lege Artis Medicinae

[History of vaccine production in Hungary ]


[This study presents the complete history of the Hungarian vaccine production, partly in association with the process of fighting vaccine-preventable infectious diseases, and underlines the fact that every government actively contributed to the age-adjusted mandatory vaccination schedule of the past 140 years. It demonstrates the various achievements from the smallpox lymph production through the launch of diphtheria serum production at Phylaxia and the establishment of the National Public Health Institute (OKI) with its vaccine production and the later institutional transformation of OKI into Humán as economic corporation to its closure. Among all OKI’s vaccine production activities, this study focuses on the production of influenza vaccines, due to its international importance in the 1960s and 1970s. The vaccine production against diphtheria tetanus and pertussis stands out from Humán’s activities, and the tetanus component of this vaccine is still used in the products of a multinational vaccine manufacturer. ]