Clinical Neuroscience

[Analysis of symptomatic epipharyngeal tumour cases with trigeminal neuralgia]

LUKÁCS Kornél1

AUGUST 01, 1963

Clinical Neuroscience - 1963;16(08)

[After describing the cases of three patients with epipharyngeal tumours, I will summarise the symptomatology of epipharyngeal tumours, emphasising the so-called latent phase, when only the elevation of pain to organic status and the correct evaluation of the otological complaints can help to establish an early diagnosis.]

AFFILIATIONS

  1. BM. Ottó Korvin Kórház I. Belosztály

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

[Cholinesterase activity of subdural haematomas]

ÁFRA Dénes, WOLLEMANN Mária

[The authors report on cholinesterase enzyme activity assays of operated subdural and intracerebral haematoma specimens. By determining the cholinesterase and acetylcholinesterase activity of the fluid obtained at surgery, they attempted to draw parallels between enzyme activity and the time of haematoma persistence. The results showed that the fluid content of the capsular haematoma is not stable from the time of formation. The variation in the activity of the two enzymes studied suggests the possibility that the fluid content is continuously replenished, presumably by transudation.]

Clinical Neuroscience

[Our experience with Parkazine and its combination with other antiparkinsonian medicines]

DOBI Sándor

[Following Klimes' positive experience with outpatients, we have also had positive experience with Parkazine in hospital, which is mostly more severe. We have experienced a pronounced antitremor effect and we have experienced what was definitely an advantage over other previous drugs, that it also has a significant antitremor effect. This anti-tremor effect, which is all the shorter the patient's anamnesis, is the main advantage of Parkazine and justifies its use in all cases of Parkinson's syndrome. In addition to its beneficial effects on tremor and rigor, it also significantly improves akinesia through rigor reduction, without affecting primary motor impulsion. The latter should be classified as psychic symptoms, which are not affected by parkazine. Nevertheless, it does have a significant secondary psychic effect, which can be attributed to an improvement in the ability of helpless tremor patients to move and a reduction in tremor, by which the emotional afficiability of patients is also reduced. To influence the autonomic phenomena, which are a sub-symptom of Parkinson's syndrome and which greatly impair social integration, the drug can be preferably combined with belladonna derivatives, in our experience most notably Bellafit. This implies, accepting the different localisation mechanisms of the main components of PD, that Parkazine targets the areas involved in the generation of PD tremor and rigorous tonicity. ]

Clinical Neuroscience

[Spontaneous intracerebral haematomas surgical treatment]

ÁFRA Dénes, OROSZ Éva

[The authors report the results of surgical treatment of 28 spontaneous intracerebral haematomas. In 12 cases, the cause of the haemorrhage was hypertonic arteriosclerosis based on clinical investigations; in 2 juvenile patients the haemorrhage was due to a microangioma undetectable by angiography, while in the other cases the aetiology was unknown. The cases were classified into 3 groups according to onset and course : 1. pseudotumoral or chronic form, 2. apoplectiform onset and 3. subarachnoid haemorrhage. The distribution of haematomas according to localisation was as follows: frontal 5, temporal 8, capsular 5, trigonal 9, cerebellar 1. Of the 28 patients, 5 died (18% surgical mortality). Of the 10 patients operated on within two weeks, 4 died, and of the 18 operated on later, 1 died. Despite the strikingly better results of late surgery, categorical avoidance of early intervention is not possible, but requires individual assessment of the surgical indicatio, especially in acute fasciitis. ]

Clinical Neuroscience

[Nervous system of engine builders working on assembly lines]

BÁLINT István, HÓDOS Tibor

[By means of modern technology and organization of work, the effect of stress on the nervous system caused by factors outside the objective nature of the work process can be substantially reduced in the case of production on the production line. The success of the measures aimed at reducing the strain on the nervous system of people working on the production line can only be increased if the stress situation resulting from the nature of the work process is changed. Since the repetitive and uniform manipulations during the bound work process primarily require an adaptation of the individual tempo and rhythm within narrow limits, the nervous system load on the working person is reflected in the mental performance of the adaptation at the given moment of time. The investigations concerning time perception have shown the necessity of improving the working conditions in two areas with regard to the further reduction of the nervous system load: 1. in order to further limit monotony, the linking of the tasks on the production line must be regulated in a new way, 2. in order to facilitate time adaptation, more micro-breaks must be inserted between the individual tasks on the production line than before.]

All articles in the issue

Related contents

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

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

Clinical Neuroscience

Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias

BALÁZS Nóra , BERECZKI Dániel, KOVÁCS Tibor

In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]