Clinical Neuroscience

[Analysis of symptoms and polygraphic data of Elysion psyches]

ZSADÁNYI O.1, HALÁSZ P.1, KARÁCSONY A.1

APRIL 01, 1967

Clinical Neuroscience - 1967;20(04)

[Elysione (phenylcyclohexylpiperidine monohydrochloride) has gained widespread use in anaesthesiology due to its sensory blocking effect. Transient psychotic symptoms after surgery have been described and analysed by several authors as a side effect of the drug. The psychotic picture that develops may also be considered a schizophrenomimetic agent because of certain characteristics.]

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  1. Debreceni Orvostudományi Egyetem Ideg- és Elmegyógyászati Klinika

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Clinical Neuroscience

Die ventrale Fusion im Bereich der Halswirbelsäule bei Bandscheibenschäden

W. Grote, P. Röttgen

Das so genannte Zervikalsyndrom, dessen häufigste Erscheinungsformen Schulter- und Armschmerzen, Nacken- und Kopfschmerzen, zervikale Migräne, vertebraler Schwindel und zervikale Myelopathie sind, ist wesentlich schwieriger zu diagnostizieren als das Lumbalsyndrom. Bei Vorliegen eines Zervikalsyndroms wurden folgende Operationen durchgeführt: La-Minektomie oder Hemilaminektomie mit oder ohne Entfernung der vorgefallenen Bandscheibe, Radikotomie nach Jackson oder Frykholn. 1962 führten Cloward (Honolulu) und Dereymaeker und Mulier (Belgien) die Operation ein, bei der die vorgefallene Bandscheibe durch ventrale Penetration entfernt und eine knöcherne Fusion zwischen den Wirbelkörpern hergestellt wurde. Nach Lindblom wird die chirurgische Indikation durch eine Diskographie mit 60 % Urographie ergänzt. Seit 1962 wurden 84 Patienten operiert (Tabelle 5). Die Myelographie wurde in 33 Fällen durchgeführt. Bei 37 Patienten wurde eine einzelne und bei 42 Patienten eine multiple Diskusläsion festgestellt. 28 Patienten wurden nicht fusioniert. Bei der Mehrzahl der Patienten wurde die Knochenfusion bei 8 Patienten mit autoplastischem Knochen, bei 42 Patienten mit homoplastischem Knochen und bei 6 Patienten mit heteroplastischem Knochen durchgeführt. Postoperative Ergebnisse (Tabelle 17): Von 29 Brachialgien zeigten 15 eine deutliche Besserung (wg), 10 eine deutliche Besserung (g), 4 hatten unveränderte Beschwerden (u). 17 Brachialgie und Zephalalgie postoperative Ergebnisse Verteilung: 11, 3 und 3. 8 Zephalalgie (C34): 5, 2 und 1. 30 Myelopathie: 7, 7 und 16. Wenige chirurgische Komplikationen: ein Fall von Ösophagusverletzung, ein Fall von Hämatom mit Atemnot, zwei Fälle von Abrutschen des Knochensplitters. Manchmal kann auf eine Knochenversteifung verzichtet werden, aber im Falle einer Versteifung ist das Operationsergebnis besser. Bei Myelopathie ist der Verzicht auf eine Indikation gerechtfertigt, aber auch in diesem Bereich können hervorragende Ergebnisse erzielt werden; ein Patient mit Tetraplegie war nach der Operation arbeitsfähig.

Clinical Neuroscience

[Ehlers-Danlos syndrome associated with neurological symptoms]

KOMÁR József, KRÁNITZ Géza

[The authors diagnosed a 43-year-old woman and her 8-year-old son with classic Ehlers-Danlos syndrome. In the mother, the underlying disease was accompanied by muscular atrophy and symptoms suggestive of spinal cord dorsal cord injury. The authors associate the onset of neurological symptoms with the underlying disease and attribute it to dysplastic vasculature.]

Clinical Neuroscience

[Eozinofil granulocytak a liquorban]

PÉTER Ágnes, KOVÁCS Ferenc

[Eosinophilic cells were detected in a small percentage of CSF in both bacterial and non-bacterial infections. Intense CSF eosinophilia was found only in bacterial processes. In these cases, an allergic pathomechanism was hypothesized. Unique in the literature, liquoreosinophilia accompanied by a leukocytic reaction was observed in our 1 case of meningitis in the setting of collagenosis and in our 3 cases of granulomatous menongoencephalitis. This specific CSF cytological reaction was highlighted in the group of diseases of the nervous system with immune-allergic syndrome. Immuno-allergic CSF syndromes with eosinophilic cell proliferation were divided into three groups according to the involvement of plasma cells. The factors determining the type of reaction response remain to be elucidated. Our patient with periarteritis nodosa with 26% eosinophils in his meningogram complements literature data. Of particular interest is our case No 4, who developed cerebroesinophilia after myelography.]

Clinical Neuroscience

[Data on the psychiatric use of chlormethiazole (Heminevrin)]

KARDOS György

[Author reviews the literature on the pharmacological and clinical effects, side effects and complications of Heminevrin. He reports on 77 cases he has observed and treated. He confirms the excellent efficacy of Heminevrin in delirium tremens, where in 31 patients Heminevrin therapy led to recovery in a few days without mortality and without complications. He has used the drug praeventively in 27 cases of praedelirosus withdrawal syndrome, which he considers to be a beneficial combination for the treatment of endogenous and reactive psychogenic depressions (based on 13 cases). ]

Clinical Neuroscience

[The role of the limbic lobe in incentive production]

FENYVESI Tamás

[Two cases of a midline tumour destroying limbic structures were described. In both cases, the clinical picture was characterized by a high degree of inducibility loss, which was already evident at the onset. We evaluate our cases as recent data on the role of limbic structures in the maintenance of incentin production. ]

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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.]