Clinical Neuroscience

[Anterior and posterior stabilization following the resection of a thyroid gland tumor destroying more cervical segments]

FECZKÓ József, BARÁTH István, SÁRVÁRY András

FEBRUARY 20, 2003

Clinical Neuroscience - 2003;56(01-02)

[Case report - Authors report a case of thyroid gland carcinoma. The tumor had metastases into the CV-VI-VII vertebras. Through an anterior approach, they removed the malignant tumor together with the bodies of the affected cervical vertebras and a two stage combined (anterior and posterior) cervical instrumentation was performed. The anterior fusion was carried out with iliac crest bone grafting and plate fixation. After four years the patient is alive and well, without symptoms of tumor recurrence or neurologic deficiency. The ventral fusion is stable. Conclusions - Authors present a case of a successful operation of thyroid gland malignant tumor having metastatases in the CV-VI-VII vertebras. Tumor resection, fusion and instrumentation is suggested to be carried out in one stage. The anterior and posterior instrumentation is essential. Radical removal of the tumor is mandatory even with complex instrumentation and oncotherapy procedures.]

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[Primary intramedullary glioblastoma multiforme of the spinal cord: report of eight cases]

BANCZEROWSKI Péter, SIMÓ Magdolna, SIPOS László, SLOWIK Felícia, BENOIST György, VERES Róbert

[Primary glioblastoma multiforme located intramedullary in the spinal cord is a very rare entity. The authors report eight cases and discuss the clinical features, the possibility of diagnosis, combinated treatment and pathomorphological signs focusing on the relevant literature and their experience.]

Clinical Neuroscience

[The role of electrical neuromodulation in the therapy for chronic lower urinary tract dysfunction]

BANYÓ Tamás

[The electrostimulation techniques may be used as a supplement or an alternative to standard therapy. Electrical therapy for chronic lower tract dysfunction comprises of noninvasive pudendal nerve neuromodulation and invasive sacral nerve stimulation. Short-term functional electrical stimulation seems favourable in selected patients with detrusor hyperreflexia. Sacral nerve stimulation may be a successful treatment option for patients with refractory detrusor overactivity and some forms of urinary retention.]

Clinical Neuroscience

[Unusually located metastatic tumors of the spine]

BAZSÓ Péter, NAGY László

[Metastatic spine tumors are representing a growing number of oncological patients. In this paper the authors would like to focus on a rare type of metastatic spine tumors, the unusually located ones. Since the advent of MRI and with the progress in general oncology this formerly rare tumors became more frequently recognized. Consequently these tumors are causing a new challenge for the oncologists, neurologists and neurosurgeons as well. The aim of the authors with this paper was to raise, especially the neurologists' attention to this emerging problem.]

Clinical Neuroscience

[Spinal stabilizations in our department 1989-2002]

HÁVEL János, GÖBÖL László, GÖRÖMBEY Zoltán, KISS Tibor, LAJKÓ Albert, VALÁLIK István, VIOLA Árpád, JULOW Jenő

[With the aim to compare results to those found in the literature, authors present a retrospective overview of the spinal stabilisations carried out in the Neurosurgical Department at the St. John’s Hospital, Budapest, Hungary between 1989 and 2002. This 37 bed department provides neurosurgical services to the Buda region with its one million inhabitants. Out of 156 000 injuries in total in the past 13 years, the department has dealt with 9360 neurotraumatologic cases, 560 of them suffering from spinal injuries. In parallel, non-traumatic cases were also treated for tumour, infections, degenerative diseases and for the instability of the spine. The 224 stabilised cases were classified into three groups: cervical, thoracic, lumbar. The authors enumerate the type of operation in each level and they present the number of cases belonging to each type. Septic complications occured in 2.5% of cases. Screw breaking or slackening of the implanted devices was observed in 2% of the cases. The types of spinal operations applied provide satisfactory method for controlling the problems caused by the instability the spinal trauma, degenerative and tumourous cases. These results do not diverge from those found in the literature.]

Clinical Neuroscience

[Operative treatment of pressure sores of the pelvic region in spinal cord-injured patients]

JÓSVAY János, DONÁTH Antal, KERTÉSZ Györgyi, KLAUBER András

[by either conservative or surgical methods. Shortened healing period and long lasting results can be achieved by surgery. Between 1993 and 2001 the authors performed 64 operations with musculocutaneous or musculo-fasciocutaneous flaps in all cases. All patients healed primary except one, whose 20-year-old pressure sore transformed malignant and gave metastasis. The complication rate was 21.42%, that equals with the data of the literature. Measuring the late postoperative results by follow-up questionnaire, a 9.52% ratio of recurrence was found, which was significantly smaller than data of the literature (19-82%). Authors analyse the causes of their (good) results.]

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[Solitary osteochondroma presenting as a neck mass with spinal cord compression and central cervical cord syndrome]

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[Osteochondromas are rarely the cause of spinal pathology and neurological dysfunction. A case of cervical osteochondroma with spinal cord compression and central cord syndrome is reported, and the pathological, clinical and radiological features are discussed with a brief review of the literature.]

Lege Artis Medicinae

[The cervical spine in rheumatoid arthritis]

KORDA Judit, VERES Róbert

[The neck is the third most common site of involvement after the hands and feet in rheumatoid arthritis (RA). Deformities of the cervical spine can appear in the early stage of the disease, but most often they are seen in patients with rheumatoid arthritis with more than ten years of duration. Progression of the deformity is unpredictable, but follow up for five to ten years has shown the worsening of the instability in 16-80% of the patients. Many patients with rheumatoid disease of the cervical spine remain asymptomatic for years, but they are at risk of a range of neurological complications and even sudden death from me dullary compression. Neurological abnormalities may be subtle and difficult to establish in the presence of deforming arthritis. Once myelopathy develops, it is usually rapidly progressive. The primary goal in the management of the cervical spine is to prevent the onset of irreversible neurological deficit. Patients should have regular physical examinations to avoid the masking of subtle changes of myelopathy by severe peripheral joint disease. Use of the different measurements, especially posterior atlantodental interval and subaxial canal diameter measured on plain lateral cervical radiograph is a reliable screening tool to identify high risk patients who require further evaluation. The primary technical objective of surgery is stabilization of the diseased spinal segments and relief of spinal cord compression via reduction of subluxation or decompression. Complications are not uncommon, but tend to occur less frequently, and neurological recovery is most favorable when severe cord compression is not present preoperatively. ]

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.