Clinical Neuroscience

[Bilateral tibialis anterior syndrome]

KÓMÁR József1, LEHOCZKY Tibor1

AUGUST 01, 1967

Clinical Neuroscience - 1967;20(08)

[Authors describe bilateral tibialis anterior syndrome after strenuous standing work in a 49-year-old female patient. Based on histopathological examination of muscle biopsy, increased subsidence and leukocytosis, the clinical symptoms are considered to be due to myositis. Treatment with ACTH relieved the patient of symptoms. The syndrome is considered to be polyaetiological and, on the basis of Morger's studies, conservative treatment with anti-inflammatory drugs is recommended instead of fasciotomy. ]

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  1. Fővárosi István Kórház, Ideggyógyászati Osztály

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Clinical Neuroscience

[Maniform psychosomatic alternating periodic hypersomnia ]

POHL Ödön, HAITS Géza

[The authors describe a 19-year-old male patient who developed a parotitis epidemic 2 years ago and experienced severe drowsiness lasting for days. Since then, his hypersomnia has recurred 5 times over a period of 2-3 weeks, with repeated episodes of manic psychosis in between. Authors hypothesize meningoencephalitis as an aetiological factor accompanying parotitis epidemica and leading to diencephalon, but they also suggest that genetic factors may be involved in the onset of maniform pictures. ]

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[Follow-up results of trigeminal excisions for tic douloureux]

ZAPPE Lajos, NAGY Vilmos

[Authors report 1-7 year follow-up results of 121 intracranial trigeminal truncations in 120 patients and report the following findings: 1. in the area of the auricle and angulus mandibulae, the separation of the trigeminal and adjacent innervated areas is not sharp, and there is certainly overlap. 2. Any regeneration that may occur after surgery starts from this area, with the loss of sensation extending back towards the medial orbital ridge. 3. After complete shutdown of the nerve, regeneration is limited and neuralgia hardly ever recurs, but anaesthesia dolorosa develops quite often, although it is severe in only 4% of cases. 4. Recurrence is quite frequent after partial excision, occurring predominantly in the first 4 years after surgery - but is usually reversible with further surgery. Their studies have shown that the effect of surgery against T.N. is based on the elimination of the incoming stimuli, deafferentation. During radicotomies, root compression, breaking and stretching at the pyramidal apex have never been observed. Their observations have led to a position on the pathomechanism of the facial nerve root and the therapy to be chosen. It seems best to start with a ganglion treatment resulting in partial disconnection of the nerve. If, however, radicotomy is performed, total root transection is the correct solution. ]

Clinical Neuroscience

[Diagnostic errors in meningiomas of the cerebellum in old age]

ÉDER Mária, LŐRINCZ Gábor

[Diffuse oedematous phenomena were found in the white matter of both cerebral hemispheres, more pronounced on the same side as the tumour. We also observed oedema in the white matter of the cerebellar hemisphere of the cerebellum, which was accompanied by even older and more recent microscopic haemorrhages on the tumour side. The investigators in this case were led to an incorrect pathology by a nearly one and a half year asymptomatic period, a rapidly developing personality change, symptoms characteristic of diffuse cortical damage, a negative fundus finding throughout and last but not least the result of the Gamma EG examination. ]

Clinical Neuroscience

[Drug treatment trials for the treatment of chronic alcoholism (II)* a) About the metronidazole-alcohol reaction ]

KARDOS György, SZABADOS Pál

[Alcohol aversion or because of the risks and complications of disulfiram cures, interest in the temperance drugs (cyanamide, calcium carbamide citrate, etc.) ensuring relative intolerance has increased in recent years all over the world. Verff. report 117 therapy drinking tests on 50 patients and some self-experiments with trichomonacid-metronidazole. At equal doses of alcohol, the reaction whose main symptoms are described is much milder than the disulfiram-alcohol reaction; on the other hand, at greater alcohol exposure, which, however, corresponds to habitual and relatively insignificant consumption in drinkers, very unpleasant and agonizing nausea (headache, vomiting, dizziness, weakness, etc.) may occur. An overview is given of the isolated clinical-pharmacological data obtained concerning metronidazole, partly in alcoholics, partly in schizophrenics. According to these, the drug is supposed to have a thymoanaleptic effect, reminiscent of MAO inhibitors, as well as an abolishing effect on alcohol dependence. It would be essential to remedy its chronic toxic effect, further to increase the tempering effect by structural changes to the metronidazole molecule, or to favor its usability against alcohol by attenuating the side effect. ]

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[E250 (phenylisopropylmethylpropynylamine Hcl.) clinical experience]

A. Tibor, LIPÁK János, KLEININGER Ottó

[Authors observed the effects of E250 (phenylisopropylmethyl propinylamine HCl) in a total of 56 patients. Their experience was unfavourable in major depressive disorder associated with marked anxiety and abnormal thought processes. In milder depressions, it has been found to be effective in combination with tranquillisers and sleeping pills. It can also be used as a stimulant in adjusted doses depending on individual tolerance. Almost without exception, it enhanced activation and psychic performance in patients with occupational therapy for epilepsy. This was also convincingly confirmed by concurrent reactio-temporal measurements and psychological test studies (Rorschach, Lüscher test). ]

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Clinical Neuroscience

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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

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Clinical Neuroscience

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Clinical Neuroscience

[Tension type headache and its treatment possibilities]

ERTSEY Csaba, MAGYAR Máté, GYÜRE Tamás, BALOGH Eszter, BOZSIK György

[Tension type headache, the most common type of primary headaches, affects approximately 80% of the population. Mainly because of its high prevalence, the socio-economic consequences of tension type headache are significant. The pain in tension type headache is usually bilateral, mild to moderate, is of a pressing or tightening quality, and is not accompanied by other symptoms. Patients with frequent or daily occurrence of tension type headache may experience significant distress because of the condition. The two main therapeutic avenues of tension type headache are acute and prophylactic treatment. Simple or combined analgesics are the mainstay of acute treatment. Prophylactic treatment is needed in case of attacks that are frequent and/or difficult to treat. The first drugs of choice as preventatives of tension type headache are tricyclic antidepressants, with a special focus on amitriptyline, the efficacy of which having been documented in multiple double-blind, placebo-controlled studies. Among other antidepressants, the efficacy of mirtazapine and venlafaxine has been documented. There is weaker evidence about the efficacy of gabapentine, topiramate, and tizanidin. Non-pharmacological prophylactic methods of tension type headache with a documented efficacy include certain types of psychotherapy and acupuncture. ]