Clinical Neuroscience

[Book review]

CZOPF József

MARCH 20, 1994

Clinical Neuroscience - 1994;47(03-04)

[Klaus Lowitzsch: Triggered potentials in adulthood and childhood Klaus Poeck: Differential diagnostic issues in neurology]

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Clinical Neuroscience

[Young neurologists XI. forum]

[Correlation between carotid artery lesions and cerebral perfusion (Carotid Duplex scan and brain SPECT). Stenosis or dissection? Differential diagnostic issues in carotid circulation disorders. AVM diagnosed by 3D TCD. Possible diagnostic errors in supraaortic duplex UH scans and angiography. Causes of diagnostic errors in duplex ultrasound studies of the carotid arteries and ways to avoid them. The role of duplex ultrasonography in the surgical evaluation of common carotid artery occlusion (case report). Follow-up of Moyamoya disease with transcranial Doppler (TCD). Platelet function tests in the acute and chronic phase of cerebral circulatory disease. Multicausal cerebral circulatory disorders. Co-occurrence of parkinsonism and giant aneurysm (case report). Teratoma adultum, germinoma, spinal and cerebral metastases in the background of intermittent headache - 5-year patient follow-up Differential diagnosis of meningeal tumours. Extracranial tumours presenting with symptoms of brain metastasis. Pitfalls in the diagnosis of craniocervical transitional and high cervical space occupying processes. Diagnosis of benign spinal tumours. Spinal dermoid cyst - data on the aetiology of low back pain syndrome. Experimental and clinical potential of brain microdialysis. Treatment of multiple intracranial tumours. Tremor and reflex tests in Parkinson's disease. HMPAO SPECT studies in Parkinson's disease. Aurorix treatment in cases of Parkinson's syndrome complicated with depression. Drug therapy of Parkinson's syndrome with special reference to diurnal performance fluctuations. Jumex in the early phase of Parkinson's syndrome. Conductive education in parkinsonism. Use of biophysical methods in the study of the pathomechanism of neurological diseases. Large blind spot syndrome. Investigation of optokinetic nystagmus in solitary frontal laesio. Hypocalcaemia and epilepsy. Difficulties in the recognition of epileptic seizures. Hypnosis treatment in partial epilepsy. Migraine, depression, anxiety. Verbalization features of headaches. Fahr's disease in our class material. CT scanning of cerebral vascular lesions and differential diagnostic difficulties. Binswanger's disease. CT lesions in patients with psychopathological symptoms. The importance of 3D MR angiography in occlusive cerebral vascular disease. Comparative study of cervical large vessel imaging. Difficulties in the diagnosis of craniocervical transition in a case report. Differential diagnosis of spinal cord disease. History and epidemiology of Parkinson's disease. Recent data on the pathomechanism of parkinsonism; experimental therapies Diagnostic errors in Parkinson's syndrome. Sinemet CR - advances in drug therapy. Oxidant phenotype studies in Parkinson's syndrome patients. Madopar-HBS treatment of patients with Parkinson's syndrome. Co-occurrence of complicated migraine and idiopathic cerebral atrophy. Family study in adreno-leuko-dystrophy. Electrophysiological study of patients with anaemia perniciosa. Cartilage drift into the sacral dura sac. Results of electrophysiological studies in patients with Parkinson's syndrome. EMG-SCAN studies in patients with Parkinson's syndrome. A case of adult myotubular myopathy in our department. Advanced picture of Kugelberg-Welander syndrome. Immunological study of idiopathic inflammatory myopathies. Recessive generalized myotonia (Becker). Differential diagnosis of myotonia in a case report. Glossopharyngeal neuralgia with syncope. Familial occurrence of multisystemic atrophy. Apert syndrome in the light of modern diagnostics. Infant with Reit syndrome (video case presentation). Juvenile cardiogenic stroke. Sneddon syndrome. Cerebrovascular patients in our department in the first half of 1993. Cerebellar haemorrhages. Changes in the assessment of prognosis in the patient population of our department. A case of medial thalamic atrophy thought to be multiple sclerosis. Extrapyramidal damage caused by stroke. Cases of bilateral occipital lobular atrophy. Case of severe brainstem lesion (central pontine myelinolysis). Long-term follow-up of the cellular and humoral immune response in patients with multiple sclerosis. Current problems of Lyme borreliosis in our departmental practice. Listeria monocytogenes as a possible causative agent of purulent meningitis. Incidence of lower limb root pains causing diagnostic difficulty in our department. Peripheral neuropathy in hypereosinophilic syndrome. Eye movement disorders caused by brain stem diseases. Depression in patients with Parkinson's syndrome, with particular reference to the possibility of presuicidal syndrome (RINGEL).]

Clinical Neuroscience

[Dementia and related problems '93. an overview]

TARISKA Péter

[Based on extensive investigations carried out the epidemiology of dementias in the last decade in Europe the methodology has become unified. The most important elements are: two-step screening in two time periods, population of 4000 or more, unified screening and diagnostic methods. The incidence was 1 p.c. established in the population between the ages of 60–64; the proportion nearly doubled in each 5 year period. Regarding the recently published risk factors of Alzheimer's disease (AD) the possible protective role of smoking and the low educational level seem to be very interesting. In the group of AAMI the biological life events as possible causative factors seem to be of importance. The functional assesment scale of Reisberg is reported from psychometric tests. An outline is given about the clinical diagnostic criteria of AD and vascular dementias based on the widely discussed system published on the latter in 1993. The problems of different clinical subtypes of AD with relevance to biochemical markers are discussed as are the diganostic criteria of Lewy body type dementia. A summary on some new etological results (genetic heterogenety, new possible ways of amyloidogenesis, glutamate-theory, etc.) is given. After highlihgting the importance of the different kinds of psychotherapy and mental training, social factors are stressed, and some ethical conflict situations (driving, coercive measures, etc.) are shortly presented.]

Clinical Neuroscience

[The history of Hungarian neurology (Part I)]

BEKÉNY György

[Every nation has its great people of whom it is proud. In our country, intellectuals think that Hungarians are particularly talented in music and mathematics. However, our outstanding geneticist believes that the genetic background of different abilities is equal between nations and that the different results are caused by external circumstances. Indeed, the "accumulation" of great Hungarian conductors and musicians in the United States, and the careers of many Nobel Prize-winning mathematicians and physicists in the United States, were made possible by the fact that they had to leave their homeland for political reasons. Contrary to what is suggested above, the first 50 years of a very successful and internationally respected period of Hungarian neuroscience were hampered by these circumstances. All the more reason to appreciate the neurological output of this period. I would be glad if the readers of this work would share this opinion. I have selected those publications for illustration which appeared in the so-called 'world languages'. The only exceptions are monographs, theses and one or two major works, some of which have already been published in a foreign language. Due to the limitations of space, many areas of neuroscience could not be discussed. Thus, I have not been able to write about international greats in neuroanatomy such as Mihály Lenhossék, Apáthy, Szentágothai; about neurophysiologists, especially those working on the cochleovestibular system such as Hőgyes, Bárány, Békésy; about neuroendocrinology or about many details of neurochemistry. The importance of neurosurgery, which is closely related to our subject, calls for a separate presentation. A small monograph on the history of Hungarian neuroscience was published in 1976 by István Környey, a great teacher and scholar of Hungarian neurology. In 1992, Zoltán Nagy published a history of Hungarian neurology in the last century under the title Hungarian Neurology in The Last Century. These historical summaries were important precursors to my present work. ]

Clinical Neuroscience

[Voltage mapping studies of generalized spike- wave patterns associated with absence seizures]

CLEMENS Béla

[In this retrospective study, scalp electric fields of ictal generalized spike-wave discharges were analized by the so-called topographic voltage mapping method. The 17 patients displaying absences (with or without other seizures) belonged to different age groups and diverse epileptic syndromes. Main results: 1. Maps derived at the points of the spike and the wave components belong to different classes. A-type spikes show frontal, P-type spikes show posterior voltage maxima. Also atypical spike (map) configurations exist. 2. A spike maps frequently show a characteristic modification along the GSW pattern. 3. Waves can display bilateral (L) or medial (M) frontal voltage maxima. 4. At least in the time window of several weeks, the dominant spike map pattern and the pattern of the waveform was characteristic to each patient. Configurations of the different spike and wave components show some relation to a limited set of clinical data. The combination of A- spikes with L-waves was found in children who had , typical" absence- epilepsies. On the contrary, irregular spectrum of different spikes and M-waves was found in elder absence patients showing rather unfavorable course of their illness.]

Clinical Neuroscience

[Immunological test for idiopathic inflammatory myopathies]

HORVÁTH Rita, ALZIRA A S Carvalmo

[Sceletal muscle biopsy specimens from patients with various inflammatory myopathies – dermatomyositis, polymyositis and inclusion body myositis – have been investigated by immunocytochemical methods with the help of monoclonal antibodies. Conclusions about the pathomechanism of these disorders were saught. In dermatomyositis the humoral immunity and the damage of the small vessels of muscle fibres may play an important role. The appearance of class I MHC antigens on diseased muscle may make the affected tissue a target for cytotoxic T8 cells, and may thus have a role in muscle fibre damage in polymyositis and inclusion body myositis.]

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Lege Artis Medicinae

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]

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REM sleep, REM parasomnias, REM sleep behaviour disorder

SZÛCS Anna , MUTTI Carlotta, PAPP Anikó, HALÁSZ Péter, PARRINO Liborio

We review the literature on REM parasomnias, and their the underlying mechanisms. Several REM parasomnias are consistent with sleep dissociations, where certain elements of the REM sleep pattern emerge in an inadequate time (sleep paralysis, hypnagogic hallucinations and cataplexy) or are absent/partial in their normal REM sleep time (REM sleep without atonia, underlying REM sleep behavior disorder). The rest of REM parasomnias (sleep related painful erection, catathrenia) may have other still unclear mechanisms. REM parasomnias deserve attention, because in addition to disturbing sleep and causing injuries, they may shed light on REM sleep functions as well as the heterogeneous etiologies of parasomnias. One of them, REM sleep behavior disorder has special importance as a warning sign of evolving neurodegenerative conditions mainly synucleinopathies (some cases synucleinopathies themselves) and it is a model parasomnia revealing that parasomnias may have by autoimmune, iatrogenic and even psychosomatic etiologies.

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VIDA Nóra, PAPP László

[Delirium is defined as a disturbance of consciousness and cognition that develops over a short period of time and fluctuates over time. During the last decade, the number of publications dealing with different aspects of delirium have been grown. The key points in most articles are pharmacological prevention and treatment, but because the rise of health care expenditures, all activities, which cost-effectively support the care process, is getting more and more important. The aim of the study: The aim of this research is to review the non-pharmacological prevention and treatment possibilities of delirium in elderly patients undergoing hip surgery. Systematic review, using articles published between 1999 and 2019 in PubMed and Wiley Online Libraries. Non-pharmacologic treatments significantly reduced the incidence (p=0.003–0.045) and duration (p=0.009–0.03) of delirium. The interventions also contributed to decrease the number of episodes (p=0.03), and to make the symptoms lighter. Early mobilisation and adequate fluid and electrolyte intake are key factors in reducing the incidence of delirium. Measuring oxygen saturation and support, appropriate nutrition, effective pain treatment, minimizing drug-interactions, maintaining good sleep and managing sensory dysfunctions have an effect on incidence, duration and severity of delirium.]

Clinical Neuroscience

Neuroscience highlights: The mirror inside our brain

KRABÓTH Zoltán, KÁLMÁN Bernadette

Over the second half of the 19th century, numerous theories arose concerning mechanisms involved in understanding of action, imitative learning, language development and theory of mind. These explorations gained new momentum with the discovery of the so called “mirror neurons”. Rizzolatti’s work inspired large groups of scientists seeking explanation in a new and hitherto unexplored area of how we perceive and understand the actions and intentions of others, how we learn through imitation to help our own survival, and what mechanisms have helped us to develop a unique human trait, language. Numerous studies have addressed these questions over the years, gathering information about mirror neurons themselves, their subtypes, the different brain areas involved in the mirror neuron system, their role in the above mentioned mechanisms, and the varying consequences of their dysfunction in human life. In this short review, we summarize the most important theories and discoveries that argue for the existence of the mirror neuron system, and its essential function in normal human life or some pathological conditions.

Clinical Neuroscience

[Treatment and new evidences in neuromyelitis optica spectrum disorder ]

ILLÉS Zsolt

[Treatment and new evidences in neuromyelitis optica spectrum disorder Illés Zs, MD, PhD Ideggyogy Sz 2021;74(9–10):309–321. Neuromyelitis optica spectrum disorder (NMOSD) is associated with antibodies against AQP4 in about 80% of the cases. In about one-fourth of seronegative cases, antibodies against the MOG protein are present in the serum (MOG-antibody associated disease, MOGAD). This article discusses off-label azathioprine and mycophenolate mofetil in the treatment of NMOSD and reviews the evidence-based clinical aspects of B/plasma cell depletion, antagonization of IL-6 signaling and blocking the complement pathway. The review also summarizes basic aspects of NMOSD pregnancy focusing on treatment, and the different therapeutic approach in MOGAD. In the recent two years, phase 3 clinical trials provided class I evidence for the efficacy and safety of rituximab (anti-CD20), inebilizumab (anti-CD19), tocilizumab (anti-IL6R), satralizumab (anti-IL6R), and eculizumab (anti-C5) in combination with other immunosuppressants or in monotherapy. The treatment approach in MOGAD is complicated by the monophasic course in about half of the cases and by the potential disappearance of MOG antibody. The necessity of maintenance treatment in MOGAD should be decided after tapered oral steroid. Immunosuppression is recommended in NMOSD during pregnancy and lactation, and this should be considered for optimal selection of treatment in fertile female patients. The new monoclonal antibodies broadened treatment options NMOSD, and the treatment strategy of MOGAD has become more straightforward.]