Clinical Neuroscience

[Book review]

PÁLFFY György

JULY 20, 1994

Clinical Neuroscience - 1994;47(07-08)

[A rewiev of Lóránt Leel-Őssy: Neurology Sprinter, 1993]

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Clinical Neuroscience

[The history of Hungarian neurology (Part II)]

BEKÉNY György

[1935-1945: László Benedek and his time]

Clinical Neuroscience

Personality traits in scheuermann's disease - a controlled study

SOMHEGYI Annamária, JÁNOSFI Zsuzsa, BALÁZS István, RATKÓ István

High muscle tone in various muscle groups is typical in Scheuermann's disease, and secondary fibromyalgia often occurs in young adults after this condition. There are clinical observations of emotional-psychological disturbances in adolescents with Scheuermann's osteochondritis. For these reasons it was of interest to determine whether any particular personality traits were manifested in adolescents with Scheuermann's disease, that - in addition to the spinal pathology – would contribute to the high muscle tone. Using four personality diagnostics tests (Brengelmann's questionnaire, Taylor's anxiety scale, Neurosis Scale, Lüscher's 8-colour test) we investigated the emotional life of 52 adolescents with Scheuermann's osteochondritis and that of 52 matched healthy controls. Test results of the two groups were statistically evaluated using chi square tests, with a significance limit of p < 0.05. The most striking difference between the two groups was that the patient's volitional and diffuse psychic tensions were increased (c = 1.00 and p < 0.0005) and, at the same time, were accompanied by a significant deficiency of the means to discharge them ( c = 1.00 and p < 0.0005). The results indicate that Scheuermann-patients do not answer to the stresses of everyday life in the usual way but by an increase in muscle tone. Their muscles act as their stress organ. This - in addition to the spinal pathology - may contribute to the tightness of their muscles and might be considered as a possible predisposing factor to later secondary fibromyalgia. Therapy should seek to interrupt this vicious circle by complementing regular exercise with relaxation techniques.

Clinical Neuroscience

Management proposal for the treatment of acute odontoid fractures

RÓBERT Veres, GILES Hamilton Vince

Optimum management of the acute odontoid fracture has always been extensively discussed. Nowadays, with the availability of new operative techniques such as anterior odontoid screw fixation and the posterior C1-C2 transarticular screw fixation the management policy has to be reevaluated. The authors review 115 cases of type II and type III acute odontoid fractures admitted to the National Institute of Traumatology in Budapest between 1980 and 1990. For study purposes a modified Anderson-D'Alonzo classification was introduced allowing a more detailed description of the fracture components and thus enabling to find more clear guidelines for treatment planning. The patients were treated with: a. various types of non-Halo external fixation in 27 cases; b. Halo immobilization in 13 cases; c. various surgical procedures resulting in a loss of atlantoaxial joint function in 22 cases; d. anterior odontoid screw fixation in 53 cases. Modern therapy should be focused on preserving the function of the atlanto-axial joint whenever possible. This can be sufficiently achieved using anterior odontoid screw fixation. However, the main determining factor in the choice of the appropriate treatment - providing the ligaments are intact - is the direction and course of the fracture line. If the fracture line runs horizontal or oblique posterior anterior screw fixation is the most favourable treatment. On the other hand if the fracture line runs oblique anterior Halo immobilization or C1-C2 posterior fixation is the method of choice.

Clinical Neuroscience

[CT guided stereotactic radiosurgical treatment of cerebral metastatic tumors]

FEDORCSÁK Imre, HORVÁTH Ákos, KONTRA Gábor, SLOWIK Felicia, OSZTIE Éva

[Radiosurgery has in recent years been used with promising results in the treatment of cerebral metastases. Between July 1991 and January 1993 we treated 23 patients harbouring brain metastases (39 lesions) with our Linear accelerator based radiosurgery system. The median tumor size was 1.9 cm (1.0-3.0 cm) and the median delivered dose was 18.7 Gy (13–25Gy). Follow up CT scans at 4 months showed a complete remission or greater than 50% tumor volume reduction in 19 patients (82%). No change was noted in 2 patients (9%), and after a transitory decrease an increase in tumor size was seen in 2 patients (9%). Follow up time was minimum 6 month (or till death), and maximum 26 months. We have lost 13 patients during the study, and the cause of death was neurologic in only 2 cases. Our experience supports the cumulating evidence that radiosurgery is an effective treatment for metastatic brain tumors, is well tolerated by the patients, and can be applied also in cases where open surgery can not be performed.]

Clinical Neuroscience

[Real time and color doppler sonographic investigation in cases of fetal hydrocephaly and cerebral hemorrhage]

JAKOBOVITS Ákos, JÖRN Hendrik

[In three hydrocephalic and one fetus with intra- and periventricular hemorrhage real time imaging was used to identify cerebral changes. Color flow imaging was used to identify the fetal middle cerebral and umbilical artery for subsequent pulsed Doppler sonographic studies. Cerebral blood flow patterns of hydrocephalik fetuses seem to differ individually from case to case presenting normal, increased and decreased velocity waveform indices. The resistance index and pulsatility index of the middle cerebral artery in case of cerebral hemorrhage increased with advancing worsening of the fetal state of health. Loss of diastolic cerebral or umbilical flow followed by retrograde flow during diastole antenatally could be a bad sign prognostically. ]

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[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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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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[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

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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.

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[Treatment and new evidences in neuromyelitis optica spectrum disorder ]

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