Clinical Neuroscience

[Book review]

CLEMENS Béla

JULY 20, 1994

Clinical Neuroscience - 1994;47(07-08)

[Book rewiev of Wong P K H Introduction to Brain Topography]

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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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[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.]

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.

Clinical Neuroscience

Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.

Clinical Neuroscience

[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

RÓZSA Csilla

[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

Clinical Neuroscience

[Dysphagiafelmérések akut stroke-ban]

SZABÓ Pál Tamás, MÛHELYI Viktória, BÉRES-MOLNÁR Katalin Anna, KOVÁCS Andrea, BALOGH Zoltán, FOLYOVICH András

[Stroke associated dysphagia can have serious consequences such as aspiration pneumonia. The Hungarian guideline on nutritional therapy for stroke patients recommends dysphagia assessment, as early screening can optimize disease outcome and hospital cost. Thus far, this may be the first study in Hungarian that has documented a systematic review about the available validated dysphagia assessments of acute stroke. Purpose – The aim of this study was to summarize the instrumentally validated bedside dysphagia screening tools for acute stroke patients, which were published in the last twenty years. Our objective was to describe the characteristics of the validation studies, examine their study design, and sample the sub-tests and the diagnostic accuracy of the assessments. A systematic research was carried out of the literature between 2001 and 2021 in eight scientific databases with search terms appropriate to our objectives. Subjects of the study – 652 articles were found and were reduced to eight. We made a comparative analysis of these. The GUSS test reached a high level of sensitivity compared to the others. In our study sample, the prevalence of instrumentally confirmed dysphagia among acute stroke patients was 56.1%. The focus and the composition of the analyzed studies differed and posed problems such as the ambiguity of the concept of dysphagia, the difference in outcome indicators, or the timing of screening. The GUSS test, which offers domestic management, is a suitable tool for the Hungarian clinical use.]