Clinical Neuroscience

[Book review]

GARZULY Ferenc, RAJNA Péter

SEPTEMBER 20, 1994

Clinical Neuroscience - 1994;47(09-10)

[G. S. Barolin: Kopfschmerzen - multifactoriell Erfassung und Beobachtung (Multifactorial perception and treatment of headaches), István Bitter: Psychiatry summary of books ]

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Clinical Neuroscience

[Evaluation of gliomas by means of multi-model techniques]

BORBÉLY Katalin

[Gliomas constitute more than 50% of brain tumours. Primary malignant forms recur within 1/2 to 1 year after surgery, and even totally removed benign forms may recur. 50% of recurrent astrocytomas are more malignant than the original tumour. The time elapsing until recurrence strongly depends on the degree of malignity and the surgical removal. However, the age of the patient also plays an important role. Survival of the patient after the establishment of diagnosis also depends on the therapy. Effective treatment requires a knowledge of the degree of malignity as well as differentiation between recurrent tumour and radiation necrosis. CT and MRI scans offer high sensitivity, but poor specificity. Evaluation of tumour metabolism by means of 18F-fluoro-deoxy-glucose positron emission tomography (PET-FDG) helps to determine the degree of malignity of the gliomas, and recurrent tumour can safely be differentiated from necrosis following radiation therapy.]

Clinical Neuroscience

[Symptomps, localization of cerebral lesions and aetiology of "letter-by-letter" reading]

SÉRA László, MÁRKUS Atilla, BERNÁTH László

[The symptoms, localization of cerebral lesions and aetiology were analysed literally data of 78 patients suffering from pure alexia (letter-by-letter reading). During the 100 years since Déjerine's first case study on the issue was been published our knowledge on the clinical and pathomorphological characteristics of pure alexia has become more exact. On the one hand, clinical symptomatology has narrowed, eg. right homonymous hemianopsia is no regarded as a compulsory concomintant symptom on the other hand, the locus of damage underlying the symptoms may be at various areas of the brain (eg. subangular), not only at the occipital regions. The role of the posterior trajectory system in the reading process emphasized. In addition however, taking into account recent neuropsychological findings, the importance of other areas of the brain is presumable. In accordance with cognitive psychological research of the reading process it is concluded that it is essential the is for our understanding of the whole reading process that all of these factors are taken into consideration.]

Clinical Neuroscience

[Transoral and posterior fixation for inveterated fracture of odontoid process - Case report]

VERES Róbert, LAKATOS István, KENÉZ József, PENTELÉNYI Tamás

[Combined operative treatment is reported of a fixed malpositioned type III. (according to Anderson-D'Alonso) oblique anterior odontoid process fracture. Due to the ventral and dorsal compression of the spinal canal a part of the dens and a part of the C.li body were transorally removed, and a part of the arch of the atlas also removed by a dorsal approach. The position was fixed by means of a combined method of a transoral Harms-plate and a posterior C.I.-C.II. fransarticular screwing according to Magerl. With this method were achiered proper decompression and stabile C.1.-C.II. arthrodesis.]

Clinical Neuroscience

[Cerebral aspergillosis]

ILLÉS Zsolt, GARZULY Ferenc, BRITTIG Ferenc, PERENYEI Miklós

[Four cases of cerebral aspergillosis are reported. Brain abscesses developed in a patient with chronic alcoholism and pyogenic urogenital process, and in a baby, treated for aplastic anaemia. Haemorrhagic necroses were found in the other two cases, one of them suffered from agressive hepatitis, the other had lymphoid leukaemia. Pulmonary alterations were observed as part of generalised aspergillosis in all the cases. Early diagnosis of pulmonary processes should be emphasized as the disease can hardly be influenced when neurologic symptoms appear.]

Clinical Neuroscience

[The effect of the cue-controlled modification of the level of vigilance on the intentional inhibition of seizure in patients with partial epilepsy]

SZUPERA Zoltán, RUDISCH Tibor, BONCZ István

[The cue-controlled modification of the level of vigilance, as one of the methods of self-control appeared to be a practicable therapeutic intervention for the intentional inhibition of epileptic seizures in some special cases of epilepsy. The authors worked out a variation of the above self-control technique, in which the aura imagined in hypnosis was associated with the change in vigilance in patients suffering from partial epilepsy, in order to enable them to try to inhibit the epileptic fits with this associated modification of the level of alertness during auras. The authors report two cases of intractable partial epileptic patients, in which the patients attained the application of this self-control method. The first patient carried out intentional seizure inhibition in 73 cases over one year, reducing the frequency of the fits from the previous 115 to 77. In the second case, the patient was able to decrease considerably even the number of epileptic auras by learning and applying the technique, consequently the number of auras decreased to 7 compared with the 38 fits observed in the previous 8 months, further he was able to terminate the attack in 6 cases out of auras. The authors think, that their method might be useful for a certain group of patients suffering from partial epilepsy to inhibit epileptic attacks, and would mean a new possibility in the management of intractable cases.]

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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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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

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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.

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

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[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. ]

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[Dysphagiafelmérések akut stroke-ban]

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[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.]