Clinical Neuroscience

[Book review]

GARZULY Ferenc

NOVEMBER 20, 1993

Clinical Neuroscience - 1993;46(11-12)

[Book review of István Barakonyi, József Szántó, János Nikl:Liquor-citodiagnostics in clinical practice]

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Clinical Neuroscience

[In Memoriam György Bekény]

HORVÁTH Sándor

[After a life of struggle and success, and after a serious illness borne with dignity and discipline, death took him at the age of seventy-eight. Even in the last years of his life, ill but tireless, he served his vocation with his knowledge: healing and teaching; patients and interested students; the Clinic. Shortly before his death, he completed his last scientific work, The History of Hungarian Neurology.]

Clinical Neuroscience

[The illogical therapy]

SZIRMAI Imre, SUREK György, KAMONDI Anita, MAGYAR Hedvig, JUHÁSZ Csaba

[Most of the causative pathological factors in ischemic cerebrovascular events cannot be recognized during the acute stage of the disease partly because of to the complexity of biophysical model of cerebral microcirculation, partly because the causative factors in this model cannot be confidently weighted. Clinical diagnoses on cerebral circulation disorders are based on the fundamental causes of the disorders. Evoking factors are hypotheses, consequently therapies are directed to hypotheses. The mathematical model of cerebral microcircualtion is mondeterministic. The interactions between vascular factors and blood fluidity can be roughly estimated. Judging the therapeutic efficacy is hindered by the nondeterministic disease model, the indefinite clinical clues, their individual variations, heterogenous diagnostic groups, and tendency of spontaneous restoration of symptoms. Non-specific drugs are used to treat cerebral ischemia, and trials making use of monotherapies have failed to change the life expectancy or the clinical course of ischemic patients. The acute stage of the disease cannot be defined and because of the incompleteness of clinical indicators „stroke prevention" appeares to be ambiguious. Therefore, the nature of the treatment of ischemic cerebrovascular disease is at present based on trial and error.]

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[Molecular characterization of the T cell receptor in experimental allergic encephalomyelitis and multiple sclerosis - new therapeutical approaches]

KÁLMÁN Bernadett, LUBLIN D. Fred

[The authors review here the most recent literature on experimental allergic encephalomyelitis and multiple sclerosis, focusing on the efferent branch of the immune response. They attempt to describe the molecular characteristics of the myelin antigen specific T cell receptors. Identification of the most distinct properties of the disease mediating cells may not only provide clues to the etiology of MS, but also opens new avenues to specific therapeutical approaches.]

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[Experimential allergic encephalomyelitis multiplex sclerosis!]

KAPÓCS Gábor

[T-lymphocytes and molecular engineering]

Clinical Neuroscience

[Transcranial doppler of extracranial stenosis in internal carotid artery]

NAGY Valéria, BEDŐ György

[Endeavours were made to determine why mean velocity and pulsatility index changes in middle and anterior cerebral artery are caused by the unilateral occlusion of the internal carotid artery or by severe stenosis. The transcranial Doppler method is suitable for judgingre pathologic intracranial blood flow conditions, especially when data are compared to those of healthy conditions.]

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Lege Artis Medicinae

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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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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]

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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. ]

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.]