Clinical Neuroscience

[Brainstem reflexes associated with temporal tumour]

FORNÁDI Ferenc1

MAY 01, 1960

Clinical Neuroscience - 1960;13(05)

[We report a case of brainstem syndrome associated with a right temporal tumour, partly as a reflex rhythm and partly of localisational significance.]

AFFILIATIONS

  1. Budapesti Orvostudományi Egyetem Psychiatriai Klinika

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Further articles in this publication

Clinical Neuroscience

[Experiences and conclusions from using Hirepin]

GOLDSCHIMDT Dénes

[My experience with Hirepin in 22 patients and the conclusions I have drawn from it are summarised below: 1. the potential for parkinsonoid symptoms caused by Hibernal and Rausedyl to occur is increased when the two drugs are used together, which is otherwise desirable, and sometimes inhibits further effective treatment. 2. The use of Hirepin, while retaining the psychopharmacological benefits of Hibernal 4- Rausedyl, virtually eliminates the occurrence of parkinsonoid symptoms. 3. Hirepin has produced psychiatric improvement above the level of Hibernal 4- Rausedyl that causes parkinsonoid symptoms without the above symptoms, so parkinsonoid symptoms are not a necessary concomitant of psychiatric improvement, but are a necessary indicator of the individually effective level of medication.]

Clinical Neuroscience

[Treatment of anaesthetic poisoning with beta-beta-methyl-ethyl glutarimide (Megimide) ]

PATAKFALVI Albert, DUS Vince

[Authors report on the treatment of 13 patients with Megimide, mostly severe, some purely barbiturate, some combination intoxication. Megimide has the advantages of rapid onset of action, avoidance of side effects with careful dosing, and a very high therapeutic range of action. In our case, no toxic symptoms were observed with 1800 ml. ]

Clinical Neuroscience

[Lessons learned from 200 Andaxin treatments]

KARDOS György, SIMKÓ Alfréd

[In half a year (first half of 1959) 200 patients were treated with Andaxin. Our experience has shown that Andaxin has an excellent effect in abnormal experiential reactions, especially when the premorbid personality does not show abnormal, "psychopathic" features; in the latter case it has a more favourable effect than Hibernal (chlorpromazine) and Rausedyl (rauwolfia), an important factor being that the side-effects are fewer and considerably milder. Another important aspect in outpatient psychiatry is that the drug is non-toxic, practically harmless and not suicidal. In schizophrenic patients, chlorpromazines are more effective, but combination with Andaxin seems preferable when the clinical picture (mainly defect syndromes) is dominated by anxious or hostile irritability, or when a parkinsonoid syndrome or akathisia-like obsessive-compulsive hyperkinesia has developed. Andaxin can be a useful adjunct to the treatment of chronic alcoholics, cerebro sclerotic patients and parkinsonism. It is likely to be most effectively used in combination with Tofranil for depression and with chlorpromazine for manic states. Side effects are few and harmless. These include "adynamia" at the start of treatment, mild allergic reactions in about 5% of cases and, finally, three cases of "loss of tone" which are not well understood.]

Clinical Neuroscience

[Operated intracerebral haemorrhages]

HARASZTI Erzsébet, HULLAY József

[In addition to a brief review of the literature on intracerebral haemorrhages and their surgical management, we described the clinical and surgical management of 12 cases. The clinical picture is characterized by acute onset and bloody or xantochromic cerebrospinal fluid, the development of nodal symptoms and progressive intracranial pressure increase, which may be pathognomic for apoplexy in the case of advanced age and hypertension, otherwise most often for haemorrhage from cerebral haemorrhage, the latter especially when paroxysmal phenomena are present before the acute onset. The cause of bleeding in our cases was, according to the literature, hypertension, angioma, aneurysm, trauma and unknown cause. The surgical solution consisted of aspiration of the haemorrhage or excision of the hemorrhage from the capsule and, where possible, resolution of the occult lesion. Of 12 patients, none were lost after surgery and the outcome was satisfactory in 11 cases. Our conclusion on the question of surgery for non-hypertensive haemorrhages is the same as the general principles, but for hypertensive haemorrhages it avoids any generalised constraint on the choice of time. ]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

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Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

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Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

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[The Comprehensive Aphasia Test in Hungarian]

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[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

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[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]