Clinical Neuroscience

[Catheter-based method of vertebral angiography]

FÉNYES György1

MAY 01, 1966

Clinical Neuroscience - 1966;19(05)

[The author describes a catheter-based method of vertebral angiography performed through the brachial artery without complications in 110 cases. ]

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Clinical Neuroscience

[Adult onset panencephalitis nodosa with retinal nodule and unusual course]

POHL Ödön, REMENÁR László, HAITS Géza

[The authors describe the case of a 20-year-old man whose pathological findings showed a typhoid picture of panencephalitis nodosa. A clinically remarkable atypical course was noted. The first symptom, 3 years before death, was severe visual loss in the right and then in the left eye. Retinal oedema, haemorrhages, very marked retinal vasoconstriction, vascular tympanic visual field loss, later papillary decolorization and chorioretinitis foci were observed. Psychiatric features were a slow intellectual decline and a great lack of motivation in the weeks preceding death, reminiscent of catatonic stupor. From a neurological point of view, it is emphasised that the abnormal movements appeared only in the terminal stage, and then only in an abortive form. The authors hypothesise the possibility of an atypical ocular onset in panencephalitis nodosa on the basis of early ocular signs and attribute permeability-pathological and anoxia-vascular mechanisms for the development of both ocular and cerebral lesions.]

Clinical Neuroscience

[The state of rehabilitation of the mentally ill in Hungary ]

DUBOVITZ Dénes

[There is a long tradition of rehabilitation and one of its most important tools, occupational therapy, in the care of the mentally ill, both in our country and around the world. Nevertheless, the rehabilitation of the mentally ill and the use of occupational therapy in mental wards have not developed sufficiently.]

Clinical Neuroscience

[A kortikoszteroid-pszichózisokról]

POHL Ödön, HAITS Géza

[The authors describe three cases of corticosteroid depression and typologically separate these pictures from the major depressive forms in the psychiatric literature.]

Clinical Neuroscience

[Differential diagnostic problems of debilitas and imbecillitas]

KLEININGER Ottó

[Oligophrenia is a persistent intellectual and personality development disorder with a deficit of mental decline, caused by organic damage to the central nervous system between about the ages of 0 and 3 or 4. Therefore, we wanted to differentiate debilis from imbecilis not only by differences in intellectual level but also by differences in personality traits. Thus, the debilis are characterized by: being teachable in basic operations, being formally well spoken, being emotionally infantile, having a formal sense of community, being attached to their families until puberty, lacking intellectual emotions. They are motivated in their tantrums, are emotionally unstable, and are easily neuroticised due to their reduced tolerance skills. Their instinct for species preservation is characterised by a drive for convention, self-preservation tends to occur only at puberty. Their egotism makes them incapable of serious friendship. Their willpower is reduced and they need more control when encouraged. They have active, even focused attention, but need more and more stimuli to maintain it. Their ability to remember is characterised by an inability to remember dependencies, and they are therefore self-conscious. In general, we can speak of the reproductive intellect of the retarded. Their thinking is primitive and stereotyped. IQ: between 0.85 and 0.7, according to W. Stern. They are capable of stereotypical work independently. Imbecilic: movement is characterised by inhibition or staggering and they cannot be taught to write continuously. Speech: speech disorders of a grammatical nature (speech without verbs or formulas). No sense of community. Generally attached to the family, no intellectual sense of course. Affect lability, lack of motivation in outbursts of anger. Persistent depression is rare. Self- and species-preserving instincts may be satisfied at the cost of aggression. They have no need for mates. Their will life is abnormally diminished, they are incapable of sustained activity and are highly suggestible. They have only passive attention. Their memory for words and numbers is so poor that they have difficulty learning words and confuse their meanings. They cannot be taught the four basic operations. We cannot even talk about reproductive intelligence at school age. They have some elements of objective thinking in their thinking. IQ: between 0.7 and 0.4 according to W. Stern. They are capable of stereotyped work only under constant control and guidance. We wish to emphasise once again that we do not consider it possible to separate the debilitated from the imbecilic on the basis of age of intelligence alone, but that this can only be done by taking into account all personality traits. ]

Clinical Neuroscience

[Comment]

ZSAKÓ István

[The author reports on the Hungarian medical history of family care of the mentally ill.]

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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.

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Lege Artis Medicinae

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

FARSANG Csaba

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]