Clinical Neuroscience

[Central nervous system metastases from malignant melanoma ]

LEEL-ŐSSY Lóránt1, TÖRÖK Pál2

MAY 01, 1959

Clinical Neuroscience - 1959;12(05)

[The authors provide a clinicopathological description of five CNS m. m. metastases and, in their assessment, conclude : 1. CNS metastases of m. m. occur in 8-12% of other malignant tumour metastases. 2. They draw attention to the danger of removing naevi and melanomas. 3. The most common clinical presentation is subarachnoid haemorrhage. Symptoms of multiple metastasis are often difficult to recognise. 4. The need for neurosurgical intervention is emphasized in the presence of symptoms suggestive of a nodule. The tissue picture suggests a neuroectodermal origin of melanoma. They seek to explain the pathomechanism of the frequent subarachnoid haemorrhage and address the mode of metastasis.]

AFFILIATIONS

  1. Debreceni Orvostudományi Egyetem Ideg-Elmeklinikája
  2. Debreceni Orvostudományi Egyetem Idge-Elmeklinikája

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Further articles in this publication

Clinical Neuroscience

[About Lissauer's apperceptive blindness]

SIMONYI Gusztáv

[A 59-year-old patient with Alzheimer's disease slowly developed object agnosia, prosopagnosia, spatial disorientation, and apraxia of dressing over five years. There is evidence of visual analyser disability, left hemianopsia, visual loss. In projection at distance and angle of tachystoscopic examination, paralysis of the Bálint gaze. In addition, progressive dementia. None of the usual symptoms of colour agnosia or colour naming disorder, and no aphasia in any other way. These are the symptoms analysed by the author, who does not yet see any justification for dropping the traditional concept of agnosia, which has been a matter of debate in the literature in recent years.]

Clinical Neuroscience

[Structural analysis of Wahnstimmung]

IRÁNYI Jenőné

[In our cases, we provided a psychopathological analysis of Wahnstimmung in the light of a structural approach. The regression symptoms of the relational structure are prominent in the state picture. The emotional polarization disorder due to the lack of differential inhibition results in total perplexity, anticipatory uncertainty, ambivalence that generally colours psychic events. The symptoms are accompanied by phenomena triggered by a reduction in psychic energy and regression of cognitive and adaptive structures. In cases where the structural regression symptoms are accompanied by an energetic insufficiency, the condition is stuck in a state of pathological imbalance constituting the delirium. The striving for a new pathological state of equilibrium manifests itself in the personality's effort to correct itself in the face of pathological symptoms. In such cases, new dynamic stereotypes are seen to develop in the form of secondary pathological cognitive structures, in the form of positive or negative misconceptions. ]

Clinical Neuroscience

[Effect of vasomotor reflexes on abnormal electroencephalogram]

HASZNOS Tivadar

[A review of our data and a comparison with the literature shows that in our patient population, only a relatively small percentage of activation procedures described by others have been successful. The large number of patients included in our study precludes us from explaining negative cases by statistical variance. In particular, it is difficult to explain the ineffectiveness of apnce, because while in carotid compression it is conceivable that the pressure was not applied in the right place and with the right force, in the patient who underwent apnce we were able to check in all cases that the patient complied with our request. Based on the negative results, the activation methods listed were no longer used indiscriminately in all patients. Carotid artery compression and oculo-cardiac reflex are performed in patients where it is necessary to differentiate between syncope and sacer. In vascular pathologies, amyl nitrite inhalation will continue to be performed. This is a relatively difficult EEG diagnostic problem and the small number of positive cases justifies the use of this test. Evipan is routinely used in combination with hyperventilation. This has the distinct advantage, in our opinion, of achieving the same effect with a relatively low dose of Evipan, which is therefore harmless, as compared to deeper anaesthesia, which requires a higher dose, or other more prolonged methods that are more likely to have complications.]

Clinical Neuroscience

[Formation of an ophthalmo-otoneurology working group]

[The author reports on the ophthalmo-otoneurological working group established on 25 March 1959 at the headquarters of the Medical-Health Trade Union, within the framework of the "Pavlov" Neurological Specialist Group.]

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Clinical Neuroscience

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.

Lege Artis Medicinae

[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]

KAPÓCS Gábor

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

[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

[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.]