Clinical Neuroscience

[Characteristics of gadolinium-enhancement in ischemic stroke]

KENÉZ József1, BARSI Péter1, KULIN Árpád1, NAGY Zoltán2

NOVEMBER 20, 1994

Clinical Neuroscience - 1994;47(11-12)

[Stroke is a clinical diagnosis. In acute stroke, CT is the first examination of choice to exclude hemorrhage. In ischemic stroke, MR detects the changes earlier and more exactly, than CT. Contrast-enhanced MR imaging shows specific enhancement phenomena, viz. Intravasal high signal in the vessels of the ischemic cerebral region, meningeal enhancement, transitorial, mixed type enhancement and parenchymal enhancement. Our paper is deals with the causes and diagnostic significance of the different types of these enhancement effects, and discusses some differential diagnostic conclusions. In the near future, after installing more modern MR equipment, a more exact knowledge of the pathomechanism of stroke and, as a consequence, new and more effective therapies can be expected.]

AFFILIATIONS

  1. Országos Pszichiátriai és Neurológiai Intézet, Radiológiai Osztály, Budapest
  2. SOTE Pszichiátriai Klinika, Budapest

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[Béla Horányi clinical neuroscience association]

MÁRKUS Atilla

[By agreement between the Board of the Neurology Journal and the management of our Society, the Béla Horányi Clinical Neuroscience Society became a co-owner of the Neurology Journal in July 1994. This event has prompted us to describe some of the most important features and operational characteristics of our society.]

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PAPP I. Mátyás

[ln the late sixties the revelation that more than half of the dementia cases in elderly people were caused by Alzheimer's disease and not by „cerebral arteriosclerosis" gave dementia research a new impetus, which accelerated in the eighties and has nowadays become explosive and has supplied us with a mass of data almost beyond comprehension. Nevertheless, even though it is most intensively, studied elucidation of the etiology and pathogenesis of the Alzheimer' s disease is still not expectable in the near future. ln addition to Alzheimer's disease, new results basically changing our views, have been achieved in the field of the vascular dementia and in dementias with Parkinsonian syndrome. Frontostriatal circuits discovered recently have helped our understanding of the subcortical dementia in these diseases and in others. By means of neuroimaging techniques, several dementia syndromes - paramedian thalamic infarcts, the watershed infarcts and the so called Binswanger's disease - have turned out to be much more common than previously believed. Clinicopathological observations have verified the role of the damage to the limbic and paralimbic structures, frontostriatal circuits and association pathways in the pathomechanism of dementias. ]

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[Typical behavior models of dealing with epilepsy - the models present between patient and members of the family]

NEMESSÚRI Judit, TÖLGYES Tamás, VERES Judit, RAJNA Péter

[Four are main symptom groups described which were previously considered to be not more than an organic consequence of epilepsy. In most cases in the background of these groups a pathogenic/ pathogenetic role of typical relationship constellations between the patient and his/her relatives can be observed. These constellations are illustrated by case descriptions. It is pointed out that: 1. Epilepsy is a chronic illness in the course of which in every case certain psychodynamic events take place between the patient and his or her relatives in the immediate environment. 2. According to the present „neurological" approach and to the social expectations in the course of the patients' care the main stress is on biological events and changes. As a result intrapsychic and social-psychiatric motives are frequently manifested in the form of biological symptoms, too. 3. It follows from the above that the psychic constellation is interiorized by the patient and then he/she expresses it through somatic symptoms. At first sight these symptoms seem to be typical epileptic problems”. In actual fact, somatic „epileptologic” treatment cannot be regarded as succesful. 4. Since care is mainly based on auto- and heteroanamnestic data the phenomena discussed earlier could be highlighted only by means of the simultanious exploration of the family in question and by possible disagreement between the patient and his/her environment. 5. In order to treat the epileptic patient it is essential to consider the illness in relation to the patient and the members of the family.]

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[Determination of serum C-reactive protein in the illnesses of central nervous system]

PINTÉR Erzsébet, KÁLI Gábor, VUKMIROVITS György, NIKOLOVA Radka, YOUSEF M. Gassar, GYARMATI Éva

[Serum quantitative C-reactive protein concentrations were measured in 186 patients admitted with suspected neuroinfection or symptoms of other diseases in the central nervous system. The diagnoses were purulent meningitis (102), abscessus cerebri (5), meningitis basilaris (2), meningitis cryptococcica (1), sepsis (11), encephalitis (22), encephalopathia (5), autoimmune central nervous illness/disease/disorder (22), non-inflammatory central nervous disease/ disorder (12) and tumour cerebri (4). The highest values of C-reactive protein were measured in patients suffering from abscessus cerebri (250.8 +/ 64.2 mg/l), sepsis (221 +/- 16.4 mg/l) and purulent meningitis (153.0 +/- 94.59 mg/l). Serum C-reactive protein concentrations were moderately increased in viral infections (36.8 +/- 36 mg/l). The C-reactive protein level in the normal range in patients suffering from non-inflammatory and autoimmune central nervous illnesses/diseases/ disorders (4.0 +/- 1.5 mg/l or 10.0 +/- 18.5 mg/l). During our examinations the C-reactive protein levels showed both local and septicaemic reactions. C-reactive protein is considered as a valuable laboratory parameter both in diagnosings central nervous system diseases with suspected bacterial infection and in monitoring therapeutic efficiency.]

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[Chronic recurrent transverse myelitis or multiple sclerosis]

UNGUREÁN Aurélia, PÁLFI Sándor, DIBÓ György, VÉCSEI László

[The simultaneous appearance of multiple sclerosis and transverse myelitis is a known phenomenon. Apart from the appearance of spinal symptoms, other neurological signs of the brain involvement can urually be found, MRI shows disseminated foci in the brain. The positive evoked responses, the immunological abnormalities of the CSF, and the oligoclonality together prove the presence of multiple sclerosis. In these cases the symptoms of transverse myelitis may precede other signs of multiple sclerosis, or appear separately as a relapse. Recurrent transverse myelitis as an independent entity with negative MRI and CSF immunology, is an exciting topic concerning the etiologic factors and therapeutical considerations. Tvolging from the literature, the appearance of transverse myelitis as an independent entity, is rather rare. Details are given of a female patient with recurrent spinal cord signs, negative MRI and CSF immunology. During her ten-year follow-up no, symptoms of multiple sclerosis have developed. Further studies are needed to clarify the etiological factors, pathomechanism and therapeutic considerations of this relatively new and probably independent clinical entity.]

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Rapid changes of stroke management in recent years facilitate the need for accurate and easy-to-use screening methods for early detection of large vessel occlusion (LVO) in acute ischemic stroke (AIS). Our aim was to evaluate the ability of various stroke scales to discriminate an LVO in AIS. We have performed a cross-sectional, observational study based on a registry of consecutive patients with first ever AIS admitted up to 4.5 hours after symptom onset to a comprehensive stroke centre. The diagnostic capability of 14 stroke scales were investigated using receiver operating characteristic (ROC) analysis. Area under the curve (AUC) values of NIHSS, modified NIHSS, shortened NIHSS-EMS, sNIHSS-8, sNIHSS-5 and Rapid Arterial Occlusion Evaluation (RACE) scales were among the highest (>0.800 respectively). A total of 6 scales had cut-off values providing at least 80% specificity and 50% sensitivity, and 5 scales had cut-off values with at least 70% specificity and 75% sensitivity. Certain stroke scales may be suitable for discriminating an LVO in AIS. The NIHSS and modified NIHSS are primarily suitable for use in hospital settings. However, sNIHSS-EMS, sNIHSS-8, sNIHSS-5, RACE and 3-Item Stroke Scale (3I-SS) are easier to perform and interpret, hence their use may be more advantageous in the prehospital setting. Prospective (prehospital) validation of these scales could be the scope of future studies.

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In this study, we wanted to investigate the effect of antiplatelet and anticoagulant use on the success of mechanical thrombectomy in acute ischemic stroke cases. 174 patients who were brought to the Stroke Center of Gaziantep University Şahinbey Research and Practice Hospital between January 2018 and February 2019 due to acute ischemic stroke and who underwent mechanical thrombectomy were retrospectively analyzed. The demographic characteristics, antiplatelet/anticoagulant use before the stroke and mTICI (modified-Throm­bolysis-In-Cerebral-Infarction) scores used for reperfusion in mechanical thrombectomy were evaluated. The findings were analyzed statistically (p<0.05). The mean age was 63.3 ± 13.5 in 174 patients who underwent mechanical thrombectomy. 23/174 (13.2%) patients were using anticoagulant therapy (warfarin-OAC or new generation oral anticoagulant-NOAC) and 28/174 (16.1%) were using antiplatelet therapy. A history of atrial fibrillation (AF) was significantly higher in patients receiving anticoagulant therapy before acute ischemic stroke (p=0.001). Patients with a history of hyper tension (HT), diabetes mellitus (DM) and coronary artery disease (CAD) before acute ischemic stroke were receiving antiplatelet therapy in higher rates (respectively; p=0.003, p=0.037, p=0.005). Successful recanalization (mTICI ≥ 2b) was higher in patients with a history of anticoagulant use and who underwent mechanical thrombectomy (p=0.025). Our study showed that the use of anti­platelet or anticoagulants before mechanical thrombec­tomy may have an indirect positive effect on the success of the procedure.

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