Clinical Neuroscience

[Clinical interpretation of Evipan sleep-activated EEG abnormalities in non-epileptic psychiatric patients]

NAGY A. Tibor1, KAJTOR Ferenc1, HALÁSZ Péter1, KLEININGER Ottó1

JANUARY 01, 1967

Clinical Neuroscience - 1967;20(01)

[Authors search for correlation between activated EEG abnormalities in 86 patients and various non-epileptic psychiatric disorders. They hypothesize organic brain damage and varying degrees of cerebral atrophy as causal factors underlying chronic clinical syndromes classified as neurosis - psychopathy - psychosis. It is not considered acceptable to extend the concept of epilepsy to all those with abnormal EEG findings without clinical epileptic manifestations. Linked to this, the question of the specificity of the seizure potential is raised. They include in the concept of "organic psychopathy" those with EEG abnormalities and PEG findings suggestive of a cerebral dysfunction, which may take other forms besides personality changes, due to pathoplastic factors. ]

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  1. Debreceni Orvostudományi Egyetem Ideg- és Elmegyógyászati Klinika

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Clinical Neuroscience

[Changes in the clinical picture of neurological diseases due to drug therapy]

HORÁNYI Béla

[In our medical practice, we often do not fully and correctly use all the possibilities of drug therapy. Medical thinking tends to be biased towards simple, easy-to-remember, templated treatment procedures. But in any case, we will only exhaust the potential of drug therapy if, on the basis of careful consideration of all the circumstances, we know the mechanism of action of the drug and the pathophysiology of the disease, we give the right drug at the right time, in the most appropriate dose, distribution and manner. Perhaps not enough emphasis is placed in university clinical education on the principles of drug therapy.]

Clinical Neuroscience

[Neuropathological lesions in animal studies of B12-avitaminosis]

LEHOCZKY Tibor, SÓS József, HALASI Margit

[induced central and peripheral nervous system lesions in white rats with B. deficiency. These were essentially identical to the typical neuropathological lesions of anaemia perniciosa (myelopathy, neuronal proliferation). The discrepancy, such as the rare or absent glial reactions and the extensive and severe damage to nerve cells, was explained by the more intense biochemical effects of experimental B12 deficiency. ]

Clinical Neuroscience

[Clinical significance of the Circulus arteriosus Willisi with special reference to hypoplasia]

LEEL-ŐSSY Lóránt

[After a detailed anatomical description of the circulus arteriosus Willisi, the first part of the paper describes the occurrence of hypoplasia in each branch. In the second part, the dynamic characteristics of the blood circulating in the CAW are used to illustrate the crucial regulatory, distributive and collateral role of the formula in the first stage of cerebral circulation. In the third part, the clinical relevance of anomalies (mainly hypoplasia) is highlighted. A study of the brains of 100 cerebrovascular and 100 non-cerebrovascular deceased individuals shows the well-known fact that CAW anomalies are twice as common in cerebrovascular diseases as in non-vascular diseases. It describes the predisposing, preforming, pathoplastic effects of anomalies in emollients, haemorrhages and thromboses. The frequent occurrence of anomalies is known in pituitary aneurysms, and anomalies often allow the development of severe arteriosclerosis in the basal vessels, if the mechanical theory of anteriosclerosis is considered. In relation to general CAW hypoplasia, he lists 19 cases of vascular injury or other disease, functionally modified by the anomaly. Among the latter, he points out the atypical course of three endogenous pathologies in particular. ]

Clinical Neuroscience

[Effect of metopirone on cerebral electrical activity]

FREY Zsuzs, HALMY László

[Authors have studied the effects of Metopiron on brain electrical activity in endocrinology patients. In 5 of 13 patients studied, regularisation of electrogenesis was observed. It is hypothesized that the resulting lesion is due to a direct or indirect effect of Metopirone on the hypothalamus. In their further conclusions, they point to the possibility of a relationship between diurnal fluctuations in ACTH synthesis and the chronometric function of alpha-rhytmus.]

Clinical Neuroscience

[Five recurrent subarachnoid haemorrhages from a cerebrovascular arterio-venous vessel]

FORNÁDI Ferenc, SZEGEDY László, HAITS Géza

[The authors describe a 45-year-old female patient who has been clinically treated 5 times in 15 years for recurrent subarachnoid hemorrhages. The clinical interest of the case is given by the good general condition of the patient and her relatively well-preserved personality during the time between each bleeding episode. The bleeding was due to an arteriovenous aneurysm in the upper third of the mesencephalon. Presumably, this aneurysm, in addition to the recurrent bleeding, may have played a role in the development of the very marked cerebral atrophy and the strikingly severe arteriosclerotic vascular lesions by altering the hemodynamic relationships. ]

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Clinical Neuroscience

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

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

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.

Clinical Neuroscience

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

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

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.

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]