Clinical Neuroscience

[Clinicopathology conference]

SZIRMAI Imre1, PAPP Mátyás1, KÁDÁR Anna2

JULY 20, 1994

Clinical Neuroscience - 1994;47(07-08)

[Summary of the clinicopathology conference of the Department of Neurology and II. Institute of Pathology of Semmelweis University of Medical Sciences]

AFFILIATIONS

  1. SOTE Neurológiai Klinika
  2. SOTE II. Kórbonctan

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[The history of Hungarian neurology (Part II)]

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Personality traits in scheuermann's disease - a controlled study

SOMHEGYI Annamária, JÁNOSFI Zsuzsa, BALÁZS István, RATKÓ István

High muscle tone in various muscle groups is typical in Scheuermann's disease, and secondary fibromyalgia often occurs in young adults after this condition. There are clinical observations of emotional-psychological disturbances in adolescents with Scheuermann's osteochondritis. For these reasons it was of interest to determine whether any particular personality traits were manifested in adolescents with Scheuermann's disease, that - in addition to the spinal pathology – would contribute to the high muscle tone. Using four personality diagnostics tests (Brengelmann's questionnaire, Taylor's anxiety scale, Neurosis Scale, Lüscher's 8-colour test) we investigated the emotional life of 52 adolescents with Scheuermann's osteochondritis and that of 52 matched healthy controls. Test results of the two groups were statistically evaluated using chi square tests, with a significance limit of p < 0.05. The most striking difference between the two groups was that the patient's volitional and diffuse psychic tensions were increased (c = 1.00 and p < 0.0005) and, at the same time, were accompanied by a significant deficiency of the means to discharge them ( c = 1.00 and p < 0.0005). The results indicate that Scheuermann-patients do not answer to the stresses of everyday life in the usual way but by an increase in muscle tone. Their muscles act as their stress organ. This - in addition to the spinal pathology - may contribute to the tightness of their muscles and might be considered as a possible predisposing factor to later secondary fibromyalgia. Therapy should seek to interrupt this vicious circle by complementing regular exercise with relaxation techniques.

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Management proposal for the treatment of acute odontoid fractures

RÓBERT Veres, GILES Hamilton Vince

Optimum management of the acute odontoid fracture has always been extensively discussed. Nowadays, with the availability of new operative techniques such as anterior odontoid screw fixation and the posterior C1-C2 transarticular screw fixation the management policy has to be reevaluated. The authors review 115 cases of type II and type III acute odontoid fractures admitted to the National Institute of Traumatology in Budapest between 1980 and 1990. For study purposes a modified Anderson-D'Alonzo classification was introduced allowing a more detailed description of the fracture components and thus enabling to find more clear guidelines for treatment planning. The patients were treated with: a. various types of non-Halo external fixation in 27 cases; b. Halo immobilization in 13 cases; c. various surgical procedures resulting in a loss of atlantoaxial joint function in 22 cases; d. anterior odontoid screw fixation in 53 cases. Modern therapy should be focused on preserving the function of the atlanto-axial joint whenever possible. This can be sufficiently achieved using anterior odontoid screw fixation. However, the main determining factor in the choice of the appropriate treatment - providing the ligaments are intact - is the direction and course of the fracture line. If the fracture line runs horizontal or oblique posterior anterior screw fixation is the most favourable treatment. On the other hand if the fracture line runs oblique anterior Halo immobilization or C1-C2 posterior fixation is the method of choice.

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[Radiosurgery has in recent years been used with promising results in the treatment of cerebral metastases. Between July 1991 and January 1993 we treated 23 patients harbouring brain metastases (39 lesions) with our Linear accelerator based radiosurgery system. The median tumor size was 1.9 cm (1.0-3.0 cm) and the median delivered dose was 18.7 Gy (13–25Gy). Follow up CT scans at 4 months showed a complete remission or greater than 50% tumor volume reduction in 19 patients (82%). No change was noted in 2 patients (9%), and after a transitory decrease an increase in tumor size was seen in 2 patients (9%). Follow up time was minimum 6 month (or till death), and maximum 26 months. We have lost 13 patients during the study, and the cause of death was neurologic in only 2 cases. Our experience supports the cumulating evidence that radiosurgery is an effective treatment for metastatic brain tumors, is well tolerated by the patients, and can be applied also in cases where open surgery can not be performed.]

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[In three hydrocephalic and one fetus with intra- and periventricular hemorrhage real time imaging was used to identify cerebral changes. Color flow imaging was used to identify the fetal middle cerebral and umbilical artery for subsequent pulsed Doppler sonographic studies. Cerebral blood flow patterns of hydrocephalik fetuses seem to differ individually from case to case presenting normal, increased and decreased velocity waveform indices. The resistance index and pulsatility index of the middle cerebral artery in case of cerebral hemorrhage increased with advancing worsening of the fetal state of health. Loss of diastolic cerebral or umbilical flow followed by retrograde flow during diastole antenatally could be a bad sign prognostically. ]

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