Clinical Neuroscience

[Comparative study of digital subtraction angiography and MR-angiography in ischemic stroke of children]


NOVEMBER 20, 1997

Clinical Neuroscience - 1997;50(11-12)

[A report is given on 10 children suffering from ischemic stroke. In all children the ischemic lesions were confirmed by CT scans. The patients underwent both Digital Subtraction Angiography (DSA) and MRA. In five cases of stenotic or occlusive changes the MRA correlated well with DSA findings. However 3 cases of moyamoya disease, 1 case of arterial spasm and 1 case of stenotic change were not shown on MRA. MRA can be a valuable alternative method to DSA in occlusion of major intracerebral arteries.]


  1. Borsod-Abaúj-Zemplén Megyei Kórház-Rendelőintézet Gyermek-egészségügyi Központ, HIETE II. Gyermekgyógyászati Tanszék, Miskolc
  2. Radiológiai és Izotópdiagnosztikai Intézet, Budapest



Further articles in this publication

Clinical Neuroscience

[Antecendents and epilepsy in dyskinetic/dystonic cerebral palsy]

BALOGH Erzsébet, KOZMA Gyuláné, VARGÁNÉ Kiss Anna

[The rate of cerebral palsy (1-3/1000) is not diminishing, but the prevalence of athetosis seems to be decreasing. 234 athetosis cases (born 1972–1992) have been studied in Budapest (n=149) and in London (n=85) for birth weight, icterus, hypoxia and/or neonatal convulsion and epilepsy. The majority of athetosis cases were born with a birth weight above 2500 g. Kernicterus has not been found, but 43.3% (Budapest) and 75.3% (London) of the cases showed clinical signs of hypoxia with or without perinatal convulsion. Hypoxia and icterus were rarely found together. Athetosis with epilepsy occurred in one fourth and one third of the cases, respectively. Long term hypoxia of mature infants has to see the most relevant risk factor for the severe cerebral palsy with (29.5% Budapest, 23.5% London) and without epilepsy.]

Clinical Neuroscience

[Advances in the diagnostics of spinal muscular atrophy]


[The three most common types of childhood spinal muscular atrophy (SMA) are type I or Werdnig Hoffmann disease, type II or intermediate form, and type III or Kugelberg-Welander disease. The clinical features of these three types are characteristic, profound limb hypotonia, wasting of muscles and areflexia. All three forms of SMA reveal an autosomal recessive mode of inheritance. The gene responsible for all three types of SMA is located on the long arm of chromosome 5 in the region of 5q11.2-913.3. Starting from 1993 blood samples were collected from 87 Hungarian families with all 3 types of SMA. DNA samples of all family members were analysed with the currently available highly informative microsatellite DNA markers in the locus 5q11.2 q13.3. Moreover, affected persons and their family members have been analysed for deletions of the survival of motor neuron gen (SMN). Prenatal diagnoses were performed in 28 cases at the request of the affected families. The possibility of prenatal diagnosis is a major step forward in helping these families, as the risk of recurrence of this devasting, untreatable disease is 25% in affected families.]

Clinical Neuroscience

[Prognosis of newborns of very low birthweight]

BEKE Anna, FEHÉRNÉ Szekszárdi Márta, CSIKY Erzsébet, KUCSERÁNÉ Gráf Rózsa, NÉMETH Tünde, SZABÓ Györgyné

[Development of 357 ventilated newborns born from January 1989 to 30 September 1996, who weighed 1500 gm or less at birth, was investigated in follow-up studies. Of the 357 infants, 9 died after one month of age. The outcome of 348 survivors was followed up by a team after the same protocol. Infants were divided into two groups according to year of birth. In the first four-year group, there were 168 children (from 1989 to 1992), in the second one there were 180 children (from 1993-1996). The two periods are different in the obstetrical and neonatological therapeutic methods. Comparing the results of follow-up studies, the authors investigated the influence of the new therapeutic methods on the neonatal morbidity and prognosis of newborns of very-low birthweigt. Although the survival rate increased from 61% to 78% between the two four-year periods, and the survival rate of newborns of very very low birth weight became two times higher (from 19.8% to 41 %), the neurological morbidity (rate of cerebral palsy), did not changed essentially. Important improvement was found in the ophthalmological outcome. The conclusion is that the quality of life for infants and children born of very-low birthweight has not yet improve significantly in every area of development.]

Clinical Neuroscience

[99 M TC HMPAO SPECT in children with intractable epilepsy]

NEUWIRTH Magdolna, BORBÉLY Katalin, KOPCSÁNYI Zsuzsanna

[We examined the role of HMPAO SPECT examinations in presurgical evaluation of children with intractable partial epilepsy. SPECT studies (ictal, interictal) were performed on 31 children aged 1-18 years. The focus was restricted in 18 cases and extensive, ie, a whole hemisphere or some lobes, in 4 cases. SPECT indicated pathological changes in the relevant areas in 15 of 18 cases, but in 9 children with temporal epilepsy in all. The focus was extensive in 4 cases, e.g. in 3 children with Rasmussen syndrome. SPECT was pathologic in all of them when MRI did not yet show hemiatrophy of the brain. In 3 cases of partial epilepsy MRI did not demonstrate lesion, the focus was not well-defined by EEG, in contrast to SPECT. Thus it can be stated that SPECT provides valuable information on presurgical evaluation in children with intractable partial epilepsy.]

Clinical Neuroscience

[Pedigree analysis of hungarian rett syndrome girls]


[Rett syndrome is a neurodevelopmental disorder that has been reported exclusively in females. It was first described by Andreas Rett in 1966. The disorder is characterized by a progressive loss of cognitive and motor skills as well as the development of stereotypic hand movements, occurring after an apparently normal 6 to 18 months of development. The aetiology of the syndrome is still unknown. Since genetic origin can be presumed we examined the potential gene sources of the Hungarian Rett syndrome patients. Genealogical tests were carried out based on 22 Hungarian families with Rett syndrome girls. None of our 23 probands was born to first-cousin couples, but we found an increased number of consanguineous marriages among the ancestors of the patients: in two families first-cousin marriages among the great grandparents on the maternal sides; in one family, one second-cousin marriage on the maternal side. Considering the rate of the consanguineous marriages in Hungary the observed rate is highly increased. On investigating the place of origin of the Rett families we found a predominance in the north east part of Hungary. Our results support the findings of a Swedish analysis.]

All articles in the issue

Related contents

Clinical Neuroscience

A case with angiographic demonstration of isolated anterior spinal artery occlusion

DOGAN Burcu Vasfiye, KARA Batuhan, SELCUK Hatem Hakan, DIRICAN Ceyhan Ayten, KOKSAL Ayhan

Anterior spinal artery syndrome (ASAS) is a rare syndrome which occurs due to thrombosis of anterior spinal artery (ASA) which supplies anterior two thirds of the spinal cord. A 27-year-old female patient was admitted to emergency clinic with sudden onset neck pain, sensory loss and weakness in proximal upper extremities which occurred at rest. Thrombophilia assessment tests were negative. Echocardiography was normal. Serum viral markers were negative. In cerebrospinal fluid (CSF) examination, cell count and biochemistry was normal, oligoclonal band was negative, viral markers for herpes simplex virus (HSV) type-1 and type-2, Brucella, Borrellia, Treponema pallidum, Tuberculosis were negative. Diffusion restriction which reveals acute ischemia was detected in Diffusion weighted MRI. Digital subtraction angiography (DSA) was performed. Medical treatment was 300mg/day acetilsalycilic acid. Patient was discharged from neurology clinics to receive rehabilitation against spasticity.

Clinical Neuroscience

First experiences with MR-compatible implants in the management of Aneurysmal subarachnoid haemorrhage

DÓCZI Tamás, KÖVÉR Ferenc, HORVÁTH Zoltán, MÉSZÁROS István, VADON Gábor

Aneurysm clips made of titanium alloy were considered to be useful for clinical application due to the expected reduction in artifact formation on postoperative CT and MR. First, the behaviour of the new titanium clip (Aesculap) was investigated in phantom experiments in CT and MR scanners. After the in vitro tests had proved the applicability of the new implants, a series of operations was performed employing the new clip in 21 patients and the traditional phynox clip in 17 patients. All patients with a titanium implant had postoperative 11, T2 and proton-weighted MR scans. In 12 cases pre- and postoperative; in 9 cases only postoperative MR angiographies were carried out. In 4 patients both control MR- and catheter angiographies were performed. Clinical results as analysed at least 6 months following the operation were not different from those of 1992 and 1993 of the same team and were comparable to recently published data in the literature. The study has shown that ability to effectively diagnose clip-adjacent brain structures can be improved considerably by employing clips of titanium alloys. Concerning the value of postoperative MR angiography either with or without contrast material to control the effectiveness of aneurysm occlusion, the following conclusion was drawn: while the postoperative potency of the parent artery was clearly visualized in every case, it was impossible to define whether occlusion of the aneurysm had been complete.

Lege Artis Medicinae



[Magnetic resonance imaging has become a basic imaging method in neurological diagnosis in the past decade. It provides excellent anatomical, morphological and in special indications, functional information on the central nervous system. In this issue, the role of magnetic resonance imaging in the diagnosis of brain diseases is outlined in connection with relevant clinical courses and the cardinal neurological signs.]

Clinical Neuroscience


BAHNER Udo, GEIGER Helmut, PALKOVITS Miklós, LENKEI Zsolt, LUFT C. Friedrich, HEIDLAND August

[To test the effect of dehydration on brain atrial natriuretic peptide (ANP) concentrations in areas important to salt appetite, water balance and cardiovascular regulation, we subjected rats to dehydration and rehydration and measured ANP concentration in 18 brain areas, as well as all relevant peripheral parameters. Water deprivation decreased body weight, blood pressure, urine volume, and plasma ANP, while it increased urine and plasma osmolality, angiotensin II, and vasopressin. ANP greatly increased in 17 and 18 brain areas (all cut cerebral cortex) by 24 h. Rehydration for 12 h corrected all changes evoked by dehydration, including elevated ANP levels in brain. We conclude that chronic dehydration results in increased ANP in brain areas important to salt appetite and water balance. These results support a role for ANP as a neuroregulatory substance that participates in salt and water balance.]

Clinical Neuroscience



[The unparalleled global rates of obesity and type 2 diabetes, together with the associated cardiovascular morbidity and mortality, are referred to as the "diabesity pandemic". Changes in lifestyle occurring worldwide, including the increased consumption of high-caloric foods and reduced exercise, are regarded as the main causal factors. Central obesity and insulin resistance have emerged as important linking components. Understanding the aetiology of the cluster of pathologies that leads to the increased risk is instrumental in the development of preventive and therapeutic strategies. Historically, skeletal muscle, adipose tissue and liver were regarded as key insulin target organs involved in insulinmediated regulation of peripheral carbohydrate, lipid and protein metabolism. The consequences of impaired insulin action in these organs were deemed to explain the functional and structural abnormalities associated with insulin resistance. The discovery of insulin receptors in the central nervous system, the detection of insulin in the cerebrospinal fluid after peripheral insulin administration and the well-documented effects of intracerebroventricularly injected insulin on energy homeostasis, have identified the brain as an important target for insulin action. In addition to its critical role as a peripheral signal integrating the complex network of hypothalamic neuropeptides and neurotransmitters that influence parameters of energy balance, central nervous insulin signalling is also implicated in the regulation of peripheral glucose metabolism. This review summarizes the evidence of insulin action in the brain as part of the multifaceted circuit involved in the central regulation of energy and glucose homeostasis, and discuss the role of impaired central nervous insulin signalling as a pathogenic factor in the obesity and type 2 diabetes epidemic.]