Clinical Neuroscience

[CONTRIBUTIONS to the World Psychiatric Association, 5-11 September 1966 held in Madrid from 5 to 11-11 May 1997]

A. L., J. P.

MARCH 01, 1967

Clinical Neuroscience - 1967;20(03)

[The author reports on the IV Congress of the World Psychiatric Association held in Madrid, September 5-11, 1966.]

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Clinical Neuroscience

[Data on the surgical management of posterior-scalene meningiomas ]

ZOLTÁN László, FÉNYES István

[Authors have tried to provide some data on the surgical management of infratentorial meningiomas based on data from 41 of their own patients and literature reviews. Their experience, together with the available literature data, suggests that the greatest possible radicality should be carried through in the surgical resolution of posterior-scalene meningiomas. They are aware that the neurosurgeon has always tried to perform complete excision of any tumour, but especially extracerebral tumours, within the limits of possibility. However, the assessment of the possibility of radicality is not an absolute concept. It depends, first and foremost, on the use of one's own experience and that of the literature in a given situation to determine the mortality rate and the manner and quality of recovery from similar operations carried out up to that point. When considering the surgical solution of posterior meningiomas in the future, they recommend their modest experience: in evaluating the surgical situation, the chosen method should preferably be radical extirpation, even if this seems to be too high a risk in the given situation. ]

Clinical Neuroscience

[The role of succinimides in the treatment of childhood epilepsy]

KISZELY Katalin, MÁTTYUS Adorján

[We report on 42 children with epilepsy treated with Zarontin (Suxinutin) and Celontin, who had defied all therapies until then. 9 of 11 "classic" petit mal (3 c/s spike-wave) were seizure-free, 2 improved greatly. 7 of 13 children with petit mal varians EEG became seizure-free, 4 improved greatly. Of 9 cases with "other generalised" EEG (clinically mostly mixed GM and PM), 4 had no seizures, 1 had a severe seizure disorder. Of 8 focal epilepsies, 1 improved moderately, 2 greatly. Side effects were unpleasant, but no bone marrow, liver or kidney lesions occurred. Based on therapeutic results, succinimides are considered to be very effective and relatively non-toxic compounds, provided that they are administered under constant supervision and on the basis of an appropriate indication.]

Clinical Neuroscience

[Acute necrotizing encephalitic herpes virus encephalitis of childhood ]

CSERMELY Hubert

[The author describes the histopathological picture of a fatal encephalitis of a 3 and a half year old girl child, which has 4 features: 1. extensive meningocortical massive infiltration, 2. diffuse coagulative necrosis of the cortex, 3. reactive glial-mesenchymal proliferation, 4. inclusion bodies. On the basis of a combined consideration of the clinical and pathological picture, his diagnosis is herpes virus encephalitis.]

Clinical Neuroscience

[About Melkersson-Rosenthal syndrome ]

KOMÁR József, LEHOCZKY Tibor

[The authors describe 5 patients with Melkersson-Rosenthal syndrome. No neurological symptoms other than the classic symptom triad were observed. The clinical features and histological changes of the disease are reviewed, and questions of aetiology and therapy are addressed. We would like to thank Dr. György Czappán, Adjunct Professor, for kindly allowing us to present case 5. ]

Clinical Neuroscience

[Alcoholism and endogenous psychoses]

KARDOS György, MÁRIA Béla

[Chronic alcoholism is not a nosological category, but a clinical umbrella term: it encompasses different syndromes of habitual drunkenness and of real and symptomatic alcoholism, which are built up by a combination of co-pathogenic factors. Authors have studied cases of symptomatic alcoholism where daily or periodic alcohol abuse is associated with other psychiatric pathologies. They report on their studies of coincidences of endogenous psychoses and alcoholism. On the basis of the literature and 23 cases they observed, they identified five possibilities for typical forms of pathoplastic interactions between schizophrenia and alcoholism, which they described and illustrated with an example. On the basis of a psychopathological analysis of their cases, they have shown, on the one hand, how the clinical picture of atypical alcoholic psychosis is modified by latent schizophrenia and, on the other hand, how the organic psychosyndrome of chronic alcohol intoxication, leading to a specific emotional incontinence and personality changes, masks or prevents in some cases the more severe emotional blunting, the deepening of autism and the extinction of social contacts. Therefore, the prognosis of "alcoholic" schizophrenics seems to be more favourable than that of untreated schizophrenics. The frequency of coincidences between cyclothymia and alcoholism was approached from the cyclothymia perspective, in contrast to previous data. They found alcohol abuse in 19 of their 100 non-selected cases of manic-depressive patients, and in eight of these cases there was an interaction between the two disorders that led to alcohol habituation, i.e. habitual drinking. They observed a close pathogenetic relationship between cyclothymia and dipsomaniac syndrome in their patients and noted that the particular forms of abuse and intoxication associated with the immune phase, resembling manic or depressive exaltation, are important signs for the correct diagnosis and timely treatment of patients. It has been pointed out that, unlike the coincidences of schizophrenia and alcoholism, where in some cases pathoplastic interactions are found that modify the prognosis of the dual illness, but presumably only pathoplastic interactions are found, endogenous and endoreactive disturbances of emotional life are also involved in the pathogenesis of alcoholism syndromes, especially in women.]

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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.

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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

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.