Clinical Neuroscience

[Data for the isolation of midline subfrontal meningiomas]

HULLAY József1

JULY 01, 1965

Clinical Neuroscience - 1965;18(07)

[The author, reviewing the surgical descriptions of 20 cases of meningiomas with midline subfrontal and praesellar localization, found that in 5 cases the tumor was located on the lamina cribrosa and crista galli, in 3 cases it was located in the tuberculum sellae but also spread to the limbus sphenoidalis, and in 12 cases, the most frequent, it was located on the planum (jugum) sphenoidalis. He found the striking frequency of meningiomas adherent to the planum remarkable because in the publications on meningiomas this variant is not listed as a separate group, but is classified with the two former variants. - The correct analysis of the anamnesis, the osteo-, angio- and pneumographic images, and the justification for this is that while the site of adhesion of olfactory meningiomas is the os ethmoidale, that of planum meningiomas is the os sphenoidale, and while the former tends to destroy the base of the anterior scala, the latter tends to cause bone outgrowth. Although the tuberculum meningioma and planum meningioma are attached to the same bone and the limbus may be blurred, the former may show at most a slight bone lesion at the site of attachment, whereas the latter usually shows marked hyperostosis and specific bone outgrowth. On these grounds, he considers it justified to include planum meningioma as a separate variant alongside tuberculum meningioma and olfactory meningioma.]

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  1. Debreceni Orvostudományi Egyetem Ideg-és Elmeklinika

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Further articles in this publication

Clinical Neuroscience

[Recording of pulsus-frequency and amplitude variation and its significance during posterior scala surgery]

OROSZ Éva

[The most delicate neurosurgical interventions are those involving manipulation of the midline structures, supratentorially near the hypothalamus and infratentorially near the pons, medulla oblongata. Not only direct damage to these structures, but also temporary circulatory disturbances caused by pressure or traction may result in consequential oedema or atony, which may lead to a very serious condition of the patient, possibly death. While there are little or no signs of hypothalamic injury during surgery, even minor lesions of the posterior scala of the brain stem are immediately apparent in the form of vegetative reactions (in the anaesthetised patient), changes in pulse, blood pressure and respiration. It is the anaesthesiologist's task to monitor these very carefully and report them to the surgeon.]

Clinical Neuroscience

[About "aseptic" meningitis]

MOLNÁR Sándor

[Worming in aseptic meningitis should be considered in the presence of varying degrees of eosinophilia in the blood and CSF, especially in the presence of ascaris lumbricoides, cysticercosis and trichinellosis which may have spread to the nervous system. Meningitis tends to be partly toxic and partly neuroallergic. The CSF pattern of so-called sympathetic or concomitant meningitis, maintained by inflammatory foci, mainly purulent, of the body or brain, is always dependent on the development of the underlying disease. Changes in the latter are followed by changes in both the quantitative and qualitative cellular picture of the CSF and, to a lesser extent, in the protein levels. ]

Clinical Neuroscience

[Vascular traffic studies in neurological patients with special reference to Hallervorden-Spatz disease]

SZÁNTÓ József, GALLYAS Ferenc

[Four out of 20 neurological patients (2 Friedreich's, 1 Wilson's, 1 gargoylism) were found to have abnormal overall iron metabolism by isotope analysis. In contrast, the general iron turnover of our Hallervorden-Spatz patients was found to be normal despite abnormal iron metabolism in the pallidum and substantia nigra. Iron storage in these formulas is continuous. These findings can be used in the pathogenesis of Hallervorden-Spatz disease. ]

Clinical Neuroscience

[Use of Nuredal (Niamide) in neuropsychiatry]

NAGY A. Tibor, ZSADÁNYI Ottó

[Authors report their experience with Nuredal (Niamide) in 52 patients. The effect on psychomotor inhibition, a core symptom of depression, was found to be indisputable and primary, and they suspect this to be an extension of the scope of psychotherapy. This potential is seen in the possibility of transforming reactive depressive disorders into neurotic depression.]

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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.

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

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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

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[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

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[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]