Clinical Neuroscience

[Data on carotid circulation disorders I. Thombosis of the internal carotid artery]

DÉNES Iván1, KÉKES Ede1, HORÁNYI Péter1

NOVEMBER 01, 1968

Clinical Neuroscience - 1968;21(11)

[The authors analysed data from 29 patients with internal carotid artery thrombosis. They highlight the importance of prevention and early diagnosis of the disease. In addition to the common clinical signs, they recommend monitoring changes in blood pressure, palpation of the carotid artery, performing a carotid pulse curve, and looking for contralateral murmur. In their experience, novocaine infiltration of the carotid sinus area is always effective in the treatment and prevention of severe hypertension in the setting of the disease.]

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  1. Orvostovábbképző Intézet Ideggyógyászati Tanszéke és III. sz. Belgyógyászati Tanszéke

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Clinical Neuroscience

[Age-related lesions of the choroid plexus]

HORÁNYI Béla, SZENDRŐI Mária

[Authors studied 30 cases of age-related lesions of epithelial cells and stroma of the choroid plexus. In all cases, they found plexus sclerosis of variable intensity. In 21 cases, Biondi's lesions were detected in the epithelial cells of the plexus, detectable by silver impregnation. The morphological characteristics of these formations are discussed. In their material, they have compared the choroid plexus abnormalities with the occurrence of other age-related brain lesions, i.e. senile plaques and Alzheimer's fibrillum lesions. ]

Clinical Neuroscience

[Factors affecting the offsetting ability psychopathic reactions ]

MAGYAR István

[To summarise what has been said, I would like to present my views on psychopathy below. 1. The abnormal personality structure is not a disease and thus does not in itself affect the integrity of the capacity to reason. 2. The abnormal personality structure may facilitate the commission of a particular act, but its assessment as a mitigating circumstance is a matter for the judge. It is rarely necessary to draw the attention of the mental health professional to this fact, and in particular in the case of recidivists, prison as a "forced treatment" should be acknowledged and approved. 3. The involvement of the capacity to reason comes to the fore in manifest psychopathic states, i.e. in cases of psychic decompensation reaching pathological levels, or when a psychotic reaction occurs at the base of a pathological personality structure. In these cases, the most crucial question is to determine the relationship between the pathological state that has developed and the sinful act; in Nyírő's definition, the disease is criminal or the conscious self. 4 I have not discussed the structural aspects of military justice and pathological personality, but I will merely mention that the issue here is complicated by special military problems, including the question of military fitness and the occurrence of special military crimes. More common is the disqualification or incapacity to report if the offender was or has become unfit for military service. The assessment of special military offences is different and the shaping influence of the military environment changes the assessment. These issues have been mentioned for the sake of completeness, as they would exhaust the scope of a paper, but they are also a specific problem affecting a narrower range of people. The title of my topic promised a description of psychopathic reactions affecting the ability to report and this is apparently not what I gave. However, I believe that without a negative assessment of the abnormal personality structure, which is still a controversial issue in both psychiatry and forensic psychiatry and which does not generally affect the integrity of sanity, the issue cannot be discussed. Practical experience has shown that in the vast majority of cases, the psychoanalytical assessment of pathological conditions arising from pathological personality structures is less of a problem than the correct interpretation of the pathological personality structure itself, psychopathy, and its impact on the integrity of the mental capacity. ]

Clinical Neuroscience

[Stereotactic treatment for Parkinson's disease ]

HULLAY József

[The author reports observations from 40 stereotaxic surgeries in 35 Parkinson's patients. He has developed a new stereotaxic method which, as far as possible, is maximally adapted to ventricular and structura variations and, accordingly, allows not only accurate targeting but also in vivo localization, documentation and interpretation of surgical events. Using his new method of laesio analysis, he detected compression of tremor- and tonus-responsive laesios at the boundaries of V.o. 1 p. and V. im. and V. o. a. in the thalamus, and at the boundaries of Z. i. and Ra. prl., I, in the subthalamus. At the target point corresponding to the site of subthalamic compression, he observed a persistent tremor arrest during EMG-traced electrode insertion, and a single small lesion (40 mm) at this site proved to have a very good effect on both tonus and tremor. Evaluating the surgical results according to the site of laesio placement, he found that combined laesio of the VL nucleus and subthalamus gave better results than pallidum laesio, but the best results were observed after subthalamus, Z. i., Ra. prl. laesio. Undesirable psychic side effects were most often observed with VL nucleus and subthalamus laesio combination. Positive development of the psychic picture and the least side effects were observed after subthalamic laesio. He considered the improvement of psychomotor function as an important factor in the somatomotor improvement or its preservation.]

Clinical Neuroscience

[Analgesic and spasmolytic effects of scutamil-C tablets in neurosurgical patients]

VIDOVSZKY Tamás

[Scutamil-C was tested in a total of 64 patients treated in neurosurgery wards and outpatient clinics. An average of 4X1 tablets was given and it was found to be effective in patients with conditions where painful muscle spasms are the main complaint and symptom, without causing adverse side effects. ]

Clinical Neuroscience

[The intrauterine feeding disorder late neuropsychiatric consequences]

LIPÁK János, BAZSÓ János, KLEININGER Ottó, ZSADÁNYI Ottó, SOÓS Árpád, MALÁN Mihály

[Anthropological, paediatric, ophthalmological, neuropsychiatric and psychological examinations were performed on 20 pairs of twins aged 10-17 years. In all twin pairs, the birth weight of one twin was at least 15% lower than that of the other twin, and in all cases below the median. All other influencing factors than birth weight were excluded. There is no doubt that there is a strong levelling off tendency in the low birth weight group, but the levelling off is not complete even at puberty. Significant differences are found in visuomotor perception, body weight and almost significant differences in locomotor development. There is a non-significant but consistent retardation in the low-weight group in all parameters of physical and mental development, and a similar disadvantage in neuropsychiatric aspects. We believe that intrauterine malnutrition should be recognised as an aetiological factor in the field of physical and mental subnormalities after the age of 10 years. ]

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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

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

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Clinical Neuroscience

Atypical presentation of late-onset Sandhoff disease: a case report

SALAMON András , SZPISJAK László , ZÁDORI Dénes, LÉNÁRT István, MARÓTI Zoltán, KALMÁR Tibor , BRIERLEY M. H. Charlotte, DEEGAN B. Patrick , KLIVÉNYI Péter

Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.

Lege Artis Medicinae

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

FARSANG Csaba

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]