Clinical Neuroscience

[Data on the mechanism of generation of cortical spasm potentials]

FEHÉR Ottó1, HALÁSZ Péter1, MECHLER Ferenc2

DECEMBER 01, 1959

Clinical Neuroscience - 1959;12(12)

[Authors have induced seizure potentials in cat cerebral cortex by the combined use of strychnine, d-tubocurarine, and one of these agents and an eserine acetylcholine solution. The neuronal substrates of these spasm potentials were studied by surface and deep macroelectrode and microelectrode ablation. It was found that strychnine and d-tubocurarine potentials are also generated in the sleeping cortex and are not accompanied by single-cell activity. The latter is only associated with a mainly first, positive phase of these potentials in awake cortex. Eserine acetylcholine induces a rhythmic afterglow in the cortex treated with the two former agents, which is no longer localised to the upper 5-600 Y of the cortex but is detected throughout the entire depth of the cortex. Single-cell discharges are then observed in precise correlation with all surface waves. There is no rhythmic afterdischarge without single-cell activity. Authors conclude that the neuronal substrate of rhythmic aftershocks, which is very similar to the epileptic electrogram, is a vertical excitatory circuit within the cortex, in which the excitation moves from the surface to the deep and then switches back to the surface. This circuit, which also sends impulses to other brain areas and the periphery of the body, can be interrupted by the use of atropine and diphedan. The type of discharge described above is considered by the authors to be a model of discharge during an epileptic seizure, which seems to be suitable for testing antiepileptic effects. ]

AFFILIATIONS

  1. Debreceni Orvostudományi Egyetem Élettani Intézete, Ideg-és Elmegyógyászati Klinikája
  2. Debreceni Orvostduományi Egyetem Élettani Intézete, Ideg-és Elmegyógyászati Klinikája

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Clinical Neuroscience

Hyperkinese und Motilitätspsychose

KARL Leonhard

Die Hyperkinese, d. h. rein im Psychomotorischen ablaufende Erregung, gibt noch keinen Hinweis auf eine Katatonie. Wenn es sich um eine einfache Vermehrung der Reaktiv- und Ausdrucksbewegungen handelt, dann ist im Gegenteil eine heilbare Motilitätspsychose anzunehmen. Erst, wenn Verzerrungen im Bewegungsablauf erkennbar werden, ist die Diagnose und Prognose im Sinne der Katatonie zu stellen. In akinetischen Zustenden weisen Verzerrungen der Haltung oder negativitische Züge darauf hin, dass nicht die heilbare akinetische Motilitätspsychose, sondern eine akinetische Katatonie vorliegt. Von der periodischen Katatonie sind fernehin die systematischen Formen von Katatonie mit ihren charakterischen Bildern und einem schleichenden Verlauf zu trennen.

Clinical Neuroscience

[Clinical and pathological data on poiloencephalitis haemorrhagica superior]

JUHÁSZ Pál, SÉRA Ibolya

[Our 43-year-old patient presented with two well-known pathologies, spinal demyelination and polioencephalitis haemorrhagica superior, due to deficiency disease and toxic damage. The co-occurrence of the two is unknown in the literature. From the clinical picture, it appears that polyoencephalopathic reactio is a relatively late complication of spinal demyelinopathy. ]

Clinical Neuroscience

[Cerebral venous pressure testing in humans ]

SOLTI Ferenc, SIMONYI Gusztáv, RÉV Judit, HERMANN Róbert, PÉTER Ágnes, ISKUM Miklós

[Cerebral venous pressure was measured regularly by puncture of the internal jugular vein. 1. Cerebral venous pressure varied within wide limits (19-164 mmW). 2. There was no parallel between the cerebral venous pressure and the cubital venous pressure, and the two venous systems usually behaved differently on inspiration. 3. No correlation was found between CSF pressure magnitude and cerebral venous pressure magnitude. Similarly, there was no correlation between CSF pressure and venous cubital pressure. 4 Our experiments suggest that the determination of cerebral venous pressure is necessary for experimental studies of cerebral circulation.]

Clinical Neuroscience

[Neurological complications of malignant haematopoietic disorders]

AMBRÓZY György, ECKHARDT Sándor, GALLAI Margit

[1.In 6.2% (19 cases) of 306 malignant haematological malignancies we observed neurological complications, 11 patients had radiculomedullary syndrome, 3 patients had disturbed consciousness, 5 patients had lesions of the cranial nerves and one patient had lesions of the sympathetic nervous system. 2. In seven cases, neurological symptoms were the initial complaint of the patient. In order to diagnose the pathology early, we call attention to histological examination of lymph nodes, skeletal radiography, serum and CSF electrophoresis, peripheral blood count, bone marrow aspirate if necessary. 3. Radiotherapy for local neurological lesions ; combined cytostatic and radiotherapy for generalised tumours or advanced leukaemias ; surgical treatment for severe spinal cord compression. ]

Clinical Neuroscience

[Report]

HORÁNYI Béla

[The author reports on the symposium held in Jena, Germany, October 17-19, 1959, by the Electroencephalography Society of Democratic Germany.]

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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

[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

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.]