Clinical Neuroscience

[Data on the pathomechanism of ventricular diverticulus formation]

SOÓS Imre1, MOHÁCSI Ildikó1

NOVEMBER 20, 1953

Clinical Neuroscience - 1953;6(04)

[A case of a lateral ventricular diverticulum herniating into the cisterna ambiens and a case of multiple intracerebral ventricular diverticulosis were described. Cisterna ambiens diverticulum may form in adulthood on rigid hydrocephalus cerebrum, although it has also been described in children. It is essentially an infratentorial herniation of the retrosplenial gyrus in a slowly developing brain pressure gradient. A large differential between supratentorial and infratentorial pressures is a favourable condition for its development. It can be diagnosed in vivo only by ventriculography. It is to be distinguished from arachnoid cysts of the cisterna ambiens, which do not converge with the ventricular system and have no parenchyma or ependyma in their walls. Intracerebral diverticula may originate anywhere in the ventricular system of the juvenile hydrocephalus brain. The pathomechanism of their origin is due to the readiness of the severely oedematous parenchyma to infiltrate and secondary collapse into the ventricular system. (Weber and da Rugna: dissezierende intracerebrale Divertikel) The involvement of the dilated third ventricle in the cisternae is not a true diverticulum, but is notoriously common in hydrocephalus. The clinical significance of diverticulum formation is that it is a self-healing activity that eliminates obstruction to cerebrospinal fluid circulation and provides a route for the surgical resolution of occlusive hydrocephalus.]

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  1. Budapesti Orvostudományegyetem Elme- és Idegklinikája és Idegsebészeti Intézet

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Clinical Neuroscience

[On the treatment and origin of acute life-threatening mental disorders (so-called acute fatal catatonia)]

NAGY Tibor

[1. Acute life-threatening insanity can be cured by early and cumulative electroshock treatment. 2. The syndrome can be understood as a cluster of symptoms of cortico-cerebrospinal-pituitary-adrenal dysfunction, which may be triggered by psychic, somatic and toxic effects. 3. Instead of the various names used in the literature - delirium acutum, amentia, catatonia perniciosa, azotaemic insanity, acute toxic psychosis, etc. - a more comprehensive name seems justified.]

Clinical Neuroscience

[The u. n. treatment of acute fatal catatonia electrospasm]

VARGHA Miklós, KOVÁCS Béla

[Attempts have been made to deconstruct the nosolgical entity of schizophrenia from several angles. A detailed differentiation on the basis of psychopathology may be useful in order to find a closer link between the diverse biochemical, pathophysiological, morphological sub-scores and the psychopathological picture. Morphological lesions (Miskolczy, Hechst (Horányi), Josephy, Fünfgeld), as Miskolczy emphasises, only provide a consistent picture in certain forms of schizophrenia. The relative intactness of the cerebral areas (Stief, Hechst (Horányi)) is in contrast to some of the clinical symptoms, so that we can say that morphological lesions, whether of the brain or liver (Gaupp), etc., have not been able to prove the unity of schizophrenia or to clarify the affiliation of the different forms. Biochemical and pathophysiological research is at the stage of data collection, as Riebelling, in his most recent summary paper, has pointed out.]

Clinical Neuroscience

[Some aspects of "primary-infectious" polyradiculoneuritis ]

JUBA Adolf

[After presenting the clinical and histopathological findings of two quite acute (2 days and 7-8 days) fatal "ascending polyradiculoneuritis", the author deals with pathological issues, which, given the severity of the cases, the histopathology provides a good starting point. The focus of the tissue process falls on the area between the root nerve and the intervertebral duct. However, inflammatory infiltrates are initially very sparse, consist of lymphocytes throughout, and do not extend beyond the area of ​​parenchymal destruction; that is, they do not correspond to real but to "reparative inflammation." Morphologically verifiable parenchymal injury is also initially disproportionate to severe clinical relapses and is only approx. It unfolds in 1 week. All this is against the generally accepted origin of the virus; confirmation of the allergic origin raised by Pette may not be by histological but by clinical-laboratory tests.]

Clinical Neuroscience

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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

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

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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.

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[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

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[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.]

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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.]