Clinical Neuroscience

[Data on the psychiatric use of chlormethiazole (Heminevrin)]

KARDOS György1

APRIL 01, 1967

Clinical Neuroscience - 1967;20(04)

[Author reviews the literature on the pharmacological and clinical effects, side effects and complications of Heminevrin. He reports on 77 cases he has observed and treated. He confirms the excellent efficacy of Heminevrin in delirium tremens, where in 31 patients Heminevrin therapy led to recovery in a few days without mortality and without complications. He has used the drug praeventively in 27 cases of praedelirosus withdrawal syndrome, which he considers to be a beneficial combination for the treatment of endogenous and reactive psychogenic depressions (based on 13 cases). ]

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  1. Országos Ideg- és Elmegyógyintézet tüdőosztálya és III. B. férfi elmeosztálya

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Clinical Neuroscience

Die ventrale Fusion im Bereich der Halswirbelsäule bei Bandscheibenschäden

W. Grote, P. Röttgen

Das so genannte Zervikalsyndrom, dessen häufigste Erscheinungsformen Schulter- und Armschmerzen, Nacken- und Kopfschmerzen, zervikale Migräne, vertebraler Schwindel und zervikale Myelopathie sind, ist wesentlich schwieriger zu diagnostizieren als das Lumbalsyndrom. Bei Vorliegen eines Zervikalsyndroms wurden folgende Operationen durchgeführt: La-Minektomie oder Hemilaminektomie mit oder ohne Entfernung der vorgefallenen Bandscheibe, Radikotomie nach Jackson oder Frykholn. 1962 führten Cloward (Honolulu) und Dereymaeker und Mulier (Belgien) die Operation ein, bei der die vorgefallene Bandscheibe durch ventrale Penetration entfernt und eine knöcherne Fusion zwischen den Wirbelkörpern hergestellt wurde. Nach Lindblom wird die chirurgische Indikation durch eine Diskographie mit 60 % Urographie ergänzt. Seit 1962 wurden 84 Patienten operiert (Tabelle 5). Die Myelographie wurde in 33 Fällen durchgeführt. Bei 37 Patienten wurde eine einzelne und bei 42 Patienten eine multiple Diskusläsion festgestellt. 28 Patienten wurden nicht fusioniert. Bei der Mehrzahl der Patienten wurde die Knochenfusion bei 8 Patienten mit autoplastischem Knochen, bei 42 Patienten mit homoplastischem Knochen und bei 6 Patienten mit heteroplastischem Knochen durchgeführt. Postoperative Ergebnisse (Tabelle 17): Von 29 Brachialgien zeigten 15 eine deutliche Besserung (wg), 10 eine deutliche Besserung (g), 4 hatten unveränderte Beschwerden (u). 17 Brachialgie und Zephalalgie postoperative Ergebnisse Verteilung: 11, 3 und 3. 8 Zephalalgie (C34): 5, 2 und 1. 30 Myelopathie: 7, 7 und 16. Wenige chirurgische Komplikationen: ein Fall von Ösophagusverletzung, ein Fall von Hämatom mit Atemnot, zwei Fälle von Abrutschen des Knochensplitters. Manchmal kann auf eine Knochenversteifung verzichtet werden, aber im Falle einer Versteifung ist das Operationsergebnis besser. Bei Myelopathie ist der Verzicht auf eine Indikation gerechtfertigt, aber auch in diesem Bereich können hervorragende Ergebnisse erzielt werden; ein Patient mit Tetraplegie war nach der Operation arbeitsfähig.

Clinical Neuroscience

[Ehlers-Danlos syndrome associated with neurological symptoms]

KOMÁR József, KRÁNITZ Géza

[The authors diagnosed a 43-year-old woman and her 8-year-old son with classic Ehlers-Danlos syndrome. In the mother, the underlying disease was accompanied by muscular atrophy and symptoms suggestive of spinal cord dorsal cord injury. The authors associate the onset of neurological symptoms with the underlying disease and attribute it to dysplastic vasculature.]

Clinical Neuroscience

[Eozinofil granulocytak a liquorban]

PÉTER Ágnes, KOVÁCS Ferenc

[Eosinophilic cells were detected in a small percentage of CSF in both bacterial and non-bacterial infections. Intense CSF eosinophilia was found only in bacterial processes. In these cases, an allergic pathomechanism was hypothesized. Unique in the literature, liquoreosinophilia accompanied by a leukocytic reaction was observed in our 1 case of meningitis in the setting of collagenosis and in our 3 cases of granulomatous menongoencephalitis. This specific CSF cytological reaction was highlighted in the group of diseases of the nervous system with immune-allergic syndrome. Immuno-allergic CSF syndromes with eosinophilic cell proliferation were divided into three groups according to the involvement of plasma cells. The factors determining the type of reaction response remain to be elucidated. Our patient with periarteritis nodosa with 26% eosinophils in his meningogram complements literature data. Of particular interest is our case No 4, who developed cerebroesinophilia after myelography.]

Clinical Neuroscience

[The role of the limbic lobe in incentive production]

FENYVESI Tamás

[Two cases of a midline tumour destroying limbic structures were described. In both cases, the clinical picture was characterized by a high degree of inducibility loss, which was already evident at the onset. We evaluate our cases as recent data on the role of limbic structures in the maintenance of incentin production. ]

Clinical Neuroscience

[Analysis of symptoms and polygraphic data of Elysion psyches]

ZSADÁNYI O., HALÁSZ P., KARÁCSONY A.

[Elysione (phenylcyclohexylpiperidine monohydrochloride) has gained widespread use in anaesthesiology due to its sensory blocking effect. Transient psychotic symptoms after surgery have been described and analysed by several authors as a side effect of the drug. The psychotic picture that develops may also be considered a schizophrenomimetic agent because of certain characteristics.]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

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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

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Clinical Neuroscience

Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias

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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.