Clinical Neuroscience

[Diagnostic errors in meningiomas of the cerebellum in old age]

ÉDER Mária1, LŐRINCZ Gábor1

AUGUST 01, 1967

Clinical Neuroscience - 1967;20(08)

[Diffuse oedematous phenomena were found in the white matter of both cerebral hemispheres, more pronounced on the same side as the tumour. We also observed oedema in the white matter of the cerebellar hemisphere of the cerebellum, which was accompanied by even older and more recent microscopic haemorrhages on the tumour side. The investigators in this case were led to an incorrect pathology by a nearly one and a half year asymptomatic period, a rapidly developing personality change, symptoms characteristic of diffuse cortical damage, a negative fundus finding throughout and last but not least the result of the Gamma EG examination. ]

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  1. Budapesti Orvostudományi Egyetem Neurológiai Klinika és az Országos Rheuma- és Fürdőügyi Intézet

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Clinical Neuroscience

[Bilateral tibialis anterior syndrome]

KÓMÁR József, LEHOCZKY Tibor

[Authors describe bilateral tibialis anterior syndrome after strenuous standing work in a 49-year-old female patient. Based on histopathological examination of muscle biopsy, increased subsidence and leukocytosis, the clinical symptoms are considered to be due to myositis. Treatment with ACTH relieved the patient of symptoms. The syndrome is considered to be polyaetiological and, on the basis of Morger's studies, conservative treatment with anti-inflammatory drugs is recommended instead of fasciotomy. ]

Clinical Neuroscience

[Maniform psychosomatic alternating periodic hypersomnia ]

POHL Ödön, HAITS Géza

[The authors describe a 19-year-old male patient who developed a parotitis epidemic 2 years ago and experienced severe drowsiness lasting for days. Since then, his hypersomnia has recurred 5 times over a period of 2-3 weeks, with repeated episodes of manic psychosis in between. Authors hypothesize meningoencephalitis as an aetiological factor accompanying parotitis epidemica and leading to diencephalon, but they also suggest that genetic factors may be involved in the onset of maniform pictures. ]

Clinical Neuroscience

[Follow-up results of trigeminal excisions for tic douloureux]

ZAPPE Lajos, NAGY Vilmos

[Authors report 1-7 year follow-up results of 121 intracranial trigeminal truncations in 120 patients and report the following findings: 1. in the area of the auricle and angulus mandibulae, the separation of the trigeminal and adjacent innervated areas is not sharp, and there is certainly overlap. 2. Any regeneration that may occur after surgery starts from this area, with the loss of sensation extending back towards the medial orbital ridge. 3. After complete shutdown of the nerve, regeneration is limited and neuralgia hardly ever recurs, but anaesthesia dolorosa develops quite often, although it is severe in only 4% of cases. 4. Recurrence is quite frequent after partial excision, occurring predominantly in the first 4 years after surgery - but is usually reversible with further surgery. Their studies have shown that the effect of surgery against T.N. is based on the elimination of the incoming stimuli, deafferentation. During radicotomies, root compression, breaking and stretching at the pyramidal apex have never been observed. Their observations have led to a position on the pathomechanism of the facial nerve root and the therapy to be chosen. It seems best to start with a ganglion treatment resulting in partial disconnection of the nerve. If, however, radicotomy is performed, total root transection is the correct solution. ]

Clinical Neuroscience

[Drug treatment trials for the treatment of chronic alcoholism (II)* a) About the metronidazole-alcohol reaction ]

KARDOS György, SZABADOS Pál

[Alcohol aversion or because of the risks and complications of disulfiram cures, interest in the temperance drugs (cyanamide, calcium carbamide citrate, etc.) ensuring relative intolerance has increased in recent years all over the world. Verff. report 117 therapy drinking tests on 50 patients and some self-experiments with trichomonacid-metronidazole. At equal doses of alcohol, the reaction whose main symptoms are described is much milder than the disulfiram-alcohol reaction; on the other hand, at greater alcohol exposure, which, however, corresponds to habitual and relatively insignificant consumption in drinkers, very unpleasant and agonizing nausea (headache, vomiting, dizziness, weakness, etc.) may occur. An overview is given of the isolated clinical-pharmacological data obtained concerning metronidazole, partly in alcoholics, partly in schizophrenics. According to these, the drug is supposed to have a thymoanaleptic effect, reminiscent of MAO inhibitors, as well as an abolishing effect on alcohol dependence. It would be essential to remedy its chronic toxic effect, further to increase the tempering effect by structural changes to the metronidazole molecule, or to favor its usability against alcohol by attenuating the side effect. ]

Clinical Neuroscience

[E250 (phenylisopropylmethylpropynylamine Hcl.) clinical experience]

A. Tibor, LIPÁK János, KLEININGER Ottó

[Authors observed the effects of E250 (phenylisopropylmethyl propinylamine HCl) in a total of 56 patients. Their experience was unfavourable in major depressive disorder associated with marked anxiety and abnormal thought processes. In milder depressions, it has been found to be effective in combination with tranquillisers and sleeping pills. It can also be used as a stimulant in adjusted doses depending on individual tolerance. Almost without exception, it enhanced activation and psychic performance in patients with occupational therapy for epilepsy. This was also convincingly confirmed by concurrent reactio-temporal measurements and psychological test studies (Rorschach, Lüscher test). ]

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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

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

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

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

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. ]