Clinical Neuroscience

[Diffuse CSF invasion of oligodendroglioma ]


APRIL 01, 1959

Clinical Neuroscience - 1959;12(04)

[In our oligodendroglioma case, the histopathological examination revealed a ",total metastasis" of the tu. liquor pathways. The connective tissue elements are actively involved in the process of expansion in the subarachnoid space and show excitatory phenomena which we assume to be related to the blastomatous stimulus acting on them. The term "tumorous meningitis" is not uninteresting to designate the picture. The fact that this phenomenon occurs only exceptionally in oligodendroglioma cases could be explained by the fact that tu does not always succeed in overcoming the resistance of the meninges. Diffuse subarachnoid expansion is likely to occur only in conditions where the tu. reaches the brain surface extensively and acts on the meninges over a large surface area. ]


  1. Fővárosi XIII. ker. Tanács Kórház Női Ideg-Elme Osztálya



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Clinical Neuroscience

[Data on the cerebral hemisphere and lobes sclerosis]


[It can be concluded that the extensive cortical damage that is the hallmark of hemispheric atrophies and lobar scleroses is, according to the literature and our own case studies, the result of an anoxic-vascular disturbance, which is particularly predisposed to occur as a consequence of a disturbance of the flow through relatively large pial arterial trunks or arterial border zones. This is associated with convulsions in the majority of cases, but convulsions must be accompanied by some other factor perhaps more pathogenetically important than convulsions ; respiratory disturbances, stagnant anoxia, fever, hypoglycaemia, immunobiological processes. ]

Clinical Neuroscience

[A case of pubertal psychosis ]


[Authors have taken different paths, emphasising the dominance of different characteristics in relation to the pubertal period. It is generally accepted that this age is characterised by a breakdown of the previous relative somatic and psychic equilibrium, which, together with the heightened susceptibility to stimuli from the outside world, which is also observed at this age, may be the basis for a number of dangers, including undesirable, possibly pathological, personality development. A particular interpretation of this aspect is given by Ruckert, who says that "in this age, ... everyone has before his eyes the image of what he should be, not as an abstract formula of a categorical imperative, but as a plastic image, an entelechy of the ideal constitution of his own soul..."]

Clinical Neuroscience

[A case of congenital word blindness ]


[In summary, we believe that congenital word blindness is not a single pathology, but rather a syndrome, in which in many cases there may indeed be an anatomical abnormality, but which, as in aphasia, never causes the loss of a specific isolated function, but which, by disrupting the dynamic unity of the nervous functions, is the main symptom of a general disorder. It is therefore plausible to assume a milder degree of mental retardation, with symptoms that are more dominant than dominant in literacy, since the literacy mechanism is the result of a complex and highly complex synthesising and analysing activity, the fragility of which can be easily assumed from the complexity of the reflex processes that are layered on top of each other. ]

Clinical Neuroscience

[Electroclinical study with temporal lobectomy in Ammon's horn sclerosis epileptics]

KAJTOR Ferenc, HABERLAND Katalin, HULLAY József, ÁNGYÁN András

[Seven patients with temporal lobe epilepsy in whom biopsy histology showed Ammon's horn sclerosis were subjected to electroclinical observations. The clinical features were high seizure activity during sleep, frequency of vegetative seizure phenomena and automatisms, personality abnormalities without intellectual impairment, intense mediobasal (garati) and hippocampal spasmodic activity. Temporal lobectomy provided the best results in the areas of EEG, seizure freedom and personality changes. Authors raise the possibility of an epileptogenic role of Ammon's horn sclerosis. ]

Clinical Neuroscience



[The author reports on the meeting of the French-speaking Society of Neurosurgery held on 2-3 December 1958.]

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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

Life threatening rare lymphomas presenting as longitudinally extensive transverse myelitis: a diagnostic challenge

TOLVAJ Balázs, HAHN Katalin, NAGY Zsuzsanna, VADVÁRI Árpád, CSOMOR Judit, GELPI Ellen, ILLÉS Zsolt, GARZULY Ferenc

Background and aims – Description of two cases of rare intravascular large B-cell lymphoma and secondary T-cell lymphoma diagnosed postmortem, that manifested clinically as longitudinally extensive transverse myelitis (LETM). We discuss causes of diagnostic difficulties, deceptive radiological and histological investigations, and outline diagnostic procedures based on our and previously reported cases. Case reports – Our first case, a 48-year-old female was admitted to the neurological department due to paraparesis. MRI suggested LETM, but the treatments were ineffective. She died after four weeks because of pneumonia and untreatable polyserositis. Pathological examination revealed intravascular large B-cell lymphoma (IVL). Our second case, a 61-year-old man presented with headache and paraparesis. MRI showed small bitemporal lesions and lesions suggesting LETM. Diagnostic investigations were unsuccessful, including tests for possible lymphoma (CSF flow cytometry and muscle biopsy for suspected IVL). Chest CT showed focal inflammation in a small area of the lung, and adrenal adenoma. Brain biopsy sample from the affected temporal area suggested T-cell mediated lymphocytic (paraneoplastic or viral) meningoencephalitis and excluded diffuse large B-cell lymphoma. The symptoms worsened, and the patient died in the sixth week of disease. The pathological examination of the presumed adenoma in the adrenal gland, the pancreatic tail and the lung lesions revealed peripheral T-cell lymphoma, as did the brain and spinal cord lesions. Even at histological examination, the T-cell lymphoma had the misleading appearance of inflammatory condition as did the MRI. Conclusion – Lymphoma can manifest as LETM. In cases of etiologically unclear atypical LETM in patients older than 40 years, a random skin biopsy (with subcutaneous adipose tissue) from the thigh and from the abdomen is strongly recommended as soon as possible. This may detect IVL and provide the possibility of prompt chemotherapy. In case of suspicion of lymphoma, parallel examination of the CSF by flow cytometry is also recommended. If skin biopsy is negative but lymphoma suspicion remains high, biopsy from other sites (bone marrow, lymph nodes or adrenal gland lesion) or from a simultaneously existing cerebral lesion is suggested, to exclude or prove diffuse large B-cell lymphoma, IVL, or a rare T-cell lymphoma.

Clinical Neuroscience

[Mentalizing deficit among patients with traumatic brain injury ]

TAMÁS Viktória, BÜKI András, HEROLD Róbert

[Mentalization or theory of mind as an aspect of our social cognition, is our ability to infer mental states of others (intentions, desires, thoughts, emotions) and to predict their behavior accordingly. This function significantly affects our participation and orientation in the social world and plays an important role in conversational situations, social interactions, social integ­ration and adaptation. The brain regions that serve as the basis for mind-reading function can be damaged as a consequence of traumatic brain injury, which frequently occurs among the younger population. Traumatic brain injury can cause focal or diffuse cerebral injuries, often leading to theory of mind deficit. In this topic such publications were researched that compared theory of mind ability between traumatic brain injury patients and control subjects (comparative case-control studies). We searched for the studies in the following internet based/online databases: PubMed, Web of Science, ScienceDirect, Google Scholar, APA PsycNET (PsycARTICLES) and EBSCO Host. The search was performed using the following key word combinations: theory of mind or mentalizing or social cognition AND traumatic brain injury or head/brain injury or diffuse axonal injury. Based on the results of the included and processed studies (21 pc), traumatic brain injury often leads to mentalization deficit with different severity. With this present review we aim to draw attention to the fact that the appearance and severity of mind reading dysfunction can considerably affect the outcome of the disease, the length of rehabilitation time and the prognosis of traumatic brain injury patients. Besides this, with this review, we aim to take sides in whether theory of mind ability is domain-specific or domian-general based on studies including traumatic brain injury patients.]

Clinical Neuroscience

[Diagnosis of multiple sclerosis: A review of the 2017 revisions of the McDonald criteria]


[The revolutionary progress of research in neuroimmu­nology has led to the introduction of disease modifying therapies in multiple sclerosis at the end of the last century. The International Panel on Diagnosis of Multiple Sclerosis originally proposed the 2001 McDonald criteria to facilitate the diagnosis of MS in patients with the first objective neurological symptom(s) suggesting demyelinating event, when magnetic resonance imaging is integrated with clinical and other paraclinical diagnostic methods. New terms have been introduced to substitute clinical information by MRI: dissemination in space - indicating a multifocal central demyelinating process and dissemination in time - indicating the development of new CNS lesions over time. The criteria for diagnosis of Multiple Sclerosis have continuously evolved, they were modified in 2005 and 2010 allowing for an earlier and more accurate diagnosis of MS over time, and they provided the most up-to-date guidance for clinicians and researchers. The last recommended revisions relied entirely on available evidence, and not on expert opinion thereby reducing the risk of the misdiagnosis. The 2017 McDonald criteria continue to apply primarily to patients experiencing a typical, clinically isolated syndrome. In this review, we provide an overview of the recent 2017 revisions to the criteria of dissemination in space and time with the importance of the presence of CSF-specific oligoclonal bands; keeping fully in mind that there is no better explanation for symptoms than diagnosis of MS. In the future, validation of the 2017 McDonald criteria will be needed in diverse populations. Further investigations are required on the value of new MRI approaches, on optic nerve involvement, on evoked potential and optical coherence tomography, in order to assess their possible contribution to diagnostic criteria.]

Clinical Neuroscience

Rare complication of West Nile viral encephalitis


In our case report, we are presenting a 72 years old male patient. The patient’s symptoms were fever, dizziness, general weakness at the time of admission. The laboratory and CSF tests revealed central nervous system inflammation. West Nile virus was identified from the cerebrospinal fluid. After the symptoms of infection and during supporting treatment, severe, progressing hyponatremia evolved with unknown pathology. According to previous investigations and our diagnostic and therapeutic algorithm cerebral salt wasting syndrome identified as occasion.