Clinical Neuroscience

[Diffuse demyelinating giant cell reticulomascoma metastases ]

ÉDER Mária1

SEPTEMBER 01, 1967

Clinical Neuroscience - 1967;20(09)

[In a circumscribed case of metastatic reticulum sarcoma, severe oedema and demyelination were observed in both hemispheres. In the clinical picture, local symptoms attributable to the direct effect of the tumour were accompanied by bilateral hemisphaerial white matter lesions. In all cases of brain tumours, but especially in sarcoma metastases, bilateral symptoms should be considered not only bilateral tumour formation but also bilateral white matter oedema-necrosis.]

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  1. Budapesti Orvostudományi Egyetem Neurológiai Klinika

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Clinical Neuroscience

[Effect of anxiety on Achilles tendon reflex semi-relaxation time]

FEJÉR Arthur

[In states of anxiety, the duration of the f. r. i. of the Achilles reflex decreases, although the decrease rarely reaches the extent of the decrease in f. r. i. induced by hyperthyroidism. Both placebo injections and exam situations cause a decrease in f.r.i., but the latter effect is several times greater than the former. In a patient in a state of anxiety, 10 mg. Frenolone i.m. 1 hour after the sedative effect, a significant increase in f.r. i. is observed. This effect is significantly greater than that observed in normal controls after administration of the same dose of the drug. In hyperthyroid patients, the f.r. i. of 10 mg. Frenolone hardly alters the effect. The different behaviour of normal controls and hyperthyroid subjects from anxious patients is presumably due to the fact that Frenolone only favourably affects the central arousal associated with anxiety. During psychopharmacon therapy of anxious neurotic and psychotic patients, a gradual elongation of f.r. i. is observed as the patients calm down. This provides an opportunity to objectively monitor the effect of the therapy. ]

Clinical Neuroscience

[Valium (Diazepam) effects on epileptic crises and certain epileptic mechanisms]

HALÁSZ P., MOLNÁR Gy., HIDASI J.

[In addition to the generally observed good effect, we observed one case in which Valium worsened the epileptic mechanism (case 6). This observation seems to contradict the many reports in the literature that Valium has a good effect in petit mal and spike-wave mechanism. However, a distinction should be made between the different spike-wave mechanisms. In our other patient (case 3) we also observed a beneficial effect of Valium in spike-wave mechanism. However, this latter case was a spike-wave variant, slow spike-wave pattern. However, our case 6 showed a classic 3 c/s spike-wave pattern with clinical absances. It is not clear from the literature whether Valium is effective in all 3 c/s spike-wave mechanisms. Further experience in this direction is needed. Apart from the neuroleptic effect, no other "side effects" were observed. ]

Clinical Neuroscience

[Data for the Autogen Training methodology and indicative questions]

KORONKAI Bertalan, HORVÁTH Szabolcs

[The authors outline the main factors involved in the development, practice and spread of AT. They briefly describe Schultz's classical method. They describe in more detail the methodology they developed, which they applied to groups of 6-10 patients and in which they attach great importance to suggestive support. They share their experience with AT treatment, which they find useful for AT indicatio: all personality types except H and I are suitable for learning the exercises. Of the psychic symptoms, mood disorders, feelings of insecurity, inner tension and anxiety in particular improved, and of the autonomic disorders, sweating, tremor, hypertension, enteral disturbances, insomnia and cephalgia responded most favourably. Based on their experience, they discuss the current and perspectivicus possibilities of AT in their department. In their opinion, a gradual diffusion of AT treatment can be expected due to its advantages over other psychotherapeutic methodologies and for the practical and theoretical reasons discussed. ]

Clinical Neuroscience

[Persistent expansive-productive confabulatory image after contusio cerebri]

POHL Ödön, HAITS Géza

[The authors describe a 35-year-old male patient who developed a specific expansive confabulosis after contusio cerebri, which persisted and even progressed after the other symptoms of amnestic syndrome had resolved. The patient was re-examined 21 months after his first admission: the confabulosis persisted and was embedded in the symptoms of personality development suggestive of post-traumatic encephalopathy. The authors refer to their previous communication describing the medical history of four of their patients. Their new case analysis confirms their earlier findings and provides a catamnestic data set for this rare form of posttraumatic confabulosis. ]

Clinical Neuroscience

[On current problems in psychiatric methodology]

PETHŐ Bertalan

[Science is a systematically structured system. Today, the scientific status of psychiatry is threatened by the lack of a unified system for the many different views and schools of thought. The main reason for this critical situation is the lack of clarity of methodological problems. The methodological problem, taking into account its historical development, can be briefly outlined as follows. ]

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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

Neuroscience highlights: Main cell types underlying memory and spatial navigation

KRABOTH Zoltán, KÁLMÁN Bernadette

Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

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

Matrix metalloproteinases and their tissue inhibitors in relapsing remitting multiple sclerosis: Possible markers and treatment agents

SANLI Arzu, OZTURK Musa, SOYSAL Aysun, DOVENTAS Yasemin, BASOGLU Fulya, GOZUBATIK-CELIK R. Gokcen, BAYBAS Sevim

Matrix metalloproteinases (MMPs), which are synthesized by many cell groups and responsible for the destruction of matrix proteins, and endogen tissue inhibitors of MMPs (TIMPs) have a role in the pathogenesis of Multiple Sclerosis (MS) by affecting the blood-brain barrier. We aimed to investigate the role of MMPs and TIMPs in the immunopathogenesis and in the course of multiple sclerosis (MS). We enrolled 25 relapsing remitting MS patients, who had a definite MS diagnosis according to McDonald criteria and 25 healthy subjects similar for age and gender as control group. MMP-9- and TIMP-1 levels were measured twice in patient group (one time during an attack and one in remission) and once in healthy subjects. MMP-9- and TIMP-levels of patients during attack and remission period and MMP-9/TIMP-1 ratio were found significantly higher than in the control subjects. In patient group MMP-9 and TIMP-1 levels and MMP-9/TIMP-1 ratio during attacks were not significantly different than during remission period. However, when subdivided according to their number of attacks, patients with 2 attacks had significantly higher levels during attack period comparing to remission period (p<0.05); in case of patients with more than 2 attacks did not have a statistically significant difference in attack and remission periods. Matrix metalloproteinases are important actors in MS immunopathogenesis, particularly in the early period and inhibitor agents for these enzymes can be used as a treatment option.

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.]