Clinical Neuroscience


POZSEGOVITS Krisztián, KAZUO Suzuki, NAGY Zoltán

NOVEMBER 30, 2006

Clinical Neuroscience - 2006;59(11-12)

[Background - In the industrialized countries the very elderly stroke patient is more frequent than before. For the time being Japanese people have the highest expected lifespan, so the epidemiological features of stroke in the very elderly can be examined here quite easily. From a few publications with low case number it is known that in this group of patients the statistical characteristics of stroke is remarkably different from the youngers' one. Subjects and methods - The subjects aged 85 or more years were selected from the Akita Stroke Registry with first-ever acute stroke from 1996 to 1998. Results - 8,046 cases were recorded. There were 7362 patients aged <85 years, and 684 patients aged ≥85 years (8.5%). Sex ratio (women/men) was 1.89 in the two age groups. In the population of Akita the crude incidence of firstever stroke was 222/100,000/year, and 1,085/100,000/year in the very elderly, who were characterized with relatively lower prevalence of stroke risk factors, except that of atrial fibrillation (26.9%) and cardiac diseases (34.2%). The stroke subtype distribution (cerebral infarction 73.2%, intracerebral haemorrhage 20.6%, subarachnoidal haemorrhage 6.1%) was significantly different from the one known in Japan. Mortality rates were considerably high, especially in the SAH group. The most powerful prognostic factor of death was the consciousness level at onset. The following in order of predicting value was the SAH stroke subtype. Conclusion - While people aged 85 years or more had relatively lower prevalence of cardiovascular risk factors, they suffered stroke with very high frequency, the evolved cerebrovascular event caused very severe symptoms and led to death with high rate. Implicitly this is illuminating the complexity of aging as a procession, furthermore it raises the importance of prevention, more rather of the acute stroke care and rehabilitation in this high age group.]



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Clinical Neuroscience


FEKETE Tamás Fülöp, VERES Róbert, NYÁRY István

[Herniation of the meninges through a defect of the spinal canal is a spinal meningocele, and is usually located dorsally in the lumbosacral region. Meningoceles are usually part of a complex developmental disorder, or of a systemic disease, or it can be iatrogenic, as well. We report a very rare case of a true anterior thoracic meningocele.]

Clinical Neuroscience


Clinical Neuroscience



Clinical Neuroscience


MERKLI Hajnalka, NAGY Ferenc, PÁL Endre, GÁTI István, KOVÁCS Norbert, KOMOLY Sámuel, ILLÉS Zsolt

[Amyotrophic lateralsclerosis is a progressive neurodegenerative disease resulting in loss of upper and lower motoneurons. Here we analyzed the clinical and epidemiological data of 202 ALS patients admitted to our department between 1950 and 2004. Risk and protective factors influencing onset and progression of the disease were examined. We also analyzed the relationship between first clinical symptoms/signs and prognosis of the disease. Our data suggest the importance of toxic factors in the initiation of the disease and the effect of clinical phenotype on the progression of ALS.]

Clinical Neuroscience


GÁRDIÁN Gabriella

[Huntington’s disease is an autosomal dominantly inherited progressive neurodegenerative disorder. The main symptoms are choreiform, involuntary movements, personality changes and dementia. Huntington’s disease is a member of a group of diseases caused by CAG repeat expansions. One research aim is to determine the earliest molecular changes associated with Huntington’s disease. There is no possibility for this in humans, but various early changes have been identified in an animal model of Huntington’s disease. They are constructed by excitotoxin causing striatal lesion, or mitochondrial toxins inducing energy impairment, or by generating transgenic mice.]

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Clinical Neuroscience

Hyperhomocysteinemia in female migraineurs of childbearing ages


Background and purpose - Migraine is a risk factor for ischemic stroke in women of childbearing ages. Previous researches revealed a higher prevalence of hyperhomocysteinemia in migraineurs. Possible differences on the frequencies of hyperhomocysteinemia between migraine with aura and migraine without aura could contribute the established variances in stroke risk between these migraine types. Therefore, we aimed to search if the frequency of hyperhomocysteinemia was different between these subtypes of migraine or not. Methods - We analyzed the findings of serum homocysteine levels in female migraineurs of 16-49 years old who admitted to our outpatient clinic. Results - Homocysteine level was elevated in 13.3% of study population. There were not any significant differences on median serum homocysteine levels between migraine with aura (8.0 mikromol/L) and without aura (8.5 mikromol/L). (p=0.426) The frequencies of hyperhomocysteinemia were also similar (9.1% versus 16.7%, respectively; p=0.373). Correlation analyses did not reveal any linear correlation between ages and homocysteine levels either in group of migraine with aura or in group of migraine without aura (p=0.417 and p=0.647, respectively). Similarly, any linear correlation between disease ages and homocysteine levels either in group of migraine with aura or in group of migraine without aura was not detected (p=0.359 and p=0.849, respectively). Conclusion - The median serum homocysteine levels and the frequencies of hyperhomocysteinemia are similar between migraine with aura and without aura in women of childbearing ages. Therefore, the variances on stroke risk ratios between these types of migraine are probably not originated from the differences of serum homocysteine status.

Clinical Neuroscience

Risk factors for ischemic stroke and stroke subtypes in patients with chronic kidney disease

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Background - The aim of this study was to compare ischemic stroke subtypes with the effects of risk factors, the relationship between grades of kidney disease and the severity of stroke subtypes. Methods - The current study was designed retrospectively and performed with data of patients who were hospitalised due to ischemic stroke. We included 198 subjects who were diagnosed with ischemic stroke of Grade 3 and above with chronic kidney disease. Results - In our study were reported advanced age, coronary artery disease, moderate kidney disease as the most frequent risk factors for cardioembolic etiology. Hypertension, hyperlipidemia, smoking and alcohol consumption were the most frequent risk factors for large-artery disease. Female sex and anaemia were the most frequent risk factors for small-vessel disease. Dialysis and severe kidney disease were the most frequent risk factors in unknown etiologies, while male sex, diabetes mellitus, prior stroke and mild kidney disease were the most frequent risk factors for other etiologies. National Institute of Health Stroke Scale (NIHSS) scores were lower for small-vessel disease compared with other etiologies. This relation was statistically significant (p=0.002). Conclusion - In order to improve the prognosis in ischemic stroke with chronic kidney disease, the risk factors have to be recognised and the treatment options must be modified according to those risk factors.

Clinical Neuroscience

The evaluation of the relationship between risk factors and prognosis in intracerebral hemorrhage patients

SONGUL Senadim, MURAT Cabalar, VILDAN Yayla, ANIL Bulut

Objective - Patients were assessed in terms of risk factors, hematoma size and localization, the effects of spontaneous intracerebral hemorrhage (ICH) on mortality and morbidity, and post-stroke depression. Materials and methods - The present study evaluated the demographic data, risk factors, and neurological examinations of 216 ICH patients. The diagnosis, volume, localization, and ventricular extension of the hematomas were determined using computed tomography scans. The mortality rate through the first 30 days was evaluated using ICH score and ICH grading scale. The Modified Rankin Scale (mRS) was used to determine the dependency status and functional recovery of each patient, and the Hamilton Depression Rating Scale was administered to assess the psychosocial status of each patient. Results - The mean age of the patients was 65.3±14.5 years. The most common locations of the ICH lesions were as follows: lobar (28.3%), thalamus (26.4%), basal ganglia (24.0%), cerebellum (13.9%), and brainstem (7.4%). The average hematoma volume was 15.8±23.8 cm3; a ventricular extension of the hemorrhage developed in 34.4% of the patients, a midline shift in 28.7%, and perihematomal edema, as the most frequently occurring complication, in 27.8%. Over the 6-month follow-up period, 57.9% of patients showed a poor prognosis (mRS: ≥3), while 42.1% showed a good prognosis (mRS: <3). The mortality rate over the first 30 days was significantly higher in patients with a low Glasgow Coma Scale (GCS) score at admission, a large hematoma volume, and ventricular extension of the hemorrhage (p=0.0001). In the poor prognosis group, the presence of moderate depression (39.13%) was significantly higher than in the good prognosis group (p=0.0001). Conclusion - Determination and evaluation of the factors that could influence the prognosis and mortality of patients with ICH is crucial for the achievement of more effective patient management and improved quality of life.

Clinical Neuroscience

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FAZEKAS Gábor, FEHÉR Miklós, KOCSIS László, STEFANIK Györgyi, BOROS Zsuzsanna, JURÁK Mihály

[Evidence based medicine requires objective methods for the assessment of status of the patients. The method described by the authors makes it possible to assess motoric impairment of patients in an objective way. It is based on three-dimensional motion analysis. Authors present the case history of two patients with spastic hemiparesis due to central nervous system damage. Changes in motoric impairment were followed by three-dimensional motion analysis. This method can be adapted for the assessment of motor impairment arising from other reasons as well.]

Lege Artis Medicinae

[The association between advanced age and peripheral arterial disease]


[The high-income countries are characterized by the aging of the residents (epidemiological transition) and the change of the disease patterns that are recognized in the population (epidemiological transition). In that sense, considering the cardiovascular diseases in the last few decades, a decline of mortality of acute, fatal conditions (stroke, myocardial infarction) is notable. All these factors contributed to the recognition of the importance of peripheral arterial disease and related problems in the aging popula­tion of the affected people. The high prevalence, the decline of quality of life associated with compromised lower limb circula­tion, the risk of the limb loss, the challenge of rehabilitation and the high mortality represent a significant and increasing burden to the healthcare. The review aims to analyse the relation of the aging population and peripheral arterial disease, addressing the aspects of epidemiology, diagnostics, and therapy. ]