Clinical Neuroscience

[Experiences with carotid-doppler examinations on patients with arterial bypass operation on the lower extremities]

OLÁH László1, FÜLESDI Béla1, VALIKOVICS Atilla1, CSIBA László1, OLVASZTÓ Sándor2, BÁNFI Csaba2, KOZLOVSZKI Bertalan2

SEPTEMBER 20, 1993

Clinical Neuroscience - 1993;46(09-10)

[Carotis-Doppler examinations were performed on 83 patients with severe, obliterative disease of the arteries of the lower extremities and on 96 age-matched controls without signs and symptoms. In the group with obliterative arterial disease, severe or moderate stenosis of the carotid arteries was found in 20 and 40% of the patients, respectively, whereas in the control group the proportion of moderate carotid-stenosis was 2% and no case of severe stenosis was found. The role of risk factors was also studied. Based on their results the authors suggest, that because patients with obliterative disease on the arteries of the lower extremities have higher risk for stenosis, ultrasound investigations and regular follow up of the carotid arteries are needed.]

AFFILIATIONS

  1. Debreceni Orvostudományi Egyetem, Ideg- és Elmegyógyászati Klinika
  2. Debreceni Orvostudományi Egyetem, I. Sebészeti Klinika

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Clinical Neuroscience

[Pharmaco-EEG investigation on sedative effect of antiallergic drugs. Setastin is a non-sedative antihistamina]

RAJNA Péter, VERES Judit

[Effect of setastine on pharmaco-EEG was investigated in a double blind placebo controlled study in ten healthy volunteers. Changes caused by setastine were compared with those of two referent antihistamine drugs (chloropyramine and hismanal) having great differences in their sedative side effect. The themporo-occipital alpha per theta ratio was the most sensitive EEG marker in differentiating the two referent drugs. The EEG effect showed by setastine was very similar to that to hismanal and opposite to that of chloropyramine. In addition an increase of the total power and the power of beta was also measured. The latter changes might refer to an inherent EEG effect of setastine. EEG changes of setastine cannot be evaluated as signs of hypovigilance and the similarity of EEG effect of hismanal and setastine also supports the non-sedative nature of setastine estabilished by clinical studies. The pharmaco-EEG method utilized gives possibility for an objective investigation of psychotropic side effects of the particular drugs. ]

Clinical Neuroscience

[Efficacy of cinolazepam on insomnia generated under shift-work conditions]

KÖVES Péter

[The efficacy of cinolazepam (a benzodiazepine with middle half life time and light pharmacological potential) on insomnia generated under shift-work conditions was investigated, and shown to be an efficent hypnotic. Cinolazepam (daytime dose 20 mg, night dose 40 mg) improved significantly both sleep and awakening quality: there were no hangover effects, drug provoked intrasleep or early morning insomnia. During the time cinolazepam was administered drug tolerance was not observed. The structure of cinolazepam-induced sleep could be characterised by shortened sleep latency, increase of deep slow wave sleep, improvment of sleep continuity and unchange of REM sleep parameters both during night- and daytime.]

Clinical Neuroscience

[Observation of embolic events during carotis constructive surgery]

RÓZSA András, ENZT László, JÁRÁNYI Zsuzsa

[The changes of middle cerebral artery circulation during carotid artery surgery in 65 patients were monitored, and the observed embolic events are discussed. Of the 65 patients, 37 were operated with shunt protection (group A) and 28 without (group B). In 31 of all cases 55 embolic events were noted. In 22 of the group A patients 37 embolic events were observed, one of them occured during the declamping of the external caruiid circulation. Eighteen emboli were observed in 9 of the Group B cases. There were embolic events in 5 cases due to external declamping. All the above mentioned embolic events occured without postoperative clinical sings.]

Clinical Neuroscience

[Brachioradial syndrome: superficial radial neuropathy]

KISS Gábor

[Damage of the superficial branch of the radial nerve represents a rare, and rarely recognized, mononeuropathy. The first three cases in the Hungarian literature are presented. The essential role of electrodiagnosis in detecting of the disease is stressed. Special attention should be paid to avoid any lesion which might result from improper patient-care.]

Clinical Neuroscience

[Multiple cerebral and spinal tumors as a manifestation of neurofibromatosis]

BARÁTH Barna, KRENÁCS László, BODOSI Mihály

[Details are given of an 18-year-old boy suffering from multiple intracranial and intraspinal tumours as manifestations of central form of neurofibromatosis. Meningioma of the left convexity, and meningioma of the left occipital region spreading into the supra- and infratentorial compartment were removed together with the left acoustic neurinoma. Intramedullary ependymoma of the lower cervical region indicated the need for a further operation. Neither the asymptomatic mass of the right sphenoid wing nor the multiple caudal tumours were excised. The genetic, differential diagnostic and therapeutic problems are discussed on the basis of the literature.]

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Comparison of hospitalized acute stroke patients’ characteristics using two large central-eastern european databases

ORBÁN-KIS Károly, SZŐCS Ildikó, FEKETE Klára, MIHÁLKA László, CSIBA László, BERECZKI Dániel, SZATMÁRI Szabolcs

Objectives – Stroke is the third leading cause of death in the European region. In spite of a decreasing trend, stroke related mortality remains higher in Hungary and Romania when compared to the EU average. This might be due to higher incidence, increased severity or even less effective care. Methods – In this study we used two large, hospital based databases from Targu Mures (Romania) and Debrecen (Hungary) to compare not only the demographic characteristics of stroke patients from these countries but also the risk factors, as well as stroke severity and short term outcome. Results – The gender related distribution of patients was similar to those found in the European Survey, whereas the mean age of patients at stroke onset was similar in the two countries but lower by four years. Although the length of hospital stay was significantly different in the two countries it was still much shorter (about half) than in most reports from western European countries. The overall fatality rate in both databases, regardless of gender was comparable to averages from Europe and other countries. In both countries we found a high number of risk factors, frequently overlapping. The prevalence of risk factors (hypertension, smoking, hyperlipidaemia) was higher than those reported in other countries, which can explain the high ratio of recurring stroke. Discussion – In summary, the comparatively analyzed data from the two large databases showed several similarities, especially regarding the high number of modifiable risk factors, and as such further effort is needed regarding primary prevention.

Clinical Neuroscience

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

GÜLER Siber, NAKUS Engin, UTKU Ufuk

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

[High prevalence of burnout and depression may increase the incidence of comorbidities among Hungarian nurses]

ÁDÁM Szilvia, CSERHÁTI Zoltán, MÉSZÁROS Veronika

[Background and purpose - Poor mental health among health care professionals may have a significant impact on public health. There is limited information about the prevalence and potential consequences of burnout and depression among nurses in Hungary. The objective of this study is to explore the relationship between burnout as well as depression and somatic symptoms as well as comorbidities among nurses in Hungary. Methods - Cross-sectional study with self-administered questionnaires among 1,713 nurses. Burnout and depression were assessed by the Maslach Burnout Inventory (MBIHSS) and the Shortened Beck Depression Questionnaire, respectively. Somatisation was measured by the Patient Health Questionnaire (PHQ-15). Correlates of burnout and depression were assessed by logistic and linear regression analyses. Results - The prevalence of depressive symptom and clinical depression was 35% and 13%, respectively. The prevalence of moderate and high level emotional exhaustion, depersonalisation, and decreased personal accomplishment was 44%, 36% and 74%, respectively. We identified burnout and depression as a predictor of high prevalence of subjective somatisation. Whilst burnout showed a strong association with increased prevalence of hypertension, depression predicted almost all examined diseases, in particular, cardiac and cerebrovascular diseases, as well as neoplasms. Conclusion - We found high prevalence of burnout and depression among nurses in Hungary. As depression has been shown to be associated with higher prevalence of comorbidities than burnout, its consequences may be more significant. Appropriate prevention, diagnosis, and adequate treatment of burnout and depression may decrease the prevalence of ensuing comorbidities.]

Lege Artis Medicinae

[Cardiovascular prevention 2021 – Guidelines of European Society of Cardiology 2021. General principles]

VÁLYI Péter, KÉKES Ede

[On 31 August 2021, the European Society of Cardiology published its guideline “Prevention of cardiovascular disease in clinical practice”. This guideline provides a comprehensive review about risk factors of atherosclerotic cardiovascular disease, their assessment, potential modifiers, treatment and prevention of the cardiovascular disease itself at societal and individual levels respectively. The previous guideline issued 2016, had to be updated due to the recent significant advances in risk prediction of cardiovascular disease on atherosclerotic background and due to the beneficial effects of treatment, emerging new drugs and therapeutic targets. The risk assessment system has undergone a major overhaul and now predicts the risk of fatal and non-fatal cardiovascular events together over a 10-year horizon and over a lifetime. In the new guideline, age plays a more important role in risk classification than before. The risk assessment and staged management of apparently healthy people or patients with established atherosclerotic cardiovascular disease, diabetes mellitus and other specific diseases or conditions are detailed. The positive impact of influencing risk factors, the years of life gained can recently be presented in a lifetime perspective, which will help to make an individually tailored decision on the extent of interventions, taking into account also the patient'’s preferences.]

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.