Clinical Neuroscience

[Five recurrent subarachnoid haemorrhages from a cerebrovascular arterio-venous vessel]

FORNÁDI Ferenc1, SZEGEDY László1, HAITS Géza1

JANUARY 01, 1967

Clinical Neuroscience - 1967;20(01)

[The authors describe a 45-year-old female patient who has been clinically treated 5 times in 15 years for recurrent subarachnoid hemorrhages. The clinical interest of the case is given by the good general condition of the patient and her relatively well-preserved personality during the time between each bleeding episode. The bleeding was due to an arteriovenous aneurysm in the upper third of the mesencephalon. Presumably, this aneurysm, in addition to the recurrent bleeding, may have played a role in the development of the very marked cerebral atrophy and the strikingly severe arteriosclerotic vascular lesions by altering the hemodynamic relationships. ]


  1. BOTE Psychiatriai Klinika



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Clinical Neuroscience

[Changes in the clinical picture of neurological diseases due to drug therapy]


[In our medical practice, we often do not fully and correctly use all the possibilities of drug therapy. Medical thinking tends to be biased towards simple, easy-to-remember, templated treatment procedures. But in any case, we will only exhaust the potential of drug therapy if, on the basis of careful consideration of all the circumstances, we know the mechanism of action of the drug and the pathophysiology of the disease, we give the right drug at the right time, in the most appropriate dose, distribution and manner. Perhaps not enough emphasis is placed in university clinical education on the principles of drug therapy.]

Clinical Neuroscience

[Neuropathological lesions in animal studies of B12-avitaminosis]

LEHOCZKY Tibor, SÓS József, HALASI Margit

[induced central and peripheral nervous system lesions in white rats with B. deficiency. These were essentially identical to the typical neuropathological lesions of anaemia perniciosa (myelopathy, neuronal proliferation). The discrepancy, such as the rare or absent glial reactions and the extensive and severe damage to nerve cells, was explained by the more intense biochemical effects of experimental B12 deficiency. ]

Clinical Neuroscience

[Clinical significance of the Circulus arteriosus Willisi with special reference to hypoplasia]


[After a detailed anatomical description of the circulus arteriosus Willisi, the first part of the paper describes the occurrence of hypoplasia in each branch. In the second part, the dynamic characteristics of the blood circulating in the CAW are used to illustrate the crucial regulatory, distributive and collateral role of the formula in the first stage of cerebral circulation. In the third part, the clinical relevance of anomalies (mainly hypoplasia) is highlighted. A study of the brains of 100 cerebrovascular and 100 non-cerebrovascular deceased individuals shows the well-known fact that CAW anomalies are twice as common in cerebrovascular diseases as in non-vascular diseases. It describes the predisposing, preforming, pathoplastic effects of anomalies in emollients, haemorrhages and thromboses. The frequent occurrence of anomalies is known in pituitary aneurysms, and anomalies often allow the development of severe arteriosclerosis in the basal vessels, if the mechanical theory of anteriosclerosis is considered. In relation to general CAW hypoplasia, he lists 19 cases of vascular injury or other disease, functionally modified by the anomaly. Among the latter, he points out the atypical course of three endogenous pathologies in particular. ]

Clinical Neuroscience

[Effect of metopirone on cerebral electrical activity]

FREY Zsuzs, HALMY László

[Authors have studied the effects of Metopiron on brain electrical activity in endocrinology patients. In 5 of 13 patients studied, regularisation of electrogenesis was observed. It is hypothesized that the resulting lesion is due to a direct or indirect effect of Metopirone on the hypothalamus. In their further conclusions, they point to the possibility of a relationship between diurnal fluctuations in ACTH synthesis and the chronometric function of alpha-rhytmus.]

Clinical Neuroscience

[Clinical interpretation of Evipan sleep-activated EEG abnormalities in non-epileptic psychiatric patients]


[Authors search for correlation between activated EEG abnormalities in 86 patients and various non-epileptic psychiatric disorders. They hypothesize organic brain damage and varying degrees of cerebral atrophy as causal factors underlying chronic clinical syndromes classified as neurosis - psychopathy - psychosis. It is not considered acceptable to extend the concept of epilepsy to all those with abnormal EEG findings without clinical epileptic manifestations. Linked to this, the question of the specificity of the seizure potential is raised. They include in the concept of "organic psychopathy" those with EEG abnormalities and PEG findings suggestive of a cerebral dysfunction, which may take other forms besides personality changes, due to pathoplastic factors. ]

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Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Clinical Neuroscience

Capability of stroke scales to detect large vessel occlusion in acute ischemic stroke – a pilot study

TÁRKÁNYI Gábor, KARÁDI Nozomi Zsófia, CSÉCSEI Péter, BOSNYÁK Edit, FEHÉR Gergely, MOLNÁR Tihamér, SZAPÁRY László

Rapid changes of stroke management in recent years facilitate the need for accurate and easy-to-use screening methods for early detection of large vessel occlusion (LVO) in acute ischemic stroke (AIS). Our aim was to evaluate the ability of various stroke scales to discriminate an LVO in AIS. We have performed a cross-sectional, observational study based on a registry of consecutive patients with first ever AIS admitted up to 4.5 hours after symptom onset to a comprehensive stroke centre. The diagnostic capability of 14 stroke scales were investigated using receiver operating characteristic (ROC) analysis. Area under the curve (AUC) values of NIHSS, modified NIHSS, shortened NIHSS-EMS, sNIHSS-8, sNIHSS-5 and Rapid Arterial Occlusion Evaluation (RACE) scales were among the highest (>0.800 respectively). A total of 6 scales had cut-off values providing at least 80% specificity and 50% sensitivity, and 5 scales had cut-off values with at least 70% specificity and 75% sensitivity. Certain stroke scales may be suitable for discriminating an LVO in AIS. The NIHSS and modified NIHSS are primarily suitable for use in hospital settings. However, sNIHSS-EMS, sNIHSS-8, sNIHSS-5, RACE and 3-Item Stroke Scale (3I-SS) are easier to perform and interpret, hence their use may be more advantageous in the prehospital setting. Prospective (prehospital) validation of these scales could be the scope of future studies.

Clinical Neuroscience

[Effective therapy in highly active pediatric multiple sclerosis ]

MERÔ Gabriella, MÓSER Judit, LIPTAI Zoltán, DIÓSZEGHY Péter, BESSENYEI Mónika, CSÉPÁNY Tünde

[Multiple sclerosis (MS) is typically a disease of young adults. Childhood MS can be defined in patients under 18 years of age, although some authors set the limit un­der the age of 16 formerly known as “early-onset multiple sclerosis” or “juvenile multiple sclerosis”, seen in 3-5% of all MS patients. Nowadays, owing to ever-evolving, better diagnostic tools and well-traced, strictly defined diagnostic criteria, childhood MS is showing an increasing incidence worldwide (0.05-2.85/100 000). MS is characterized by recurrent episodes of the central nervous system with demyelination separated in space and time. In childhood almost exclusively the relapsing-remitting (RR) type of MS occurs. Based on experience in adults, the goal in the pediatric population is also the early diagnosis, to initiate adequate DMT as soon as possible and to achieve symptom relief and good quality of life. Based on efficacy and safety studies in the adult population, inter­feron β-1a and glatiramer acetate were first approved by the FDA and EMA for the treatment of childhood MS also. The increased relapse rate and rapid progression of childhood MS and unfavorable therapeutic response to nearly 45% of the first DMT necessitated the testing of more effective and second-line drugs in the population under 18 years of age (PARADIGMS, CONNECT). Although natalizumab was reported to be effective and well-tolerated in highly active RRMS in childhood, evidence based studies were not yet available when our patients’ treatment started. In this article, we report on the successful treatment of three active RRMS patients with individually authorized off-label use of natalizumab.]

Clinical Neuroscience

Neurological disorders in liver transplantation

YUKSEL Hatice , AYDIN Osman, ARI Derya , OTER Volkan , AKDOGAN Meral , BIROL BOSTANCI Erdal

Liver transplantation is the only curative treatment in patients with end-stage liver failure. It has been associated with neurological disorders more frequently than other solid organ transplantations. We aimed to detect neurological disorders in liver transplantation patients and determine those that affect mortality. One hundred eighty-five patients, 105 with and 80 without neurological disorders, were included in this study. The follow-up was categorized into three periods: preoperative, early postoperative and late postoperative. We analyzed all medical records, including demographic, laboratory, radiological, and clinical data. Neurological disorders were observed in 52 (28.1%) patients in the preoperative period, in 45 (24.3%) in the early postoperative, and in 42 (22.7%) in the late postoperative period. Hepatic encephalopathy in the preoperative and altered mental state in the post­operative period were the most common neurological disorders. Both hepatic encephalopathy (37.5%) and altered mental state (57.7%) caused high mortality (p=0.019 and 0.001) and were determined as indepen­dent risk factors for mortality. Living donor transplantation caused less frequent mental deterioration (p=0.049). The mortality rate (53.8%) was high in patients with seizures (p=0.019). While mortality was 28.6% in Wilson’s disease patients with neurological disorders, no death was observed in patients without neurological disorders. We identified a wide variety of neurological disorders in liver transplantation patients. We also demonstrated that serious neurological disorders, including hepatic encephalopathy and seizures, are associated with high morbidity and mortality. Therefore, in order to avoid poor outcomes, hepatic encephalopathy should be considered as a prioritization criterion for liver transplantation.

Clinical Neuroscience

Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.