Clinical Neuroscience

[Formation of an ophthalmo-otoneurology working group]

MAY 01, 1959

Clinical Neuroscience - 1959;12(05)

[The author reports on the ophthalmo-otoneurological working group established on 25 March 1959 at the headquarters of the Medical-Health Trade Union, within the framework of the "Pavlov" Neurological Specialist Group.]

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Clinical Neuroscience

[About Lissauer's apperceptive blindness]

SIMONYI Gusztáv

[A 59-year-old patient with Alzheimer's disease slowly developed object agnosia, prosopagnosia, spatial disorientation, and apraxia of dressing over five years. There is evidence of visual analyser disability, left hemianopsia, visual loss. In projection at distance and angle of tachystoscopic examination, paralysis of the Bálint gaze. In addition, progressive dementia. None of the usual symptoms of colour agnosia or colour naming disorder, and no aphasia in any other way. These are the symptoms analysed by the author, who does not yet see any justification for dropping the traditional concept of agnosia, which has been a matter of debate in the literature in recent years.]

Clinical Neuroscience

[Central nervous system metastases from malignant melanoma ]

LEEL-ŐSSY Lóránt, TÖRÖK Pál

[The authors provide a clinicopathological description of five CNS m. m. metastases and, in their assessment, conclude : 1. CNS metastases of m. m. occur in 8-12% of other malignant tumour metastases. 2. They draw attention to the danger of removing naevi and melanomas. 3. The most common clinical presentation is subarachnoid haemorrhage. Symptoms of multiple metastasis are often difficult to recognise. 4. The need for neurosurgical intervention is emphasized in the presence of symptoms suggestive of a nodule. The tissue picture suggests a neuroectodermal origin of melanoma. They seek to explain the pathomechanism of the frequent subarachnoid haemorrhage and address the mode of metastasis.]

Clinical Neuroscience

[Structural analysis of Wahnstimmung]

IRÁNYI Jenőné

[In our cases, we provided a psychopathological analysis of Wahnstimmung in the light of a structural approach. The regression symptoms of the relational structure are prominent in the state picture. The emotional polarization disorder due to the lack of differential inhibition results in total perplexity, anticipatory uncertainty, ambivalence that generally colours psychic events. The symptoms are accompanied by phenomena triggered by a reduction in psychic energy and regression of cognitive and adaptive structures. In cases where the structural regression symptoms are accompanied by an energetic insufficiency, the condition is stuck in a state of pathological imbalance constituting the delirium. The striving for a new pathological state of equilibrium manifests itself in the personality's effort to correct itself in the face of pathological symptoms. In such cases, new dynamic stereotypes are seen to develop in the form of secondary pathological cognitive structures, in the form of positive or negative misconceptions. ]

Clinical Neuroscience

[Effect of vasomotor reflexes on abnormal electroencephalogram]

HASZNOS Tivadar

[A review of our data and a comparison with the literature shows that in our patient population, only a relatively small percentage of activation procedures described by others have been successful. The large number of patients included in our study precludes us from explaining negative cases by statistical variance. In particular, it is difficult to explain the ineffectiveness of apnce, because while in carotid compression it is conceivable that the pressure was not applied in the right place and with the right force, in the patient who underwent apnce we were able to check in all cases that the patient complied with our request. Based on the negative results, the activation methods listed were no longer used indiscriminately in all patients. Carotid artery compression and oculo-cardiac reflex are performed in patients where it is necessary to differentiate between syncope and sacer. In vascular pathologies, amyl nitrite inhalation will continue to be performed. This is a relatively difficult EEG diagnostic problem and the small number of positive cases justifies the use of this test. Evipan is routinely used in combination with hyperventilation. This has the distinct advantage, in our opinion, of achieving the same effect with a relatively low dose of Evipan, which is therefore harmless, as compared to deeper anaesthesia, which requires a higher dose, or other more prolonged methods that are more likely to have complications.]

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Clinical Neuroscience

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

Clinical Neuroscience

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]

ZAKARIÁS Lilla, RÓZSA Sándor, LUKÁCS Ágnes

[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]