Clinical Neuroscience

[Glioma behaviour in tissue culture]

PÁLYI Irén1, TÓTH Géza1, CSÁKY László1, ÁFRA Dénes1, ZOLTÁN László1

MARCH 01, 1963

Clinical Neuroscience - 1963;16(03)

[1. In tissue cultures of gliomas after a single high dose of 6000 r., phosphorus metabolism was investigated 6 and 22 h after irradiation. 2. After irradiation, glioma cultures showed higher activity in the acid-soluble phosphorus fraction than controls. The lipid and DNA fractions, on the other hand, had lower activity compared to controls. 3. Normal tissues show no consistent changes in their phosphorus metabolism after a single high dose of radiation. ]

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  1. Budapesti Orvostudományi Egyetem Szövet- és Fejlődéstani Intézete , Országos Idegsebészeti Tudományos Intézet

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[Reactivity, pharmacological influence and association with respiration of the periodic eeg complex in subacute panencephalitis]

FENYŐ Egon, HASZNOS Tivadar

[1. The stimuli we used could not influence the shape or periodicity of the periodic complexes. It appears that periodic eeg phenomena in penencephalitis can no longer be provoked by external stimuli when periodicity is stable. 2. No rapid activity typical of the initial stage of barbiturate anaesthesia was seen in any of our patients after intravenous Evipan. The lack of rapid activity in response to Evipan is associated with panencephalitic cortical lesions. 3. After Megimide injection, spasm potentiation initially occurred only in the section corresponding to the periodic complex. On this basis, it seems reasonable to conclude that the periodic complex represents a state of increased excitability that facilitates the appearance of spasm potentials. 4. There is a statistically highly significant difference between the number of eeg complexes occurring with increased frequency during the inspiratory and expiratory phases. If we assume that the firing of inspiratory and expiratory bulbopontine neurons facilitates the emergence of the panencephalitic eeg complex, it is reasonable to conclude that the primary anatomical lesion responsible for the emergence of the periodic complex may be the bulbopontine phase of the formatio reticularis, or at least a system intensely related to it. 5. In some cases, intravenous Relaxil G caused the characteristic periodicity of the curve to disappear and the diffuse polymorphic deltaic activity characteristic of end-stage panencephalitis to develop. The Relaxil effect suggested that the structure controlling the autorhythmicity of the periodic complex may be the diffuse thalamic system. Thus, the presence of a periodic complex implies the relative integrity of the diffuse thalamic system. 6 We have discussed the differences between the panencephalitic periodic complex, the K-complex and the Forbes' secondaerial response and, on the basis of these differences, we believe that the periodic complex cannot be identified with either the Forbes' secondaerial response or the K-complex.]

Clinical Neuroscience

[Text analysis of the diary of a schizophrenic patient ]

KUNCZ Elemér, THORDAI István

[Authors examine the diaries of 33-year-old female patients - 70 handwritten pages spanning a year - which can be used to track phases of immersion in a world of closed, autistic experience and self-medication tendencies. They find that, on the one hand, the diary as a form corresponds to a written monologue by which the patient, isolated from the outside world, deceives his own solitude, and, on the other hand, a certain striving for autonomy and the role of self-preservation tendencies can be discerned in the bizarre turns of phrase and conceptual changes.]

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[Amnesticus syndrome due to Härtel's alcohol injection ]

PAP Zoltán, ADLER Péter

[We reported a patient with severe trigeminal neuralgia in whom, by Härtel's method, part of the alcohol given into the Gasser's duct was presumably introduced into the cisterna chiasmatis and caused sterile meningitis, with encephalitis in the infundibulum area and severe damage to the mammillary bodies. This resulted in acute unconsciousness, febrile delirium, a slowly recovering foggy state of consciousness and a permanent amnestic syndrome. However, neuralgia - except for the unpleasant sensation of phonia, which still exists in branch I, has disappeared. The case is interesting not only from a psychological point of view, because of the memory disturbance, but also because of the lessons to be drawn from it. Although Dandy and Frazier-Spiller's trigeminal surgery cannot be said to be completely without risk, not to mention Sjöquist's intramedullary tractotomy, the situation is really different today from what it was in Fedor Krause's time. Härtel's confident statement, quoted above, made in 1924, has lost much of its legitimacy today. His proposal for surgical interventions, like Kirschner's electrocoagulation, was restricted to a narrower field. Despite the undoubtedly positive results, its use must always be accompanied by undesirable consequences. Its recommendation should therefore be limited to patients who are not suitable for or do not agree to intracranial surgery and who cannot be made painless by other means. ]

Clinical Neuroscience

[Dr. Adolf Juba]

PÉTERFAI János

[The author gives an account of the life and work of Dr. Adolf Juba.]

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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.

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[On February 19, 2022 We celebrate the 205th anniversary of the birth of the first national matronage (head nurse), Zsuzsanna Kossuth. Zsuzsanna Kossuth was characterized by a high degree of empathy, self-sacrifice, exemplary behaviour, and professionalism. She laid the foundation for the processes of nursing and patient care and performed outstanding professional work throughout his life. She made no distinction between man and man, she only saw the suffering patient, in every soldier and injured. She sacrificed his life for his profession. The Hungarian Nursing Association founded the Zsuzsanna Kossuth commemorative medal in 1998, the year of the 150th anniversary of the War of Independence, which is donated every year on February 19.]

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.

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Clinical Neuroscience

TikTok and tics: the possible role of social media in the exacerbation of tics during the COVID lockdown

NAGY Péter , CSERHÁTI Helga , ROSDY Beáta , BODÓ Tímea, HEGYI Márta , SZAMOSÚJVÁRI Judit , FOGARASI Joseph Dominic , FOGARASI András

Over the past year, many cases with newly onset or significantly exacerbated tic disorders were observed worldwide, where some aspects of the clinical presentation or the symptomatology were atypical for established tic diagnoses. Our purpose was to describe the atypical cases and raise relevant diagnostic issues. Consecutive cases with atypical tic presentations were documented. Five atypical tic cases are described. These cases shared some common characteristics, most notably the fact that all of them had been exposed to online presentation of ticking behaviour on social media platforms prior to the de novo development or exacerbation of their tics. Even though the order of events suggests causality and therefore the diagnosis of a functional tic disorder, unambiguous criteria for classifying atypical tics as functional symptoms are lacking. Differentiating neurodevelopmental and functional tics in childhood is currently problematic. Based on the currently unresolved issues in differential diagnosis, the importance of watchful waiting and behavioural interventions is highlighted to avoid unwarranted pharmacotherapy.