Clinical Neuroscience

[Glioma optici nervi]

HAITS Géza1, IRTÓ István1

DECEMBER 01, 1965

Clinical Neuroscience - 1965;18(12)

[The authors present a case of optic nerve glioma diagnosed by X-ray examination after a schematic literature review. They emphasize the importance of slice examination among the diagnostic radiographic procedures and point out the effectiveness of complex therapy, surgery and postoperative radiotherapy. ]

AFFILIATIONS

  1. BOTE Psychiatriai Klinika és BOTE Röntgenklinika

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Clinical Neuroscience

[The current state of family care for people with mental illness]

SAMU István, BERTHOLD Magdolna, SARKADI Ádám, ANTAL Ilona

[It analyses the situation of the Balassagyarmat Hospital's tapeworm plant, in view of the changed conditions following the establishment of the production cooperatives. It concludes that the tentacle continues to be beneficial from the point of view of the patient's subjective attitude, therapy and patient retention. The objective conditions for its operation have tended to improve in recent times. It is also possible to employ patients who have failed in an occupational therapy institution. The environment and the occupation have led to a significant improvement in the condition of patients, especially when using modern, active treatments. The tentacle is inexpensive and could solve a significant part of our psychiatric bed occupancy problem. However, this function is hampered by scarce financial support - despite the objective endowment. ]

Clinical Neuroscience

[Data on the development of depersonalisation syndrome]

TAKÁCS László, VARGA Lajos

[The authors describe three patients in whom different factors were involved in the development of d. The first patient with d. experience was still on the track of neurosis. The second patient was integrated by defense mechanisms and protected himself for seven years from the harms of his environment, but a situational change - i.e. plus stress - decomposed him, delusions appeared and the pathology developed into paranoid psychosis. In the third patient, who grew up in an unusually difficult environment, a sudden insecurity of existence led to the onset of d. phenomena introduced by neurasthenia, and then, without delusions, he escaped into an autistic world in which his d. experiences dissolved, and only contact with the real world brought them back again. Authors have outlined through these three d. cases that regressive phenomena in psychopathological processes can sometimes stagnate for years at different stages depending on the situation. The individual can protect and reinforce his or her shaky psychic equilibrium for a time by means of a wide variety of defense mechanisms, often bizarre, as pathological switches. However, with the onset of new stresses, the tension of consciousness may diminish, thus deepening the regression, and in these new pathological connections, in the increasing regression and dissociation phenomena, psychosis can no longer be avoided. ]

Clinical Neuroscience

[About synkinesis]

PÁLVÖLGYI Richard

[The author describes the physiological and abnormal synkinesis of the limb and trunk muscles, after subdividing synkinesis into the areas of supply to the brain nerves. He describes a synkinesis triggered by the lateral movement of the tongue in one half of the platysma. He discusses synkinesis associated with stuttering and describes a case in which synkinesis was also detected in the right musc. biceps brachii prior to stuttering. Finally, he describes a case during recovery from emiparesis, synkinesis in the lower limb, associated with movement of the same side of the upper limb, which resolved after ten days. ]

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A case report of Morvan syndrome

AYTAC Emrah, ACAR Türkan

Morvan syndrome is a rare disease characterized by peripheral nerve hyperexcitability, encephalopathy, dys­autonomia and significant insomnia. The patient, who was included in the present study, was followed-up at our clinics for confusion, myokymia, hyperhidrosis, epileptic seizures, tachycardia, agitation, hypokalemia, and hyponatremia. The cranial MRI of the patient demonstrated hyperintensities at the T2 and FLAIR sections of the medial temporal lobe and insular lobes. Electromyography and neurotransmission examination results were concordant with peripheral nerve hyperreactivity. Contactin-associated protein-like 2 antibodies and leucine-rich glioma inactivated protein 1 antibodies were detected as positive. The patient was diagnosed with Morvan syndrome; intravenous immunoglobulin and corticosteroid treatment was started. Almost full remission was achieved. This very rare syndrome implies challenges in diagnosis and treatment; however, remission can be achieved during the follow-up. In addition, caution is needed in the long-term follow-up of these patients regarding the development of malignancies.

Clinical Neuroscience

Wnt pathway markers in low-grade and high-grade gliomas

NAGY Ádám, TOMPA Márton, KRABÓTH Zoltán, GARZULY Ferenc , MARÁCZI Alexandra , KÁLMÁN Bernadette

Aberrant activation of the Wnt pathway contributes to differentiation and maintenance of cancer stem cells underlying gliomagenesis. The aim of our research was to determine as to what degrees some Wnt markers are expressed in gliomas of different grades, lineages and molecular subtypes. Nine grade II, 10 grade III and 72 grade IV surgically removed, formalin-fixed paraffin-embedded glioma specimens were included. Mutation status of IDH1 codon 132 was defined by immunohistochemistry and pyrosequencing in all tumors. Grade II and III astrocytic and oligodendroglial tumors were further tested for the expression of p53 and ATRX by immunohistochemistry, and codeletion of 1p19q by fluorescent in situ hybridization. Expression levels of the non-canonical Wnt5a and Fzd2, and the canonical Wnt3a and beta-catenin Wnt pathway markers were determined by immunohistochemistry, and compared between subgroups stratified according to grade, lineage and the presence or absence of IDH1 R132H/C mutations. In the normal brain – grade II-IV glioma comparisons, a gradual increase was observed for the expressions of Wnt5a, Wnt3a, Fzd2 and beta-catenin. In the astroglial and oligodendroglial lineages of grade II and III gliomas, only the Wnt5a expression was significantly higher in the astroglial subgroup. Stratification according to the IDH1 status resulted in a significant increase of the Wnt3 expression in the wild type grade II-IV gliomas. These data extend previous observations and show a correlation of Wnt pathway activity with glioma grade. Further investigations of the Wnt marker expression regulation according to glioma lineage or IDH gene mutational status are in progress by using more exact molecular approaches.

Clinical Neuroscience

[LGI1 encephalitis: the first Hungarian patient]

SZŐTS Mónika, MARTON Annamária, ILLÉS Zsolt, BAJZIK Gábor, NAGY Ferenc

[In the recent years, it has been increasingly recognised that in a group of limbic encephalitis antibodies are directed against the scaffolding protein LGI1 (Leucine-rich glioma inactivated 1), which is part of the voltage gated potassium channel (VGKC) complex on neural synapses. Patients present with seizures and subacute history of neuropsychiatric symptoms, including psychosis and changes in memory, cognition, behaviour. Faciobrachial dystonic seizures can be observed, which are highly characteristic for LGI1 encephalitis. MRI shows medial temporal abnormalities in more than half of the cases. CSF evaluation is usually normal. Hyponatremia is frequently associated and may confuse the initial diagnosis. Early recognition and prompt initiation of immunotherapies are of great importance. The clinical improvements often correlate with the antibody levels. We present the case of a 64-year old man, who responded quickly to plasma exchange and major improvement was noted within few weeks.]

Clinical Neuroscience

[Temozolomide chemotherapy of patients with recurrent anaplastic astrocytomas and glioblastomas]

SIPOS László, VITANOVICS Dusan, ÁFRA Dénes

[Introduction - Anaplastic astrocytomas and glioblastomas are the most frequent and most malignant hemispherial tumours. Unfortunately, astrocytic tumours are of infiltrative character and radical removal is not possible. Recurrent malignant gliomas are rarely suitable for reoperation. In most of the cases of recurrent gliomas chemotherapy is the last choice. Patients and method - Seventy-five consecutive patients with recurrent malignant astrocytomas and glioblastomas had been treated at our institute with per os temozolomide for five days every month. The patients received two to 16 courses of chemotherapy. The toxicity, quality of life, response to chemotherapy and survival data were analysed. Results - Out of 75 patients four were excluded following the first treatment due to myelotoxicity, and allergic reactions. Among the patients treated with temozolomide in seven cases complete response, 17 partial response, 14 progressive disease were observed. In 33 cases the disease stabilized and out of them in 27% a significant neurological improvement was detected. The time to progression was 6.8 months and the median survival time 8.75 months for patients with glioblastoma and with malignant astrocytoma or malignant mixed oligoastrocytoma 9.45 and 11.15 months, respectively. The overall survival for patients with originally lower grade glioma was 70.32 and for patients with glioblastoma multiforme 17.43 months. Conclusions - Temozolomide chemotherapy in patients with recurrent malignant astrocytoma and glioblastoma proved to be efficacious and similar good results were achieved as with a nitrosourea based combined chemotherapy. Even in those patients who received previous chemotherapy temozolomide is well tolerated and a relatively long time to progression was achieved in cases of recurrent malignant gliomas. In a few number of patients where BCNU had been previously failed with temozolomide stable disease was achieved. Temozolomide seems to be a promising drug in the chemotherapy of malignant gliomas and can be applied as a second line chemotherapy, as well.]

Clinical Neuroscience

[Role of the intraoperative electrical brain stimulation in conserving the speech and language function in neurosurgical operations of awake patients]

ERÕSS Loránd, FEKETE Gábor, ENTZ László, FABÓ Dániel, BORBÉLY Csaba, KOZÁK Lajos Rudolf, ANDREJKOVICS Mónika, CZIRJÁK Sándor, FEDORCSÁK Imre, NOVÁK László, BOGNÁR László

[Aim of the study - To summarize the results gained with awake craniotomies, which were performed in either low grade glioma patients or epilepsy surgical patients whose tumor or epileptogenic zone, was in the vicinity of eloquent, mostly language, cortices. Patient selection and methods - In our retrospective study we selected 16 patients who were operated awake between 1999-2011 at the Neurosurgical Department of MÁV Kórház Budapest, or at the National Institute of Neurosciences in Budapest, or at the Neurosurgical Department of the University of Debrecen in Debrecen. In the presurgical evaluation if it was possible we performed functional magnetic resonance imaging, tractography and detailed neuropsychological testing. At the National Institute of Neurosciences all patients were operated with the aid of MR guided neuronavigation. Results - Anesthesia was carried out without complications in all of the 16 cases. Monitoring of sleep deepness has significantly contributed to the safety of anesthesia during the superficial anesthezied states of the operation. The intraoperative neuropsychological tasks used for testing language were sensitive enough to judge the little disturbances in speech during stimulation. Stimulation evoked seizures could be adequately managed during surgery and did not influence the outcome of the procedures. The use of neuronavigation helped significantly by planning the optimal place for the craniotomy and by intraoperative orientation. Conclusions - Awake craniotomies require well practiced surgical teams, which requires the cooperation of neuro-anesthesiologits, neurosurgeons, neuropsychologist and electrophysiologists. It has two goals, first to reduce the time of surgery to minimize surgical complications, secondly the detailed intraoperative mapping of cognitive and motor functions to avoid any neurological deficit. The intraoperative anatomical data provided by the neuronavigation and the functional data provided by awake intraoperative stimulation of the patient together serve the safety of the patient which is essential in the neurologically minimal invasive neurosurgical approach of the 21st century.]