Clinical Neuroscience

[Hungarian branch of the International Antiepileptic League]

CLEMENS Béla

MAY 20, 1997

Clinical Neuroscience - 1997;50(05-06)

[Eyelid myoclonia with absences. Dysplasias of cerebral cortex and epilepsy.]

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Clinical Neuroscience

[Effects of Propofol and Thiopental on median nerve somatosensory evoked potentials and cerebral blood velocity]

MÉSZÁROS István, KASÓ Gábor, BÜKI András, HUDVÁGNER Sándor, PFUND Zoltán, DÓCZI Tamás, NAGY Ferenc

[Effects of induction doses of thiopental and propofol on median nerve somatosensory evoked potentials and cerebral blood flow velocity were investigated in 50 patients suffering from degenerative lumbar spine diseases before operation and during anaesthesia. The propofol influences the cerebral electric activity and the blood flow velocity to a less extend than thiopental. Based on our results we prefer to employ propofol during neurosurgical procedures when using intraoperativ somatosensory evoked potentials and/or transcranial Doppler monitoring. ]

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VÖRÖS Erika, SZENTGYÖRGYI Réka, KUNCZ Ádám, MENCSER Zsolt, KARDOS Lilla, MILASSIN Péter

[The purpose of our study was to evaluate the role of three dimensional time of flight magnetic resonance angiography in detection of neurovascular compression in patients with trigeminal neuralgia. 53 patients (26 males, 27 females mean age 57 years) with trigeminal neuralgia underwent 3D TOF MRA. Examinations were performed on 0.5 T Elscint Gyrex V Dlx equipment. The imaging parameters were 33-38/9/25 TR/TE/flip angle with 30-50 mm slab thickness and 1-1.5 mm slice thickness. Contrast material was administered in every case. Maximum intensity projection and thin slice reconstruction (pixel by pixel) were performed in three standard directions (axial, coronal and sagittal). To evaluate the presence or absence of vascular contact, we used both the source slices and reconstructed pictures. Vascular contact with the trigeminal nerve in the entry zone was identified on the symptomatic side in 26 cases (superior cerebellar artery in 20, superior cerebellar artery and vein in one, anterior inferior cerebellar artery in 2, basilar artery or a vein in 1-1 case) and on the asymptomatic side in 3 cases (superior cerebellar arteries). No contact was detected in 24 patients. The examination was not of diagnostic value in three cases, because of head motion artefacts. Veins were better visualized on the contrast pictures. Microvascular decompression sec. Janetta was performed in 9 cases. The surgical and neuroradiological findings were identical in every case. Complete pain relief or significant diminshing of the symptoms were achieved following surgery in all patients. 3D TOF MRA is a useful method in demonstration of vascular contact with the trigeminal nerve at the entry zone, which is valuable information in planning surgical treatment for patients with trigeminal neuralgia.]

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[Uremic polyneuropathy - clinical and electrophysiological analysis]

PFUND Zoltán, CZOPF József, NAGY Ferenc

[Uremic polyneuropathy is a consequence of chronic renal failure, and is one of the symptoms of the uremic syndrome. Its etiology is not well known, several neurotoxins are presumed as pathogenic factors. Both axonal lesions and demyelinization are involved in the development of neuropathy 66 electrophysiological studies (EMG, ENG) in 57 uremic patients were performed in our department between 1978 and 1988. The correlation between clinical and electrophysiological findings are discussed. Clinical or neurographic and myographic signs of neuropathy were found in 50/57 of the patients. The number of electrophysiological signs changes parallely with the severity of uremic neuropathy. There was significant correlation between the decreased plasma calcium levels, the elevated plasma phosphate levels, and the severity of neuropathy. The electrophysiological symptoms are more frequent in cases of rapidly progressive neuropathy. Peripheral nerve pathophysiology reveals a combination of segmental demyelinization and axonal degeneration.]

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[Mental disorders after stroke (treatment of post-stroke depression with moclobemide)]

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[Post-stroke states are usually characterized by residual neurologic symptoms and movement performance, while psychological disturbances remain hidden. Stroke patients frequently present mood disturbances, cognitive decline, anxiety disorders, sometimes serious schizophorm and paranoid states. Among them, post-stroke depression is the most common and possibly amenable form to therapeutic intervention. Depression has negative effect on rehabilitation, quality of life and even long term survival. Biological, psychological and social factors play an important role in the etiology of post stroke depression. The psychotherapeutic approach is so far undeveloped; considering drug therapy, in the past decade tricyclic drugs have been replaced by newly developed second generation antidepressants with lower side-effects profile. In our experience 6-week treatment with moclobemide in 33 patients resulted in symptom reduction in 80%. Appropriate therapy extends the possibilities of rehabilitation, improves the quality of life, and reduces mortality.]

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[The genetic diagnosis of leber's hereditary optic neuropathy]

HORVÁTH Rita, ERIC A. Shoubridge, KATHERINE Fu, SOMLAI Judit, HAJDA Márta, KARCAGI Veronika, KOMOLY Sámuel

[We observed the occurence of Leber's hereditary optic neuropathy associated mitochondrial point mutations in patients with bilateral optic neuropathy. DNA samples isolated from peripheral venous blood by the phenol/chloroform method were tested with the help of PCR for the pathogenic Leber's hereditary optic neuropathy associated mitochondrial point mutations. From 14 patients suffering from bilateral visual impairment Leber's hereditary optic neuropathy associated mitochondrial point mutations were found in 5 cases. The patients were previously treated with optic neuritis or with toxic optic neuropathy. By testing the relatives of the patients some asymp tomatic Leber positive cases were observed, too. The diagnosis of Leber's hereditary optic neuropathy is based on the occurence of mitochondrial point mutations. To test for these mutations can help in the clinical practice in diagnosing bilateral optic neuropathies. In patients with the pathogenic Leber mutations the development of the clinical symptoms does not occure necessarily, however the other mechanisms determining the clinical picture are not known so far.]

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