Clinical Neuroscience

[Hungarian Neurological Society]

VÁRALLYAY György

JANUARY 20, 1994

Clinical Neuroscience - 1994;47(01-02)

[Report on the IV. International Congress of Neuroradiology.]

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Clinical Neuroscience

The changing face of neuroscience

LORD WALTON of Detchant

This paper is based upon three lectures one given in Australia in a symposiom in honour of Professor James Lance on his retirement, another delivered to the Russian Academy of Medical Sciences on 26 January 1993 and published in the procceedings of that annual symposium of the Academy. It is reproduced here with permission.

Clinical Neuroscience

The treatment of cluster headache

KARL Ekbom

Cluster headache attacks occur in series, lasting for weeks or months, that are separated by remission periods. However, in less than 15 %, patients suffer from a chronic syndrome, that is regular attacks for one year or longer. The spontaneous course of cluster headache may cause some problems when evaluating clinical trials. For instance, it may be difficult to decide whether an observed improvement is due to effects of the trial drug or to a spontaneous remission. Most studies published hitherto have used an open treatment app- roach – using a concomitant treatment – which is understandable, because the placebo effect has been regarded as being small in cluster headache. In fact, there are in the previous literature only few well-designed, randomised, double-blind clinical trials.

Clinical Neuroscience

[Visual P300 and early components in chronic schizophrenic patients (clinical, neurocognitive and biochemical correlates)]

BARTKÓ György, KUNDRA Olga, BOLLA Mariann, ZÁDOR György, SÁNTA Zsuzsa, HORVÁTH Szabolcs, ARATÓ Mihály

[P300 and early components of the visual event related potentials were compared in 26 chronic schizophrenic patients and 20 healthy subjects. The correlation between visual evoked response and clinical, neurocognitive, biochemical variables was analysed in schizophrenic group. Event related potentials in response to rare visual stimuli were recorded from central and occipital sites and 20 electrophysiological parameters were determined. Reaction time and proportion of correct recognition were also detected. The schizophrenic patients showed significant reduction is P300 amplitude. Differences in other components between groups were also demonstrated. The seven most important parameters were evaluated by discriminant analysis. The prolonged negative components latency and delayed reaction time suggest that the stimulus classification process is slower in schizophrenics, Using canonical correlation analysis three factors were found to be significant. The data showed that electrophysiological abnormality was highly correlated with chronicity of the illness, severe psychopathological features and cognitive deficit but was uncorrelated with negative symptoms and serum dopamine-beta-hydroxylase activity. These findings are compatible with other studies suggesting visual P300 has the characteristic of a state marker in schizophrenia.]

Clinical Neuroscience

[Intracerebral hemorrhages and their neurosurgical management in early infancy]

PARAICZ Ervin, KÓNYA Eszter

[The number of spontaneous intracerebral hemorrhages over early infancy has increased in the last years in Hungary. As possible cause maybe the lack of Vitamin K prophylaxis in our 19 cases. With regard to management mostly the semiinvasive treatment was succesful, the external drainage of the hemorrhage and CSF. Craniotomy was indicated only in 3 patients. The functional result was good in the majority of cases.]

Clinical Neuroscience

[Provocative myasthenia gravis and myasthenic syndromes]

SZOBOR Albert, KLEIN Magda

[Myasthenia gravis as a disease entity has long been known. With the inclusion of the paraneoplastic myasthenia syndrome, a wider area was encompassed by the disease, which became still wider by the description of different myasthenic syndromes in childhood. Recently quite a few provocative factors became known which can cause myasthenia gravis or some similar syndromes. One such-prominent-factor is D-penicillamine a drug widely used in rheumatology practice. A great number of cases were studied involving the provocative factors: D-penicillamine, the infectious diseases, drugs and other possible causes. After provocative factors myasthenia gravis disease, myasthenic syndrome with different clinical course and transitive myasthenic reaction with spontaneous remission may develop. The ability to distinguist between these conditions is important from both the therapeutic and prognostic points of view. Mild not known, or not recognized myasthenia gravis can in some cases be diagnosed by careful neurological examination and diagnostic tests. ]

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Clinical Neuroscience

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.

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

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[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]

KAPÓCS Gábor

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. ]

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]