Clinical Neuroscience

[Hungarian Society of Neurologists and Mental Doctors]

BODÓ Mihály

MAY 20, 1993

Clinical Neuroscience - 1993;46(05-06)

[Summary of the 1992 meeting of the Cerebrovascular Section of the Hungarian Society of Neurologists and Mental Health Practitioners.]

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Clinical Neuroscience

[New data in the classification, diagnostic and in the therapy of cerebrovascular diseases]

NAGY Zoltán

[High stroke morbidity and mortality in Hungary have focused to attention on stroke prevention and the organization of adequate therapy. Up till 1990 both cardiovascular and the cerebrovascular mortality had increased. The Precise analysis risk factors' determines the primary and secondary stroke prevention. The most important issues in of prevention are: proper care of hypertension, gradual change of dietary habits of the Hungarian population, and reduction of smoking. The revised stroke classification, published in 1990 suggested the further breakdown of ischemic strokes into embolic, atherothrombotic and lacunar forms. The new categories reflect the pathomechanism, and thus help in planning more successful treatment. The early treatment of embolic stroke with thrombolysis looks promising, thrombolysis in lacunar stroke implies a certain amount of risk. Hemodilution and dehydration therapy in the treatment of different forms of ischemic strokes need to be evaluated differently. Both invasive and non-invasive diagnostic examinations follow a well thought out algorithmic pattern. Since thrombolysis is a possible therapeutic choice, laboratory tests, especially the analysis of hemostatic factors have gained more significance.]

Clinical Neuroscience

[NMDA antagonists: possible kinetic and neuroprotective effect with special regard to parkinson's disease]

TAKÁTS Annamária

[The role of excitatory amino acids in the pathomechanism of several neuropsychiatric disorders became known in the last few years. Special attention is paid to glutamate, since this has proved to be an excitotoxin under certain pathological conditions. It acts through the ion-channel of the NMDA receptors via enormous Ca++ ion flow into the cell. NMDA antagonists may be of importance in the treatment of Parkinson's disease, which is characterized by increased glutamate hyperactivity. The clinical use of adamantane derivatives might be suggested because of their possible symptomatic and neuroprotective effect.]

Clinical Neuroscience

[Arteriovenous malformation and occlusive cerebrovascular disease]

BODOSI Mihály, KUNCZ Ádám, DÓCZI Tamás, BARZÓ Pál, VÖRÖS Erika

[Five rare case histories of intracranial occlusive cerebrovascular disease with arteriovenous malformation are presented. In 2 cases the middle cerebral artery and in a further 2 cases the internal carotid artery were occluded (3 ipsilateral frontal and 1 parietal angiomas). In the fifth case a temporal angioma and ipsilateral posterior cerebral artery occlusion was detected. In the first 4 cases extra-intracranial arterial bypass was performed before the excision of the malformation. ]

Clinical Neuroscience

[The role of PCR in the diagnosis of duchenne/becker muscular dystrophy]

FODOR Flóra, MECHLER Ferenc, DIÓSZEGHY Péter, ÁDÁNY Róza

[The majority of Duchenne/Becker muscular dystrophy (DMD/BMD) cases are caused by deletions affecting exons of the dystrophin gene, which results in defective protein synthesis. In order to detect deletions the multiplex PCR method was utilized on the DNA of 15 DMD/BMD patients by amplifying 9 deletion-prone exons as a first step followed by a further 5 exons when necessary. Delection were found in more than 50% of patients by this method which correlates well with that expected from the literature data. This rapid and reliable method is an important diagnostic tool in the precise characterization of muscular dystrophies.]

Clinical Neuroscience

[Fibrinogen as a general risk factor in stroke ]

SZIRMAI Imre, KAMONDI Anita

[Fibrinogen and other laboratory variables of 348 patients with various types of stroke were statistically analysed in the acute, subacute and chronic stage of the disease. Seventy two patients with non-vascular disease served as control. The actual level of plasma fibrinogen in cerebrovascular patients was attributed to the following factors: 1. presence of atherosclerotic plaques in extra and intracranial arteries, 2. the time lag between the onset of stroke and laboratory testing, 3. degre of post stroke mobility of the patients. Initial level of fibrinogen is a predictive value of death both in hemorrhagic and ischemic patients. The highest plasma concentration of fibrinogen was found in the atherothrombotic stroke group, in which was a significant negative correlation between the plasma fibrinogen and high density lipoprotein level. It was concluded that fibrinogen is a risk factor in cerebrovascular diseases.]

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Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

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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.

Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

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

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.