Clinical Neuroscience

[Hungarian Society of Neurologists and Mental Physicians SZOTE neurological round table]

JANUARY 20, 1996

Clinical Neuroscience - 1996;49(01-02)

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Clinical Neuroscience

[Differential diagnosis of Parkinson's syndrome]

FERENC Fornádi

[The fundamental improvement of therapy in Parkinson's disease during the last 25 years also led to specific requirements in differential diagnosis of Parkinson-like diseases. It has become rapidly apparent that the idiopathic Parkinson's syndrome can be treated by a substitutional levodopa therapy very well in the beginning. Considering this fact especially in the case of a so-called "primary levodopa failure" a profound differential diagnosis is necessary. On the other hand an initially diagnosed Parkinson's disease can change its character and develops a widening if symptoms secondary to a reduced levodopa responsiveness. This process can be explained bz a spread of affected cerebral systems known as multy system atrophy (MSA). In former times the differentiation of Parkinson-like diseases could only be done by clinical examination and with regard to a missing levodopa responsiveness. In the last decade diagnostic availabilities became more and more. In addition to MRI and SPECT the 18-FDG- and 18-F-levodopa-PET-scan is very helpful in the cases mentioned above. The following presentation of differential diagnosis in Parkinson-like diseases outlines especially the possibilities of PET-screening.]

Clinical Neuroscience

[Sumatriptan autoinjection in the acute treatment of migraine attack]

ERTSEY Csaba, JELENCSIK Ilona, ÁFRA Judit, BOZSIK György

[The authors report the results of the first Hungarian trial of 5-HT1 receptor agonist sumatriptan autoinjector in the acute treatment of migraine. During the treatment of 400 attacks in 67 patients a significant headache relief was reported in 41% after 30 minutes p. i. and 80.5% after 120 minutes p. i., respectively. In the same time frame complete dissolution of the headache was reported in 39.5% and 72%. The majority of the accompanying symptoms disappeared before the headache relief. Migraine recurrence was frequently noted (45.1% of all attacks). Slight side-effects were experienced in 36% of the attacks treated; in one case skin rash and in another one a temporary chest pain was reported. Using the autoinjector device did not pose serious problems to the patients.]

Clinical Neuroscience

[Vasoreactivity changes of healthy volunteers investigated by transcranial doppler]

VALIKOVICS Atilla, OLÁH László, FÜLESDI Béla, MUNKÁCSY Csaba, CSIBA László

[Transcranial Doppler (TCD) was used to measure the effect of 1 g acetazolamide (Diamox, Lederle) on blood flow velocity in the middle cerebral artery of 50 healthy volunteers (aged 20-70 years). Parameters of blood flow, blood pressure, heart rate and blood gas values were determined before and after intravenous administration of Diamox. The reserve capacity was expressed as a percentage change of baseline values. The acetazolamide did not result in significant blood pressure and blood gas changes. The mean velocity of blood flow before Diamox administration was 59.8+14.4 cm/s. The velocity of flow significantly increased after acetazolamide, peaking after 10 minutes. The extent of reserve capacity was the greatest in the age group of 31-40 years and the smallest in the 61-70 years group. The reaction was longer lasting in age groups over 50 years. Significantly higher flow parameters and greater reserve capacity was found in women than in men at each measuring time point. The reserve capacity depended on age and gender.]

Clinical Neuroscience

[Distant neuromuscular effect of locally injected botulinum toxin]

DIÓSZEGHY Péter, GLAUB Teodóra, MECHLER Ferenc

[Distant neuromuscular effect of locally infiltrated botulinum toxin was studied. The extensor digitorum communis muscle far from the place of injection was sampled with single-fiber EMG in patients treated for spasmodic torticollis. In 2 and 8–16 weeks after the infiltration the mean jitter values increased significantly compared to that of the results before the treatment. Extremely increased jitter values and blocks were found, too. The fiber density was also higher after the botulinum toxin infiltration. The electrophysiological changes may be a consequence of presynaptic blockade, the botulinum toxin induced terminal sprouting of motor axons and formation of new neuromuscular junctions. Parallel with the electrophysiological abnormalities no remote clinical effects were found. The single-fiber EMG proved to be a sensitive method to control the remote neuromuscular effect of botulinum toxin.]

Clinical Neuroscience

[Schizophrenia-like psychotic episode in Multiple sclerosis]

SIMÓ Magdolna, RÓZSA Csilla, BODROGI László, TAKÁTS Annamária

[A case is presented of a twenty-year-old female with multiple sclerosis. In 1990 the patient had three exacerbations with cerebellar, optic and pyramidal symptoms. After a four-year period of remission she was hospitalized with acute schizophrenia-like psychosis. Acute psychosis is an uncommon manifestation of multiple sclerosis which may cause difficulties in differential diagnosis.]

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Clinical Neuroscience

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

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.

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

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.]