Clinical Neuroscience

Hungarian Society of Neurosurgeons

NOVEMBER 20, 1994

Clinical Neuroscience - 1994;47(11-12)

World Federation of Neurosurgical Societies, Newsletter Spring 1994

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Clinical Neuroscience

[Clinico-morphological correlation in common dementias]

PAPP I. Mátyás

[ln the late sixties the revelation that more than half of the dementia cases in elderly people were caused by Alzheimer's disease and not by „cerebral arteriosclerosis" gave dementia research a new impetus, which accelerated in the eighties and has nowadays become explosive and has supplied us with a mass of data almost beyond comprehension. Nevertheless, even though it is most intensively, studied elucidation of the etiology and pathogenesis of the Alzheimer' s disease is still not expectable in the near future. ln addition to Alzheimer's disease, new results basically changing our views, have been achieved in the field of the vascular dementia and in dementias with Parkinsonian syndrome. Frontostriatal circuits discovered recently have helped our understanding of the subcortical dementia in these diseases and in others. By means of neuroimaging techniques, several dementia syndromes - paramedian thalamic infarcts, the watershed infarcts and the so called Binswanger's disease - have turned out to be much more common than previously believed. Clinicopathological observations have verified the role of the damage to the limbic and paralimbic structures, frontostriatal circuits and association pathways in the pathomechanism of dementias. ]

Clinical Neuroscience

[Typical behavior models of dealing with epilepsy - the models present between patient and members of the family]

NEMESSÚRI Judit, TÖLGYES Tamás, VERES Judit, RAJNA Péter

[Four are main symptom groups described which were previously considered to be not more than an organic consequence of epilepsy. In most cases in the background of these groups a pathogenic/ pathogenetic role of typical relationship constellations between the patient and his/her relatives can be observed. These constellations are illustrated by case descriptions. It is pointed out that: 1. Epilepsy is a chronic illness in the course of which in every case certain psychodynamic events take place between the patient and his or her relatives in the immediate environment. 2. According to the present „neurological" approach and to the social expectations in the course of the patients' care the main stress is on biological events and changes. As a result intrapsychic and social-psychiatric motives are frequently manifested in the form of biological symptoms, too. 3. It follows from the above that the psychic constellation is interiorized by the patient and then he/she expresses it through somatic symptoms. At first sight these symptoms seem to be typical epileptic problems”. In actual fact, somatic „epileptologic” treatment cannot be regarded as succesful. 4. Since care is mainly based on auto- and heteroanamnestic data the phenomena discussed earlier could be highlighted only by means of the simultanious exploration of the family in question and by possible disagreement between the patient and his/her environment. 5. In order to treat the epileptic patient it is essential to consider the illness in relation to the patient and the members of the family.]

Clinical Neuroscience

[Characteristics of gadolinium-enhancement in ischemic stroke]

KENÉZ József, BARSI Péter, KULIN Árpád, NAGY Zoltán

[Stroke is a clinical diagnosis. In acute stroke, CT is the first examination of choice to exclude hemorrhage. In ischemic stroke, MR detects the changes earlier and more exactly, than CT. Contrast-enhanced MR imaging shows specific enhancement phenomena, viz. Intravasal high signal in the vessels of the ischemic cerebral region, meningeal enhancement, transitorial, mixed type enhancement and parenchymal enhancement. Our paper is deals with the causes and diagnostic significance of the different types of these enhancement effects, and discusses some differential diagnostic conclusions. In the near future, after installing more modern MR equipment, a more exact knowledge of the pathomechanism of stroke and, as a consequence, new and more effective therapies can be expected.]

Clinical Neuroscience

[Determination of serum C-reactive protein in the illnesses of central nervous system]

PINTÉR Erzsébet, KÁLI Gábor, VUKMIROVITS György, NIKOLOVA Radka, YOUSEF M. Gassar, GYARMATI Éva

[Serum quantitative C-reactive protein concentrations were measured in 186 patients admitted with suspected neuroinfection or symptoms of other diseases in the central nervous system. The diagnoses were purulent meningitis (102), abscessus cerebri (5), meningitis basilaris (2), meningitis cryptococcica (1), sepsis (11), encephalitis (22), encephalopathia (5), autoimmune central nervous illness/disease/disorder (22), non-inflammatory central nervous disease/ disorder (12) and tumour cerebri (4). The highest values of C-reactive protein were measured in patients suffering from abscessus cerebri (250.8 +/ 64.2 mg/l), sepsis (221 +/- 16.4 mg/l) and purulent meningitis (153.0 +/- 94.59 mg/l). Serum C-reactive protein concentrations were moderately increased in viral infections (36.8 +/- 36 mg/l). The C-reactive protein level in the normal range in patients suffering from non-inflammatory and autoimmune central nervous illnesses/diseases/ disorders (4.0 +/- 1.5 mg/l or 10.0 +/- 18.5 mg/l). During our examinations the C-reactive protein levels showed both local and septicaemic reactions. C-reactive protein is considered as a valuable laboratory parameter both in diagnosings central nervous system diseases with suspected bacterial infection and in monitoring therapeutic efficiency.]

Clinical Neuroscience

[Chronic recurrent transverse myelitis or multiple sclerosis]

UNGUREÁN Aurélia, PÁLFI Sándor, DIBÓ György, VÉCSEI László

[The simultaneous appearance of multiple sclerosis and transverse myelitis is a known phenomenon. Apart from the appearance of spinal symptoms, other neurological signs of the brain involvement can urually be found, MRI shows disseminated foci in the brain. The positive evoked responses, the immunological abnormalities of the CSF, and the oligoclonality together prove the presence of multiple sclerosis. In these cases the symptoms of transverse myelitis may precede other signs of multiple sclerosis, or appear separately as a relapse. Recurrent transverse myelitis as an independent entity with negative MRI and CSF immunology, is an exciting topic concerning the etiologic factors and therapeutical considerations. Tvolging from the literature, the appearance of transverse myelitis as an independent entity, is rather rare. Details are given of a female patient with recurrent spinal cord signs, negative MRI and CSF immunology. During her ten-year follow-up no, symptoms of multiple sclerosis have developed. Further studies are needed to clarify the etiological factors, pathomechanism and therapeutic considerations of this relatively new and probably independent clinical entity.]

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[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. ]

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[A short chronicle of three decades ]

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[History of vaccine production in Hungary ]

ÓCSAI Lajos

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SZAUDER Ipoly

[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]