Clinical Neuroscience

[Hungarian Society of Pediatric Neurology, Neurosurgery, Child and Adolescent Psychiatry]

GYÖRGY Ilona

JULY 20, 1997

Clinical Neuroscience - 1997;50(07-08)

[This year's congress was held in Debrecen between 15 and 17 May. The venue was chosen because it was 25 years ago, in 1972, that paediatric neurology started at the DOTE Children's Hospital. The main topics of the Psychiatry Section were childhood anxiety and organisational issues in child psychiatry. The scientific programme of the Neurology and Neurosurgery Section will be presented in more detail. ]

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Clinical Neuroscience

[Patient characteristics at the stroke unit of a clinical department of neurology during a 12-month period - methods of database management, demographic characteristics and inhospital mortality]

MIHÁLKA László, BERECZKI Dániel, FEKETE István, CSABA Béla, CSÉPÁNY Tünde, CSIBA László

[Hungary is among the countries with the highest rates of stroke mortality. Accuracy of data in international statistical reports have been crlticized by several authors. The aim of the present study was to give a methodological description of the database, to report basic patient characteristics and to discuss causes of discrepancies between national and hospital stroke morbidity and mortality data. Data from a stroke unit with a catchment area of 210 000 inhabitants were used to create a database from about 100 parameters per patient discharged from the stroke unit during a 12-month period. During this period 505 patients with acute stroke were treated at the stroke unit. Of the patients admitted 15% did not have stroke. Fatality among inpatients with acute stroke was 18.6% (n=94). Assuming that all stroke patients of the catchment area were treated at the stroke unit and that stroke mortality in the catchment area equals that of the national value, 410 deaths should have occurred at the unit. The discrepancy between the number of the expected and detected stroke fatality cases might imply that either a large number of stroke patients from the catchment area do not reach the stroke unit, or actual stroke mortality is lower in our region than the national average. To examine these hypotheses, a population based prospective study should be performed. ]

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[Experiences of surgically treated temporal epileptic patients - multicentre study ]

BALOGH Atilla, BORBÉLY Katalin, CZIRJÁK Sándor, HALÁSZ Péter, JUHOS Vera, KENÉZ József, VAJDA János

[Our experiences on surgically treated temporal lobe epileptic patients are presented. Involved in the disease are the process of preoperative investigations, clinical data, types of operation and their indications, and the postoperative controls. Pre- and postoperative data of 36 surgically treated, intractable temporal lobe epileptic patients were analysed. A postoperative follow-up of longer than two years was carried out on 24 patients. The experiences of these patients on postoperative seizure frequency were evaluated using Engel's classification. Among these 24 temporal lobe epileptic patients 19 are seizure free (Engel I.), the seizure frequency significantly decreased in 3 of them (Engel II.), in the case of 2 patients the number of seizures was reduced (Engel III.). Our experiences show that neurosurgical investigation seems to be an increasingly useful, alternative way for treating intractable temporal lobe epileptic patients.]

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[Lumbar pseudoradicular pain part 1: anatomical principles]

KASÓ Gábor, DÓCZI Tamás, DÁVID Károly

[Most low back and leg pain, caused by degenerative disorders of the lumbar spine can be classified as referred (projected) pain. One of the types of referred pain is pseudoradicular pain originating from the characteristics of innervation of the spinal motion segment. Ventral parts of the spinal motion segment are supplied by the sinuvertebral nerve and the sympathetic nervous system, while the dorsal compartment is innervated by dorsal rami of the spinal nerves and both systems show considerable segmental overlap]

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[Gasoline caused hexacarbon polyneuropathy - description of five cases]

VIDA Zsuzsanna, FOLYOVICH András, GÁCS Gyula

[Based on five cases a description is given n-hexane induced polyneuropathy caused by laundry cleaning gasoline, a kind of exposition that has not been published up till now. The symptoms (subacute sensomotor polyneuropathy) and the peculiar course (further deterioration after the exposition has ceased) of hexacarbon polyneuropathy caused by gasoline were similar to that of other cases induced by other n-hexane containing materials such as diluting agents, glues, lacquers etc.]

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[Short- term video EEG analysis in a useful tool in the diagnosis of epileptic phenomena]

CLEMENS Béla, KIRÁLY Csaba

[Short-term (30–120 min) video- EEG recording and split-screen analysis is a very useful tool in investigating short- lasting epileptic or non- epileptic phenomena. The authors use this technique in different clinical situations as follows: frequent seizure- like episodes of suspected or proven epileptic etiology, with special reference to absence like and myoclonus- like episodes; motor manifestations, paroxysmal psychic phenomena, and fits induced by visual stimulation. Further indications were as follows: long-lasting pathological stupor states of suspected epileptic origin, long-lasting EEG discharges with unclear clinical correlations, precise analysis of partial epileptic seizures. The results show that, depending on patient selection, video- EEG analysis significantly contributed to precise diagnosis of epileptic seizures as well as to differentiation between epileptic and nonepileptic fits. In a few cases, rare, unsuspected epileptic conditions could only be identified by means of video- EEG analysis. The paper has been completed with a few brief illustrative case reports.]

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Cases of inborn errors of metabolism diagnosed in children with autism

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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

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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.

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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.