Clinical Neuroscience

[Hungarian Spine Association]

PENTELÉNYI Tamás

JULY 20, 1994

Clinical Neuroscience - 1994;47(07-08)

[Scientific Programme of the Hungarian Spine Association for 1994 and 1995.]

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Clinical Neuroscience

[The history of Hungarian neurology (Part II)]

BEKÉNY György

[1935-1945: László Benedek and his time]

Clinical Neuroscience

Personality traits in scheuermann's disease - a controlled study

SOMHEGYI Annamária, JÁNOSFI Zsuzsa, BALÁZS István, RATKÓ István

High muscle tone in various muscle groups is typical in Scheuermann's disease, and secondary fibromyalgia often occurs in young adults after this condition. There are clinical observations of emotional-psychological disturbances in adolescents with Scheuermann's osteochondritis. For these reasons it was of interest to determine whether any particular personality traits were manifested in adolescents with Scheuermann's disease, that - in addition to the spinal pathology – would contribute to the high muscle tone. Using four personality diagnostics tests (Brengelmann's questionnaire, Taylor's anxiety scale, Neurosis Scale, Lüscher's 8-colour test) we investigated the emotional life of 52 adolescents with Scheuermann's osteochondritis and that of 52 matched healthy controls. Test results of the two groups were statistically evaluated using chi square tests, with a significance limit of p < 0.05. The most striking difference between the two groups was that the patient's volitional and diffuse psychic tensions were increased (c = 1.00 and p < 0.0005) and, at the same time, were accompanied by a significant deficiency of the means to discharge them ( c = 1.00 and p < 0.0005). The results indicate that Scheuermann-patients do not answer to the stresses of everyday life in the usual way but by an increase in muscle tone. Their muscles act as their stress organ. This - in addition to the spinal pathology - may contribute to the tightness of their muscles and might be considered as a possible predisposing factor to later secondary fibromyalgia. Therapy should seek to interrupt this vicious circle by complementing regular exercise with relaxation techniques.

Clinical Neuroscience

Management proposal for the treatment of acute odontoid fractures

RÓBERT Veres, GILES Hamilton Vince

Optimum management of the acute odontoid fracture has always been extensively discussed. Nowadays, with the availability of new operative techniques such as anterior odontoid screw fixation and the posterior C1-C2 transarticular screw fixation the management policy has to be reevaluated. The authors review 115 cases of type II and type III acute odontoid fractures admitted to the National Institute of Traumatology in Budapest between 1980 and 1990. For study purposes a modified Anderson-D'Alonzo classification was introduced allowing a more detailed description of the fracture components and thus enabling to find more clear guidelines for treatment planning. The patients were treated with: a. various types of non-Halo external fixation in 27 cases; b. Halo immobilization in 13 cases; c. various surgical procedures resulting in a loss of atlantoaxial joint function in 22 cases; d. anterior odontoid screw fixation in 53 cases. Modern therapy should be focused on preserving the function of the atlanto-axial joint whenever possible. This can be sufficiently achieved using anterior odontoid screw fixation. However, the main determining factor in the choice of the appropriate treatment - providing the ligaments are intact - is the direction and course of the fracture line. If the fracture line runs horizontal or oblique posterior anterior screw fixation is the most favourable treatment. On the other hand if the fracture line runs oblique anterior Halo immobilization or C1-C2 posterior fixation is the method of choice.

Clinical Neuroscience

[CT guided stereotactic radiosurgical treatment of cerebral metastatic tumors]

FEDORCSÁK Imre, HORVÁTH Ákos, KONTRA Gábor, SLOWIK Felicia, OSZTIE Éva

[Radiosurgery has in recent years been used with promising results in the treatment of cerebral metastases. Between July 1991 and January 1993 we treated 23 patients harbouring brain metastases (39 lesions) with our Linear accelerator based radiosurgery system. The median tumor size was 1.9 cm (1.0-3.0 cm) and the median delivered dose was 18.7 Gy (13–25Gy). Follow up CT scans at 4 months showed a complete remission or greater than 50% tumor volume reduction in 19 patients (82%). No change was noted in 2 patients (9%), and after a transitory decrease an increase in tumor size was seen in 2 patients (9%). Follow up time was minimum 6 month (or till death), and maximum 26 months. We have lost 13 patients during the study, and the cause of death was neurologic in only 2 cases. Our experience supports the cumulating evidence that radiosurgery is an effective treatment for metastatic brain tumors, is well tolerated by the patients, and can be applied also in cases where open surgery can not be performed.]

Clinical Neuroscience

[Real time and color doppler sonographic investigation in cases of fetal hydrocephaly and cerebral hemorrhage]

JAKOBOVITS Ákos, JÖRN Hendrik

[In three hydrocephalic and one fetus with intra- and periventricular hemorrhage real time imaging was used to identify cerebral changes. Color flow imaging was used to identify the fetal middle cerebral and umbilical artery for subsequent pulsed Doppler sonographic studies. Cerebral blood flow patterns of hydrocephalik fetuses seem to differ individually from case to case presenting normal, increased and decreased velocity waveform indices. The resistance index and pulsatility index of the middle cerebral artery in case of cerebral hemorrhage increased with advancing worsening of the fetal state of health. Loss of diastolic cerebral or umbilical flow followed by retrograde flow during diastole antenatally could be a bad sign prognostically. ]

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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.

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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.

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Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

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[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]