Clinical Neuroscience

[Hungarian Spine Association]

PENTELÉNYI Tamás

MAY 20, 1993

Clinical Neuroscience - 1993;46(05-06)

[Further scientific programme of the Hungarian Spine Society in 1993.]

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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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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

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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[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]

KAPÓCS Gábor

Clinical Neuroscience

[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. ]

Clinical Neuroscience

[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. ]