Clinical Neuroscience

[In Memoriam György Bekény]

HORVÁTH Sándor

NOVEMBER 20, 1993

Clinical Neuroscience - 1993;46(11-12)

[After a life of struggle and success, and after a serious illness borne with dignity and discipline, death took him at the age of seventy-eight. Even in the last years of his life, ill but tireless, he served his vocation with his knowledge: healing and teaching; patients and interested students; the Clinic. Shortly before his death, he completed his last scientific work, The History of Hungarian Neurology.]

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[The illogical therapy]

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[Most of the causative pathological factors in ischemic cerebrovascular events cannot be recognized during the acute stage of the disease partly because of to the complexity of biophysical model of cerebral microcirculation, partly because the causative factors in this model cannot be confidently weighted. Clinical diagnoses on cerebral circulation disorders are based on the fundamental causes of the disorders. Evoking factors are hypotheses, consequently therapies are directed to hypotheses. The mathematical model of cerebral microcircualtion is mondeterministic. The interactions between vascular factors and blood fluidity can be roughly estimated. Judging the therapeutic efficacy is hindered by the nondeterministic disease model, the indefinite clinical clues, their individual variations, heterogenous diagnostic groups, and tendency of spontaneous restoration of symptoms. Non-specific drugs are used to treat cerebral ischemia, and trials making use of monotherapies have failed to change the life expectancy or the clinical course of ischemic patients. The acute stage of the disease cannot be defined and because of the incompleteness of clinical indicators „stroke prevention" appeares to be ambiguious. Therefore, the nature of the treatment of ischemic cerebrovascular disease is at present based on trial and error.]

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[The authors review here the most recent literature on experimental allergic encephalomyelitis and multiple sclerosis, focusing on the efferent branch of the immune response. They attempt to describe the molecular characteristics of the myelin antigen specific T cell receptors. Identification of the most distinct properties of the disease mediating cells may not only provide clues to the etiology of MS, but also opens new avenues to specific therapeutical approaches.]

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[Transcranial doppler of extracranial stenosis in internal carotid artery]

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[Endeavours were made to determine why mean velocity and pulsatility index changes in middle and anterior cerebral artery are caused by the unilateral occlusion of the internal carotid artery or by severe stenosis. The transcranial Doppler method is suitable for judgingre pathologic intracranial blood flow conditions, especially when data are compared to those of healthy conditions.]

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[Lumbar synovial cysts are infrequent but characteristic manifestations of the commonly encountered but rather complex degenerative disorders affecting the lumbar zygapophyseal joints. The anatomical disposition of the different components of the lumbar motion segment, their sensory innervation and their topographic relationship with the neighbouring nerve structures explain why the neurogical manifestations of these affections, as well as of other articular disorders, cannot always be distinguished from those of discal origin. However, modern imaging methods allow the resolution of the radiological and consequently of the clinical differential diagnostic problems. The systematic use of computed tomography and magnetic resonance imaging in the evaluation of low back pain syndromes has resulted in the recognition and precise description of the practically pathognomonic „radiological syndrome” of the synovial cysts of the lumbar zygapophyseal joints.]

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