Clinical Neuroscience

[Indicative guidelines and methodological dilemmas in the treatment of "alcoholism'']

KARDOS György1

JULY 01, 1967

Clinical Neuroscience - 1967;20(07)

[My report in issue 17 of the Medical Journal of 1961 (102: 769-776) summarized the experiments in the treatment of chronic alcoholism with drugs. It dealt with the expected therapeutic results, side-effects, contra-indications and complications on the basis of literature data and our own 580 case histories. The latter have been discussed in detail elsewhere (Medical Education, 37.103-119, 1962) in connection with our analysis of 33 cases of antaethyl-psychosis and alcohol withdrawal syndrome. The same applies to the socio-psychological interactions modifying the intrinsic effects of drug treatments (Psychological Studies, VII: 295-302, 1965). We must now deal with the general guidelines and methodological dilemmas of active withdrawal treatments from the point of view of a therapeutic plan aimed at resolving the pluricausal alcoholism syndromes. I would like to emphasise the latter with particular emphasis, because rejecting them could lead to fundamental errors of approach and practice, i.e. the notion that alcoholism is a monocausal disease entity and that this erroneous and even harmful view results in a barren effort to provide uniform, routine care for 'alcoholics'. ]


  1. Országos Ideg-és Elmegyógyintézet III. B férfi Osztály



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Clinical Neuroscience

[The problems of angiographic diagnosis in relation to retrograde vertebral circulation]


[Detailed angiographic evidence is provided of the retrograde vertebral circulation with respect to the possibility of a possibility of a sham,,subclavian steal" syndrome is discussed. It is emphasized that elective vertebral arteriography may also normally frequently fill the reciprocal vertebral artery retrogradely. The cause of this must be sought primarily in mechanical factors. By analyzing the angiograms of a patient with true and one with apparent "subclavian steal" syndrome, it is concluded that in case of atypical clinical symptoms or lack of angiographic evidence, one must always think of the apparent "subclavian steal'' syndrome. The differentiation of the two syndromes is only possible by serial aortography, with the help of the Gidlund syringe from the brachial artery or, in the case of occlusion of the subclavian artery, from the common carotid artery. carotis communis.]

Clinical Neuroscience

[An interesting case of a family with progressive dystrophia musculorum with dominant inheritance]


[The author presented a case of a family with autosomal dominant inheritance of shoulder girdle typos with DMP, which is different from the average in several respects. Finally, some hereditary literature on this type of DMP was presented. ]

Clinical Neuroscience

[Asymptomatic skull-base destructios]


[Authors describe two patients in whom extensive skull base destruction was detected. No syndromes of cerebral nerve injury, as expected from the location of the destructios, were observed in these patients. Possible reasons for the absence of symptoms are discussed. ]

Clinical Neuroscience

[Use of Librium in child psychiatry]

KISS Mária, KISZEL Katalin

[Based on 60 cases treated in our child psychiatry unit, and in line with what is known from the literature, we have found that Librium is indeed an effective agent in some cases. It should be given primarily for neurotic symptoms. In obsessive-compulsive neurosis, it has proved more effective than any other drug known to date. In psychosis and in behavioural disorders of organic origin, such as oligophrenia and encephalopathy, it does not seem to be effective enough. Its anticonvulsant action has not been satisfactory, but since it does not provoke seizures at low doses, it is excellent for secondary complaints of neurotic origin in epileptics. ]

Clinical Neuroscience

[Data on some relationships between blood and CSF sugar levels ]


[In 404 cases, the ratio of sugar content in blood to CSF was tested. Our experience shows that in some diseases the blood glucose/liquid glucose ratio (V/L Q) deviates significantly from the normal value of 1.5. In our opinion, this deviation is due to increased sugar consumption of nerve tissue in spinal processes and altered function of the choroid plexus in brain processes. Significantly altered V/L Q can be used in the differential diagnosis of radiculitis, radiculopathy, spinal tumour.]

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Clinical Neuroscience

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.

Clinical Neuroscience

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

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.

Clinical Neuroscience

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

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

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[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

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