Clinical Neuroscience

[International Advisory Council]

JULY 20, 1993

Clinical Neuroscience - 1993;46(07-08)

[List of members of the International Advisory Council]

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Clinical Neuroscience

Pathology of the vestibular system

GOSZTONYI György, ZILL Edith

The vestibular end organ, in spite of its small size, has extremely rich interconnections with other parts of the nervous system. The vestibular system can be damaged at the end organ, along the vestibular nerve, in its brain stem representations and in its cerebellar projections. The nature of the pathological process damaging the vestibular system is manifold: neoplastic, inflammatory, vascular, nutritional and degenerative. Neural complications of AIDS may also involve the vestibular system. The lesions may be focal, multifocal and diffuse. While in the past the results of neurootological examinations could only be correlated with post mortem findings, NMI opens new horizons for neurootological and topoanatomical correlative studies.

Clinical Neuroscience

[Vascular surgery in the prevention of stroke]

MOGÁN István, NEMES Atilla, NAGY Zoltán

[In Hungary the prevalence of cerebrovascular disorders has increased so that each year vascular reconstruction surgery is needed in 2800 cases. However, only a quarter of these eligible patients are operated. After a thorough examination if all the indications for carotid surgery are met, more and more patients will end up in vascular reconstruction units. Angiography and surgery are recommended if the carotid artery stenosis is asymptomatic and is more than 90%. Also, under special conditions an asymptomatic carotid stenosis may caused by indicate surgery (before coronary by-pass operation, etc.). Another indication is a transient ischemic attack, if carotid artery lesion and the stenosis is above 70%. Ulcerated plaques also need surgery because they are a likely source of emboli. After stroke surgery may be necessary if the angiologic status is unstable and further ischemic events, that may lead to disability are expected. An acute stroke rarely calls for surgery. In contrast to this, immediate surgery is needed after repeated, TIA, or crescendo TIA because the risk of stroke is very high in these cases. Finally, sometimes surgery is indicated because of the occlusion of internal and common carotid artery. With vertebrobasilar vascular reconstruction, we do not have enough experience. Cerebrovascular syndromes due to supraaortic vascular lesions are other indications for reconstruction surgery. However, surgery is never a satisfactory substitute for pharmacological treatment.]

Clinical Neuroscience

[Transcranial doppler detection of cerebral vasospasm following aneurysmal subarachnoid haemorrhage]

BARZÓ Pál, BORDA Lóránt, VÖRÖS Erika, KISS Mariann, BODOSI Mihály, DÓCZI Tamás

[In 22 patients with subarachnoid hemorrhage secondary to ruptured intracranial aneurysms serial neurological evaluations, transcranial Doppler examinations and computer tomographic scans were performed. Transcranial Doppler flow velocities were significantly elevated for the group with vasospasm on posthemorrhage day 2. The maximum blood flow velocities were recorded between days 9 and 18, with normalization occurring within the following 3 weeks. Increase in velocity preceded clinical symptoms and could therefore be used as a prognostic factor for the management of patients with subarachnoid hemorrhage. The data also indicated that the extent and location of blood in the subarachnoid space determine the severity and location of vasospasm.]

Clinical Neuroscience

[Spinal lipomas and their surgery]

PARAVICZ Ervin, TÓTH Katalin, TORMA Albert

[18 intraspinal lipomas were operated, mostly in childhood. Surgery seems to be indicated unavoidably in view of preoperative clinical progression and postoperative improvement. Prior MR investigation was indispensable to the surgical procedure.]

Clinical Neuroscience

[Elective extra-intracranial arterial bypass in the treatment of giant aneurysms of the carotid artery]

BODOSI Mihály, DÓCZI Tamás, BARZÓ Pál

[Clinical details are presented of 5 patients with a giant carotid aneurysm in whom both the occlusion of the aneurysm and the parent internal carotid artery were performed with an extra-intracranial arterial bypass. In the first case ligature of the giant carotid-ophthalmic aneurysm narrowed the parent artery critically and hemiplegia developed. The bypass operation did not improve the clinical outcome. In the second case the occlusion of the aneurysm was performed after an extra-intracranial anastomosis and in spite of the severely narrowed carotid artery the postoperative course was uneventful. In three cases of giant intracavernous aneurysm the occlusion of the carotid artery on the neck and just proximal to the ophthalmic artery was performed in the presence of an arterial bypass. All of the anastomoses were patent and no ischemic event developed during the follow up period. On the basis of these experiences the authors suggest that, if the preoperative tests (TCD, EEG, SPECT) reveal impending ischemic lesion after carotid compression, surgery should be performed with the combination of extra-intracranial bypass.]

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[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

RÓZSA Csilla

[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

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Clinical Neuroscience

Restless leg syndrome in adult patients with β-thalassemia major

ERDEM Ramazan , ERDEM Şimşek Nazan, KURTOĞLU Erdal

To investigate the quality of sleep and the presence of Restless Legs Syndrome (RLS) in the Turkish population with β-thalassemia major (TM). The second aim was to assess the risk factors of RLS in TM adults. The study sample comprised of 121 patients at least 18 years old with TM. The patients’ socio-demographic information, body mass indexes (BMI), current medications, laboratory data were recorded. The patients were asked if they had a history of chronic kidney disease, diabetes mellitus (DM), and polyneuropathy. Restless legs syndrome was diagnosed according to the International Restless Legs Syndrome Study Group criteria. The sleep quality of the patients was assessed using the Pittsburgh Sleep Quality Index (PSQI) scale. The Epworth Sleepiness Scale (ESS) was used to assess excessive daytime sleepiness in the patients. The median age of the patients was 25 years (range 18-52). The mean BMI was 21.49±2.5 (R 14-26.5) for all patients. The prevalence of RLS was 5% in TM adult patients. The TM patients with RLS had no major complications of TM. The median PSQI global score of all patients was 3. Twenty-two (18.1%) patients had poor sleep quality. The reason for poor sleep quality was RLS symptoms in four patients (18%). There was no significant association between PSQI total score and blood parameters of the patients. Twelve (9.9%) patients had ESS scores greater than 10, which indicates excessive daytime sleepiness. The prevalence of RLS in TM patients was similar to that of the general Turkish adult population. These results indicate that RLS may occur in patients with TM, although they had a high level of serum ferritin.