Clinical Neuroscience

[lzonicotinic acid hydrazide poisoning effects on the central nervous system]

KAPPÉTER István1, KAJTOR Ferenc1

APRIL 01, 1965

Clinical Neuroscience - 1965;18(04)

[In a patient taking 250 tbl of INH "as a replacement", after a single epileptic seizure, somnolons for 3 days, gradually improving bradypsychia for 1 month, other symptoms typical of epileptic character changes, and a slowing of brain electrical activity, epileptiform potentials, which settled after two months, were observed. This process was monitored by EEG, time-lapse studies, Rorschach tests. Our observations and the literature review suggest that epileptic and psychic changes are related to a disturbance of pyridoxine-GABA metabolism. We emphasize the difficulty of recognizing INH-intoxication and its prevention. ]

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  1. Debreceni Orvostudományi Egyetem Ideg-és Elmeklinikája

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Clinical Neuroscience

[After twenty years]

JUHÁSZ Pál

[The experience of the past 20 years: in the face of our shortcomings and failures to we can continue our work in the hope of success.]

Clinical Neuroscience

[Investigation of neuromuscular synapses in muscle diseases]

STIPULA Magda

[From the muscle biopsy material of our clinic, the subneural apparatus of the myoneural junction was examined in 32 cases by the Koelle acetylthiocholine method, and the neural part by the Bielschowsky-Gross-Schultze method modified by Coers. The amount of material studied by these tests is small in relation to the number of biopsies performed in our clinic. However, also according to our previous results, we have seen that in ALS the subneural apparatus is relatively uniformly smaller, with variable size in the initial stage of dystrophia musculorum progressiva, with more large, hypertrophic forms, while in the later stage we find smaller, more irregular forms. Intramuscular nerve fibres showed irregular course, thinning in ALS, and irregular, degenerative axonal swellings in dystrophies. We do not want to draw any far-reaching conclusions from the material we have examined so far, but based on the literature and our initial experience, we see that further and more extensive studies in this direction are absolutely necessary to better understand the pathology of skeletal muscle. ]

Clinical Neuroscience

[Effect of local brain hypothermia on ECoG and experimental epileptiform activation]

PÁSZTOR Emil, TOMKA Imre, DEÁK György

[Monopolar corticographic drainage was performed in dogs with chloralose narcosis after extensive craniotomy mk.o. Cooling of the brain surface was performed with circumscribed cold fluid. Brain temperature was measured with a copper-constantan thermoelectric thermometer at a depth of 2-3 mm. The experiments yielded the following results : 1. Electrocorticographic recordings could not demonstrate that certain phases of brain hypothermia are associated with an increased excitability state; 2. A different relationship between the change in locally generated strychnine spike activation and the change in baseline activity during cooling and spontaneous warming was observed; 3. The brain electrical activity activated by Tetracor during cooling was similar to that in unactivated cases. 4. local brain cooling on either side does not significantly affect either the basal opposite-side activity or the opposite-side strychnine-spike activity activated with Tetracor or generated locally, but eliminates the opposite-side mirror focus. Therefore, local brain cooling can be used as a probe to determine the primary or secondary nature of the counter-side spike activity.]

Clinical Neuroscience

[Additions to the study of the schizophrenomimetic effects of phencyclidine. Based on a self-experiment with Elysion]

OSZVALD Péter

[The author describes in detail his sensory and psychic hallucinogenic experiences of a schizophrenic-like symptom cluster lasting several hours, induced by intravenous phencyclidine (Elysion). ]

Clinical Neuroscience

[The use of the modified permanganate response in the early detection of neuronal constriction in early CSF diagnosis]

DÉNES Iván, TUNKL Erika, FARAGÓ András

[The described permanganate methodology seems to be a significantly more informative method than the usual CSF test in the diagnosis of neurovascular constrictions containing low mg% CSF. In the authors' opinion, it is not the protein amount or the accumulation of certain protein fractions that is responsible for this behaviour of the reaction, but the biochemical changes that occur as a result of the space-constricting process, which the authors aim to clarify further. ]

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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.

Lege Artis Medicinae

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

KAPÓCS Gábor

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

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.

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]