Clinical Neuroscience

[Maniform psychosomatic alternating periodic hypersomnia ]

POHL Ödön1, HAITS Géza1

AUGUST 01, 1967

Clinical Neuroscience - 1967;20(08)

[The authors describe a 19-year-old male patient who developed a parotitis epidemic 2 years ago and experienced severe drowsiness lasting for days. Since then, his hypersomnia has recurred 5 times over a period of 2-3 weeks, with repeated episodes of manic psychosis in between. Authors hypothesize meningoencephalitis as an aetiological factor accompanying parotitis epidemica and leading to diencephalon, but they also suggest that genetic factors may be involved in the onset of maniform pictures. ]

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  1. BOTE II. sz. Neurologiai és psychiatriai klinika

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[Bilateral tibialis anterior syndrome]

KÓMÁR József, LEHOCZKY Tibor

[Authors describe bilateral tibialis anterior syndrome after strenuous standing work in a 49-year-old female patient. Based on histopathological examination of muscle biopsy, increased subsidence and leukocytosis, the clinical symptoms are considered to be due to myositis. Treatment with ACTH relieved the patient of symptoms. The syndrome is considered to be polyaetiological and, on the basis of Morger's studies, conservative treatment with anti-inflammatory drugs is recommended instead of fasciotomy. ]

Clinical Neuroscience

[Follow-up results of trigeminal excisions for tic douloureux]

ZAPPE Lajos, NAGY Vilmos

[Authors report 1-7 year follow-up results of 121 intracranial trigeminal truncations in 120 patients and report the following findings: 1. in the area of the auricle and angulus mandibulae, the separation of the trigeminal and adjacent innervated areas is not sharp, and there is certainly overlap. 2. Any regeneration that may occur after surgery starts from this area, with the loss of sensation extending back towards the medial orbital ridge. 3. After complete shutdown of the nerve, regeneration is limited and neuralgia hardly ever recurs, but anaesthesia dolorosa develops quite often, although it is severe in only 4% of cases. 4. Recurrence is quite frequent after partial excision, occurring predominantly in the first 4 years after surgery - but is usually reversible with further surgery. Their studies have shown that the effect of surgery against T.N. is based on the elimination of the incoming stimuli, deafferentation. During radicotomies, root compression, breaking and stretching at the pyramidal apex have never been observed. Their observations have led to a position on the pathomechanism of the facial nerve root and the therapy to be chosen. It seems best to start with a ganglion treatment resulting in partial disconnection of the nerve. If, however, radicotomy is performed, total root transection is the correct solution. ]

Clinical Neuroscience

[Diagnostic errors in meningiomas of the cerebellum in old age]

ÉDER Mária, LŐRINCZ Gábor

[Diffuse oedematous phenomena were found in the white matter of both cerebral hemispheres, more pronounced on the same side as the tumour. We also observed oedema in the white matter of the cerebellar hemisphere of the cerebellum, which was accompanied by even older and more recent microscopic haemorrhages on the tumour side. The investigators in this case were led to an incorrect pathology by a nearly one and a half year asymptomatic period, a rapidly developing personality change, symptoms characteristic of diffuse cortical damage, a negative fundus finding throughout and last but not least the result of the Gamma EG examination. ]

Clinical Neuroscience

[Drug treatment trials for the treatment of chronic alcoholism (II)* a) About the metronidazole-alcohol reaction ]

KARDOS György, SZABADOS Pál

[Alcohol aversion or because of the risks and complications of disulfiram cures, interest in the temperance drugs (cyanamide, calcium carbamide citrate, etc.) ensuring relative intolerance has increased in recent years all over the world. Verff. report 117 therapy drinking tests on 50 patients and some self-experiments with trichomonacid-metronidazole. At equal doses of alcohol, the reaction whose main symptoms are described is much milder than the disulfiram-alcohol reaction; on the other hand, at greater alcohol exposure, which, however, corresponds to habitual and relatively insignificant consumption in drinkers, very unpleasant and agonizing nausea (headache, vomiting, dizziness, weakness, etc.) may occur. An overview is given of the isolated clinical-pharmacological data obtained concerning metronidazole, partly in alcoholics, partly in schizophrenics. According to these, the drug is supposed to have a thymoanaleptic effect, reminiscent of MAO inhibitors, as well as an abolishing effect on alcohol dependence. It would be essential to remedy its chronic toxic effect, further to increase the tempering effect by structural changes to the metronidazole molecule, or to favor its usability against alcohol by attenuating the side effect. ]

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[E250 (phenylisopropylmethylpropynylamine Hcl.) clinical experience]

A. Tibor, LIPÁK János, KLEININGER Ottó

[Authors observed the effects of E250 (phenylisopropylmethyl propinylamine HCl) in a total of 56 patients. Their experience was unfavourable in major depressive disorder associated with marked anxiety and abnormal thought processes. In milder depressions, it has been found to be effective in combination with tranquillisers and sleeping pills. It can also be used as a stimulant in adjusted doses depending on individual tolerance. Almost without exception, it enhanced activation and psychic performance in patients with occupational therapy for epilepsy. This was also convincingly confirmed by concurrent reactio-temporal measurements and psychological test studies (Rorschach, Lüscher test). ]

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Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.

Clinical Neuroscience

[Eating disorders and pregnancy - a review of literature]

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[Eating disorders are psychosomatic disorders affecting primarily women, and influence reproductive functions as well. They have an impact on ovarial cyclem fertility, course of pregnancy, process of delivery, post partum period. Moreover, some data show that they can influence the adult health status. Extensive research from the last three decades call the attention to the fact that besides the classical eating disorders (anorexia nervosa and bulimia nervosa) the newer types (e.g., orthorexia nervosa), and subclinical disorders also occur in a subgroup of pregnant women. For this reason it is of key importance that the personnel working in the territory of obstetrics and gynecology have a solid knowledge about the symptoms, screening and therapeutical opportunities, and outcome of these disorders. The review summarizes the recent research data about the relationship of eating disorders and pregnancy.]

Clinical Neuroscience

REM sleep, REM parasomnias, REM sleep behaviour disorder

SZÛCS Anna , MUTTI Carlotta, PAPP Anikó, HALÁSZ Péter, PARRINO Liborio

We review the literature on REM parasomnias, and their the underlying mechanisms. Several REM parasomnias are consistent with sleep dissociations, where certain elements of the REM sleep pattern emerge in an inadequate time (sleep paralysis, hypnagogic hallucinations and cataplexy) or are absent/partial in their normal REM sleep time (REM sleep without atonia, underlying REM sleep behavior disorder). The rest of REM parasomnias (sleep related painful erection, catathrenia) may have other still unclear mechanisms. REM parasomnias deserve attention, because in addition to disturbing sleep and causing injuries, they may shed light on REM sleep functions as well as the heterogeneous etiologies of parasomnias. One of them, REM sleep behavior disorder has special importance as a warning sign of evolving neurodegenerative conditions mainly synucleinopathies (some cases synucleinopathies themselves) and it is a model parasomnia revealing that parasomnias may have by autoimmune, iatrogenic and even psychosomatic etiologies.

Clinical Neuroscience

Mental health of physicians - nationwide representative study from Hungary

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Background and aim - Somatic and mental health and stress factors of physicians became an issue of growing interest in both national and international researches. Our aim is to give an overviewing analysis of Hungarian physicians’ mental health state. Methods - Representative, cross-sectional, quantitative survey on a representative sample of Hungarian physicians (n=4784). The control group was formed by the population group of a national survey conducted by “Hungarostudy 2013” (n=2000). Results - Suicidal thoughts (18.8% vs. 9.6%, p<0.001), the scores of Somatic Symptom Scale (PHQ-10, 20.4% vs. 13.6%, p<0.001) were significantly higher among physicians. The suicidal attempts (1.9% vs. 3.5%, p=0.053) and BDI depression scores (7.9% vs. 29.5%, p<0.001) were significantly higher in the control group. High Perceived Stress Scale (PPS) scores occurred in 43.3% of the physicians sample, and 43.4% of them had high scores in the Athenian Insomnia Scale (AIS). The young (<35) female physicians showed significantly higher rates of suicidal thoughts, higher scores of PHQ and PPS. In the young female cohort, the AIS scores were significantly higher than of the other physicians. Conclusions - Mental health of physicians (sleep disorders, suicidal thoughts and psychosomatic symptoms) showed poorer results than the population data. BDI scores and the rate of suicidal attempts showed favourable trends. The next step in the physicians’ mental health researches is to investigate the most decisive risk factors, and to work out the prevention tools.

Clinical Neuroscience

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FUSZ Katalin, TÓTH Ákos, VARGA Bernadett, ROZMANN Nóra, OLÁH András

Introduction - The shift work is burdensome for nurses and may lead to health problems. Aims - The purpose of the study was to examine the nursing shift system types and to analyse the effects on nutritional status, subjective state of physical and mental health in case of different shift schedules. Method - In the first phase of the research 326 nurses working in changing shifts filled out the Bergen Shift Work Questionnaire after adaptation into Hungarian. 518 nurses participated in our second study in hospitals of the South-Danubian Region, in clinics of University of Pécs and at trainings organized by the Faculty of Health Sciences of the University of Pécs. Results - Based on the psychometric characteristics of Bergen Shift Work Questionnaire technically it is suitable for the examination of sleeping disorders associated with shift work. Sleeping quality is worse in those working in irregular work shifts compared to those working in regular and flexible work schedules (p<0.001). The irregular work schedule is worse than the regular work schedule according to 76.6% of the nurses. According to 63.8% of the respondents the following regular work schedule is the best: after one 12-hour day shift one 12-hour night shift, followed by two days of rest. The average Body Mass Index (BMI) is 26.16 kg/m2. Since the nurses work in shift work 47.7% of them reported weight gain. Among the psychosomatic symptoms the most frequent is back pain (78.4%) related elevated BMI (p=0.013). The nurses’ sense of coherence on average is 61.76 points. In case of full-time employees the sense of coherence is better than those who work in shifts (t=2.933, p=0.004). The nurses working irregular shift work asses their health worst (mean rank: 166.61; p=0.019), and their sense of coherence is lower (p=0.04). Conclusion - The irregularity of work schedules is stressful for nurses. Due to the health of nurses it would be useful to establish the least exhausting work schedules.