Clinical Neuroscience

[Max Nonne]

KÖRNYEY István

JANUARY 01, 1961

Clinical Neuroscience - 1961;14(01)

[The author reports on Max Nonne's life. ]

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Clinical Neuroscience

[Malignant angioblastoma spreading between the soft tissues ("Lindau disease") ]

POTONDI András

[The author describes a case of a rapidly progressive, fatal cerebellar solid angioblastoma (Lindau), which spread diffusely along the blood vessels and between the soft tissues. He briefly reviews the literature on the subject, which did not find angioblastoma spreading in a similar manner. ]

Clinical Neuroscience

[Intravenous urea: new agent for intracranial pressure increase in intracranial pressure]

ZAPPE Lajos, VIDOVSZKY Tamás

[Our experience, which we have presented in the form of a preliminary bulletin because of the small number of cases, suggests that i.v. urea will be a much more effective and reliable tool than hypertonic solutions (dextrose, etc.) in the treatment of intracranial hypertension. The development of a side-effect-free home preparation is currently underway; we will report on clinical trials of this on larger material and on studies of the mechanism of action. ]

Clinical Neuroscience

[Our experience with Urevert, Report on our surgical observations ]

GOMBI Róza, HULLAY József

[The authors describe their experience with Urevert, a new intracranial pressure reliever. It was used to reduce increased intracranial pressure caused by brain tumours (4), ruptured aneurysms (2) and subdural haematoma (1) in 7 patients. They observed that Urevert is an easy to administer and accurately dosed dehydrating agent. It is excellent for reducing increased intracranial pressure. It reaches its maximum effect within 1-2 hours and can therefore be administered primarily as a preoperative preparation. No unpleasant side effects have been observed. Indication is wide, contraindications are active intracranial haemorrhages and various severe liver and kidney diseases.]

Clinical Neuroscience

[Catamnosis of children with elective mutism]

LÓRÁND Blanka

[The author describes 11 cases of elective mutism - with particular reference to catamnestic data recorded years later. The symptom usually comes to attention in preschool or during school enrolment. It is strikingly often associated with vegetative dystonia, enuresis and mental retardation. Although polyaetiological factors are frequently present in the history, the author is under the impression that in a significant proportion of cases, a congenitally reduced speech ability is primarily responsible for the manifestation of e.m. The therapeutic approach varies according to the type of reaction and pathogenesis. He concludes that, when sufficient time was available, the therapeutic outcome was durable in the vast majority of cases (7 complete cures, 2 improvements). The catamnestic monitoring of the therapeutic outcome also serves the purpose of facilitating and providing empirical support for the prognosis.]

Clinical Neuroscience

[Retroolivar softenings as vertebralis complications of angiography]

ASZALÓS Zoltán, CSATÁRY Zoltán

[In two cases of attempted carotid AG, the contrast material entered the vertebral artery, resulting in fatal retroolivar atrophy and haemorrhage, both of which were associated with the posterior blood supply area of the cerebellar inf. In one case very pronounced, in the other mild vascular lesions may have been a predisposing factor for AG complications. No such localized complication has been reported in the literature. ]

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Clinical Neuroscience

Effects of valproate, carbamazepine and levetiracetam on Tp-e interval, Tp-e/QT and Tp-e/QTc ratio

YASAR Altun, ERDOGAN Yasar

Aim - To evaluate P-wave dispersion before and after antiepileptic drug (AED) treatment as well as to investigate the risk of ventricular repolarization using the Tpeak-Tend (Tp-e) interval and Tp-e/QT ratio in patients with epileptic disorder. Methods - A total of 63 patients receiving AED therapy and 35 healthy adults were included. ECG recordings were obtained before and 3 months after anti-epileptic treatment among patients with epilepsy. For both groups, Tp-e and Tp-e/QT ratio were measured using a 12-lead ECG device. Results - Tp-e interval, Tpe/QT and Tp-e/QTc ratios were found to be higher in the patient group than in the control group (p<0.05, for all), while QTmax ratio was significantly lower in the patient group. After 3 months of AED therapy, significant increases in QT max, QTc max, QTcd, Tp-e, Tp-e/QT, and Tp-e/QTc were found among the patients (p<0.05). When the arrhythmic effects of the drugs before and after treatment were compared, especially in the valproic acid group, there were significant increases in Tp-e interval, Tp-e/QT and Tp-e/QTc values after three months of treatment (p<0.05). Carbamazepine and levetiracetam groups were not statistically significant in terms of pre- and post-treatment values. Conclusions - It was concluded that an arrhythmogenic environment may be associated with the disease, and patients who received AED monotherapy may need to be followed up more closely for arrhythmia.

Clinical Neuroscience

[Is second-line immunomodulatory treatment effective in multiple sclerosis?]

RÁCZ Lilla, BERÉNYI Ervin, BARSI Péter, BERNÁTH Dávid, CSÉPÁNY Tünde

[Purpose - Natalizumab is the first evidence based monoclonal antibody, which was launched for treatment in relapsing remitting multiple sclerosis in Hungary in 2010. Standardized follow-up is required to use it. Our aim was to evaluate the efficacy and to monitor the safety of natalizumab treatment by using an electronic database established for MS registry. Clinical activity was measured by annual relapse rates, functional status of patients measured by EDSS and MFSC. Radiological activity was evaluated by standard MRI protocol. Data, results of MS patients and side effects of natalizumab treatment were recorded in iMed software. Results - 31 patients started the natalizumab treatment after 6.5±5.8 years from the onset of MS. The efficacy of treatment was evaluated after a mean of 67 (min: 14 max: 128) infusions in December 2016. The drop-out rate was low, due to the presence of neutralising antibodies in one case, pregnancy in two cases and development of malignant disease in one case which was not related to the natalizumab treatment. The treatment was well tolerated with excellent compliance without serious side effects. The annual relapse rate reduced from a mean of 1.7 to 0.03 (p<0.000001) in the first 12 months of treatment compared to the pretreatment 12 month activity, and it stayed at low level during the whole follow up. EDSS was stable or improved with an exception of two cases. In 23 subjects (77%) lack of new/enlarging T2 lesions and lack of gadolineum-enhancing lesions on MRI were observed. 18 patients (60%) had no evidence of disease activity (NEDA-3). PASAT test improved in most of the cases. Conclusion - The natalizumab therapy was very effective in all cases including those patients who had active disease under the previous immunomodulatory treatment.]

Clinical Neuroscience

[Experimental data on the mechanism of the tetanus inhibitory reflex]

KIBÉDI Tibor, DIRNER Zoltán

[1. Our various tetanus interventions: During max. flexion, extension, trunk flexion, and slight compression of the chest, one or more muscle groups are always stretched. Prolongation of muscle or tendon is an adequate stimulus of proprioceptive receptors. Proprioceptive stimuli trigger the tetanus reflex. 2. Tetanus inhibition lasts only as long as the muscle is kept stretched. 3. During inhibition, the animal is capable of appropriate reflex movement. 4. The anti-tetanus reflex, when properly affected, also develops in the spinal cord of an incised animal during transection. 5. Clonus spasms caused by Cardiazol cannot be reduced by effects based on muscle or muscle elongation. 6. If the spinal cord is cut at the height of one of the dorsal segments and then the animal is poisoned with strychnine, the known effect on the pharmacy develops weaker and later during the incision.]

Hungarian Radiology

[Portal embolisation prior to liver resection]

MÓZES Péter, MÉSZÁROS György, TÓTH Judit, SÁPY Péter

[INTRODUCTION - By partial embolisation of the vena portae the number of the patients suitable for radical liverresection can be enhanced, the safety of the operation can be increased, the subsequent results improved. The method is based on the experience that when blocking the circulation of the portal system in special segments of the liver, the other part of the organ tries to substitute the functional deficiency by hypertrophy. Vena portae embolisation is justified in cases when the liver substance remaining after the planned operation is critically small. PATIENTS AND METHODS - The authors carried out vena portae embolisation at Debrecen University Medical and Health Science Centre since October 2003 on six patients. Assessments were made studying the volume of the whole liver, the lobe affected by embolisation and that of the unaffected lobe, by CT-volumetry. The average age of the patients (four men and two women) was 63 years (51-67 years). The hepatic tumour was an extended metastasis localised to one lobe in five cases, and HCC in one of the patients. In each case we carried out closing the right lobe’s portal system. RESULTS - In five cases the left lobe showed increase following the portal embolisation of the right lobe intended to be removed. On the average four-six weeks passed between the two CT-examinations. The growth of the left lobe was an average of 42% (min. 11.8%, max. 75.6%). CONCLUSION - In selected patients the embolisation of the vena portae system of the tumorous liver-segments is a suitable method for enlargening the size of the liver substance remaining after an extensive resection.]

Clinical Neuroscience

[P-wave dispersion doesn’t increase in patients with epilepsy]

SENOL Güney Mehmet, ÖZMEN Namik, YASAR Halit, TEKELI Hakan, ÖZDAG Fatih, SARACOGLU Mehmet

[Aim - Epileptic seizures have occasionally been associated with cardiac conditions as atrioventricular blocks, long QT syndrome etc. P-wave dispersion (PWD), which is the difference between the longest (P max) and shortest P-wave duration (P min), is considered as a forerunner of atrial fibrillation. In this study, we investigated P-wave dispersion (PWD) in epileptic patients; based on the hypothesis that microthromboembolism may occur in atrial fibrillation. Methods - Seventy five patients with mixed types of epilepsy and 50 age and sex matched healthy individuals were included into the study. P max, P min and PWD values were calculated for each subject from an ECG. Results - The mean age of subjects in the epilepsy group and control group were similar (p>0.05). P max in patients with epilepsy was 125.1±0.7 ms, P min was 67.3±10.3 ms, and PWD was 57.6±8.3 ms while these values in the control group were 116.8±11.0 ms, 66.5±5.5 ms and 46.8±7.1 ms, respectively. There were no statistically significant difference between two groups (p>0.05). Conclusions - PWD does not increase in patients with mixed types of epilepsy. Therefore we believe that microthromboembolism duo to atrial fibrillation can’t cause epileptic seizures in patients with no structural heart disease.]