Clinical Neuroscience

[Motorcycle Jackson seizures associated with compulsive naming ]

BENKE Bálint1

JUNE 01, 1967

Clinical Neuroscience - 1967;20(06)

[The author describes the case of a patient with epilepsy who developed Jackson seizures with forced feeding after a herniactomy. Based on the literature, he raises the problematic nature of the case and tries to find an explanation for this rare symptom association. ]

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  1. Budapesti Orvostudományi Egyetem Neurológiai Klinikája

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Clinical Neuroscience

[In the temporal lobe space-constricting processes psychiatric disorders]

RÓTH György

[The author analyses the psychiatric disorders observed in 58 cases of temporal lobe spatial constriction. These disorders occurred in 67% of the cases. On the basis of his own observations and recent research on the temporal lobe, he concludes that psychiatric disorders in temporal lobe constrictions are the result of damage to the structures located in this lobe, mainly those of the limbic system. He attributes only a secondary role to the general increase in intracranial pressure through diffuse damage to brain functions. It is noteworthy that the highest percentage of such symptoms was observed in the case of constrictive processes in the temporal lobe of the non-dominant hemisphere. ]

Clinical Neuroscience

Nachweis und Identifizierung von Autoimmunfaktoren bei der Multiplen Sklerose

SCHUMACHER K., ROSS J.

Elektrophoretische Untersuchungen zeigen durchweg einen Anstieg der Gammaglobulinfraktionen im Liquor während des akuten Stadiums der Krankheit. Immunelektrophoretische und chromatographische Untersuchungen bestätigen dies. Die Gamma-Globulinfraktionen steigen an. Immunelektrophoretische und chromatographische Untersuchungen bestätigen dies. Wenn das Gammaglobulin ansteigt, werden im Liquor Plasmazellen nachgewiesen. Diese Daten legen nahe, dass immunologische Prozesse an der Multiplen Sklerose beteiligt sind. Der Nachweis von Antikörpern gegen das ZNS-Antigen im Patientenserum scheint effektiv zu sein, denn Ross kann sie bei 40 % der Patienten ohne Selektion nachweisen. Seine Ergebnisse wurden von anderen bestätigt. Die Autoren versuchen, diese Antikörper zu identifizieren. Durch säulenchromatographische Trennung und Immunelektrophorese wurden die gesuchten Antikörper als 19 S-Gamma-Globulin oder IgM-Antikörper identifiziert. Die saure Hydrolyse und die elektrophoretische Analyse von Antikörper-Antigen-Komplexen aus Multiple-Sklerose-Serum und -Gehirnextrakten ergaben das gleiche Ergebnis. Kontrollstudien mit anderen 19 S-Gamma-Globulinen beim Menschen zeigen, dass die Spezifität nicht in Frage steht. Lamoureux und Borduas konnten während einer akuten Krankheitsepisode neben der Anhäufung von Gamma-Globulin auch eine Anhäufung von Gamma-M und Gamma-A-Globulin im Liquor nachweisen. Sie entdeckten eine zytotoxische Substanz aus den Gammaglobulinfraktionen, die Nerven- und Gliazellen in Gewebekulturen schädigte. Über die Art des Antigens ist wenig bekannt. Die Autoren gehen von mindestens zwei Arten von Antigenen aus, einem Lipid und einem Protein. Es ist noch nicht bekannt, ob der Serumantikörper ein autoaggressiver oder ein sekundärer Faktor ist.

Clinical Neuroscience

Au sujet des phenomenes convulsifs au cours de la degenerescence hepato-lenticulaeires

GEORGIEV I.

Chez 7 patients atteints de dégénérescence hépato-lenticulaire, des phénomènes convulsifs ont été observés. Elle a été observée dès l'époque de Strümpell et a depuis été rapportée par des auteurs avec une incidence de 8-20%. Le diagnostic a été établi par des tests cliniques et biochimiques. L'hérédité a été détectée chez deux d'entre eux. Trois patients de sexe masculin et quatre de sexe féminin ont eu un suivi de 2 à 10 ans. Début de la maladie à l'âge de 9 à 14 ans. Type de crise : 4 GM, dont 1 a également présenté des crises jacksoniennes, 1 psychomotrice et 2 PM, Les crises surviennent à différents stades de la pathologie. Le mécanisme n'est pas entièrement compris. Ces patients représentent la variante épileptique du syndrome. Les lésions précoces du tronc cérébral frontal sont mises en évidence à la fois par la pathologie et l'EEG. Outre la dégénérescence hépato-lenticulaire, qui provoque principalement des atteintes fronto-pariétales, lenticulaires et cérébelleuses, on peut envisager un autre analogue de la maladie, qui est une maladie du système fronto-ponto-cérébelleux, avec une épilepsie fréquente et un tableau clinique similaire à celui de la dégénérescence hépato-lenticulaire : l'encéphalite hyperkinétique progressive. Cela fait de Dawson, van Bogaert et Pette une unité nosologique. Encéphalite de Döring. Les troubles micro-structurels et biochimiques restent à analyser.

Clinical Neuroscience

[Histophysiology of antidiuretic centres]

BARA Dénes

[The regulatory role of the supraopticoneurohypophyseal system in water balance has been known for decades. Initially, ADH was thought to be secreted by the pituitary glands of the nerve lobe and their activity was regulated by the supraoptic nerve.]

Clinical Neuroscience

[The relationship between limited responsibility and the nature of new offences]

BODA Lívia, BAKONYI Ferenc, SZABÓ Árpád

[We have raised the possibility of criminal-mental-iatrogenization and the need for criminal-mental-praeventio. We suggested that, in order to avoid the former and to achieve the latter: (a) the mental health expert's opinion, if he or she finds limited competence, should include a prognosis in addition to the diagnosis; or (b) introduce a new concept to identify those persons for whom, for example, limited sanity arises because of insanity, but who, because of the individual's mental capacity, in the medical judgment, cannot be expected to obtain the necessary result from a limited sentence. Our assumptions and recommendations are supported by statistical data from our Office's files and by quotations from the ETT's Judicial Committee's decisions of principle. ]

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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

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

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]

ZAKARIÁS Lilla, RÓZSA Sándor, LUKÁCS Ágnes

[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]