Clinical Neuroscience

[Neurological complications of malignant haematopoietic disorders]

AMBRÓZY György1, ECKHARDT Sándor1, GALLAI Margit1

DECEMBER 01, 1959

Clinical Neuroscience - 1959;12(12)

[1.In 6.2% (19 cases) of 306 malignant haematological malignancies we observed neurological complications, 11 patients had radiculomedullary syndrome, 3 patients had disturbed consciousness, 5 patients had lesions of the cranial nerves and one patient had lesions of the sympathetic nervous system. 2. In seven cases, neurological symptoms were the initial complaint of the patient. In order to diagnose the pathology early, we call attention to histological examination of lymph nodes, skeletal radiography, serum and CSF electrophoresis, peripheral blood count, bone marrow aspirate if necessary. 3. Radiotherapy for local neurological lesions ; combined cytostatic and radiotherapy for generalised tumours or advanced leukaemias ; surgical treatment for severe spinal cord compression. ]

AFFILIATIONS

  1. Budapesti Orvostudományi Egyetem Neurológiai Klinika és az Országos Onkológiai Intézet

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

Hyperkinese und Motilitätspsychose

KARL Leonhard

Die Hyperkinese, d. h. rein im Psychomotorischen ablaufende Erregung, gibt noch keinen Hinweis auf eine Katatonie. Wenn es sich um eine einfache Vermehrung der Reaktiv- und Ausdrucksbewegungen handelt, dann ist im Gegenteil eine heilbare Motilitätspsychose anzunehmen. Erst, wenn Verzerrungen im Bewegungsablauf erkennbar werden, ist die Diagnose und Prognose im Sinne der Katatonie zu stellen. In akinetischen Zustenden weisen Verzerrungen der Haltung oder negativitische Züge darauf hin, dass nicht die heilbare akinetische Motilitätspsychose, sondern eine akinetische Katatonie vorliegt. Von der periodischen Katatonie sind fernehin die systematischen Formen von Katatonie mit ihren charakterischen Bildern und einem schleichenden Verlauf zu trennen.

Clinical Neuroscience

[Clinical and pathological data on poiloencephalitis haemorrhagica superior]

JUHÁSZ Pál, SÉRA Ibolya

[Our 43-year-old patient presented with two well-known pathologies, spinal demyelination and polioencephalitis haemorrhagica superior, due to deficiency disease and toxic damage. The co-occurrence of the two is unknown in the literature. From the clinical picture, it appears that polyoencephalopathic reactio is a relatively late complication of spinal demyelinopathy. ]

Clinical Neuroscience

[Cerebral venous pressure testing in humans ]

SOLTI Ferenc, SIMONYI Gusztáv, RÉV Judit, HERMANN Róbert, PÉTER Ágnes, ISKUM Miklós

[Cerebral venous pressure was measured regularly by puncture of the internal jugular vein. 1. Cerebral venous pressure varied within wide limits (19-164 mmW). 2. There was no parallel between the cerebral venous pressure and the cubital venous pressure, and the two venous systems usually behaved differently on inspiration. 3. No correlation was found between CSF pressure magnitude and cerebral venous pressure magnitude. Similarly, there was no correlation between CSF pressure and venous cubital pressure. 4 Our experiments suggest that the determination of cerebral venous pressure is necessary for experimental studies of cerebral circulation.]

Clinical Neuroscience

[Report]

HORÁNYI Béla

[The author reports on the symposium held in Jena, Germany, October 17-19, 1959, by the Electroencephalography Society of Democratic Germany.]

Clinical Neuroscience

[Data on the mechanism of generation of cortical spasm potentials]

FEHÉR Ottó, HALÁSZ Péter, MECHLER Ferenc

[Authors have induced seizure potentials in cat cerebral cortex by the combined use of strychnine, d-tubocurarine, and one of these agents and an eserine acetylcholine solution. The neuronal substrates of these spasm potentials were studied by surface and deep macroelectrode and microelectrode ablation. It was found that strychnine and d-tubocurarine potentials are also generated in the sleeping cortex and are not accompanied by single-cell activity. The latter is only associated with a mainly first, positive phase of these potentials in awake cortex. Eserine acetylcholine induces a rhythmic afterglow in the cortex treated with the two former agents, which is no longer localised to the upper 5-600 Y of the cortex but is detected throughout the entire depth of the cortex. Single-cell discharges are then observed in precise correlation with all surface waves. There is no rhythmic afterdischarge without single-cell activity. Authors conclude that the neuronal substrate of rhythmic aftershocks, which is very similar to the epileptic electrogram, is a vertical excitatory circuit within the cortex, in which the excitation moves from the surface to the deep and then switches back to the surface. This circuit, which also sends impulses to other brain areas and the periphery of the body, can be interrupted by the use of atropine and diphedan. The type of discharge described above is considered by the authors to be a model of discharge during an epileptic seizure, which seems to be suitable for testing antiepileptic effects. ]

All articles in the issue

Related contents

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

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

[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.]

Clinical Neuroscience

Atypical presentation of late-onset Sandhoff disease: a case report

SALAMON András , SZPISJAK László , ZÁDORI Dénes, LÉNÁRT István, MARÓTI Zoltán, KALMÁR Tibor , BRIERLEY M. H. Charlotte, DEEGAN B. Patrick , KLIVÉNYI Péter

Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.

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.]