Clinical Neuroscience

[NEUROPATHOLOGICAL EXAMINATIONS IN AUTOPSIES WITH SPECIAL FOCUS ON FINDINGS IN ALZHEIMER’S DISEASE]

LEEL-ŐSSY Lóránt1, KINDLER Miklós1, SZŰCS Iván1, SCHWARCZ Tibor1

MAY 30, 2006

Clinical Neuroscience - 2006;59(05-06)

[Out of an average total of 1400 autopsies per year, neuropathological examinations were performed in 477 cases between 1997 and 1999 to investigate the incidence of dementias. The majority of the studied subjects were over 50 years old. Bielschowsky's and/or Gallyas's silver methods and, in some cases, protein tau (MAP) immuncytochemistry and amyloid staining were performed beside routine examination. Pathological changes were found in 212 of the 364 cases studied by the above methods but histological changes associated with dementia were only detected in 167 cases. The various forms of Alzheimer's dementia were also classified by age. The "incipient" form of Alzheimer's disease was verified in 23 cases. Old infarcts of various extensions were found in 42 percent of Alzheimer's dementias. Very mild or age-related degenerative changes were observed in 82 cases among subjects over 50 years old. Of these, eight patients died in their 90s. In some cases (n=38) the number of neuritic plaques dominated over the number of neurofibrillary tangles but a reverse finding also occurred (n=13). Neuronal degeneration was variable and was not always proportional to the number of neurofibrillary tangles. "Simple type of senile atrophy" was defined by the presence of minor or age-related Alzheimer changes and was considered a separate entity. The "incipient" form of Alzheimer's dementia was diagnosed in relatively young individuals where mild Alzheimer changes were found at the neuropathological examination. "Preclinical" Alzheimer's dementia could only be suspected by clinical data and could very rarely be supported by the neuropathological finding of "incipient" form. The ratio of pure Alzheimer’s to vascular dementias cases proved to be 54:41 in this study. The results suggest that dementias are considerably underdiagnosed both in the clinical and pathological practice and that the recently defined "preclinical" and "incipient" forms are very hard to recognize both clinically and pathologically. The neuropathological study of the degenerative, mainly Alzheimer's type, findings in the randomly selected autopsies revealed great variations which raises many questions concerning the normal and pathologic aging of the brain as well as the "incipient" and senile forms of Alzheimer's dementia.]

AFFILIATIONS

  1. Komárom-Esztergom Megyei Szent Borbála Kórház, Patológiai Osztály, Tatabánya

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[COMPLEX GAZE DISTURBANCE CAUSED BY THALAMIC AND MESENCEPHALIC INFARCTS]

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[A 36 year-old male patient developed sudden double vision and gait imbalance. Neurological examination revealed gaze paresis upward and on the left side downward (vertical “oneand- a-half”-syndrome), horizontal gaze nystagmus on the left bulbus directed to left. The MRI revealed bilateral thalamic and left midbrain ischemic lesions. The brainstem auditory and visual evoked responses were normally configured. Optokinetic nystagmus test found rightward, upward and downward hypometric saccades, convergence-retraction nystagmus - which was not visible at physical neurological examination - saccadic smooth pursuit eye movement and pseudoabducent palsy on both sides. The complex gaze disturbance was attributed to the lesions in the intralaminar nuclei of the thalamus and in the pretectal and rostromedial tegmentum of the mesencephalon. Infarcts may have been due to a variant artery: i.e. the thalamoperforant and the superior paramedian mesencephalic arteries originate with common branch from one of the communicant basilar artery. The authors discuss the mechanism of complex gaze palsy and call attention to the diagnostic value of optokinetic nystagmus examination.]

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[CHANGES IN EEG-COMPLEXITY AFTER SUBCORTICAL ISCHEMIC BRAIN DAMAGE]

MOLNÁR Márk, CSUHAJ Roland, HORVÁTH Szabolcs, VASTAGH Ildikó, GAÁL Zsófia Anna, CZIGLER Balázs, BÁLINT Andrea, NAGY Zoltán

[Introduction - Complexity analysis of the EEG is a relatively new field in theoretical and cinical electrophysiology. The authors present results of EEG-analysis in a patient with stroke, utilizing the sensitivity of the new procedures with respect to linear and nonlinear synchronization. Participants and methods - The EEG (19 channels) was recorded in a patient with subcortical unilateral ischaemic completed stroke involving the frontoparietal white matter while leaving the cortex intact and in 12 healthy controls in eyes open and in eyes closed conditions. Results - In the patient, increased Omega-complexity was found in slow (delta, theta) and lower alpha frequencies in the side of the stroke and in high frequencies (beta2 in eyes closed, alpha2, beta1 and beta2 in eyes open conditions) in the intact side. Synchronization likelihood was higher in the ischaemic side in the beta2 (eyes closed) and both in the beta1 and beta2 (eyes open) frequencies. Increasing Omega-complexity caused by eyes opening was markedly reduced in the patient in the beta frequencies compared to that seen in the controls. The difference was more conspicuous in the side of the infarct and involved not only the beta but also the alpha frequencies as well. Opening the eyes decreased synchronization likelihood in all frequency bands in the controls and also in the patient except the alpha2, beta1 and beta2 bands in the side of the lesion. Conclusions - The increased Omega-complexity and decreased synchronization likelihood in the slow frequencies in the infarcted side is probably the result of lesioned interneuronal connections lowering the level of cooperation of neuronal systems involved in this type of activity. The increased Omega-complexity and decreased synchronization likelihood caused by eyes opening could not be observed in the beta and alpha frequencies in the side of the lesion, possibly caused by damaged thalamocortical connections.]

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Clinical Neuroscience

[ABSTRACTS OF THE 8TH CONGRESS OF THE HUNGARIAN EPILEPSY LEAGUE Pécs, 25-27 May, 2006.]

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[FREQUENCY OF DIFFERENT FORMS OF DEMENTIA IN THE DEPARTMENT OF NEUROPATHOLOGY OF THE HUNGARIAN NATIONAL INSTITUTE OF PSYCHIATRY AND NEUROLOGY DURING A 3-YEAR PERIOD]

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[Background - Dementia is an increasing problem of the society. The underlying cause of dementia may be difficult to diagnose during life. Only neuropathological examination gives definite diagnosis. Differences in the reported frequency may be related to factors such as the age or gender of subjects with dementia. Materials and methods - In our neuropathology-based study we examined 156 consecutive subjects clinically diagnosed with dementia during a 3-year period. Using histopathological criteria we calculated the frequencies of various disorders causing dementia. We studied the effect of age and gender on these frequencies. Results - Alzheimer’s disease was the most frequent pathologic finding (57.7%) followed by vascular dementia (43%); diffuse Lewy body disease (15.4%); argyrophilic grain dementia (12.1%), various forms of frontotemporal dementia (5.7%); and other (4.5%). The latter comprise prion disease, alcoholic encephalopathy, and hippocampal sclerosis. Mixed pathology was common: concomitant Alzheimer’s disease was present in 41.6% of diffuse Lewy body disease cases and in 49.2% of vascular dementia patients. Pure disease forms are rare: Alzheimer’s disease: 26.3%, vascular dementia: 17.3%, diffuse Lewy body disease: 5.1%, argyrophilic grain dementia: 2.5%. Females were overrepresented among those with Alzheimer’s disease with age at death above 75 years (p <0.02), while males were overrepresented in patients below 75 years with vascular dementia (p <0.05). Conclusions - Our study indicates that the frequency of neurodegenerative dementias is high in the examined patients, but vascular pathology frequently influences the clinical course.]

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[The diagnosis of herpesencephalitis - a case-based update]

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[Herpes simplex virus encephalitis (HSVE) is a rare and lifethreatening infection. The clinical signs are diverse and often misleading regarding the aetiology. However, focal seizure with fewer and typical CT/MRI finding should always raise the possibility of HSVE as early diagnosis and antiviral therapy is crucial. Before the advent of molecular techniques and high-tech imaging histological examination from multiple brain biopsies were often necessary. Although nowadays PCR and other molecular methods may provide an aetiological diagnosis some cases need neuropathological verification. Due to the high IgG seropositivity rate in the population the plasma IgG titer is not diagnostic and elevation of its plasma level requires several weeks. We report the case of a 25-years old male patient who initially presented with epileptic fits. There was no final diagnosis and causal treatment in the district general hospital. The patient was admitted to our institution in comatose state on day 9; the initiated diagnostic tests and therapy could not save the patient who died next day. The autopsy and subsequent neuropathological examination revealed HSVE. We present a flowchart on diagnostic work-up and special techniques to aid diagnosis in suspected viral encephalitis.]

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[DISCREPANCIES BETWEEN THE CLINICAL AND PATHOLOGICAL DIAGNOSES IN CASES OF MALIGNANT TUMOUR]

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[THE ROLE OF CHRONIC BRAIN HYPOPERFUSION IN THE PATHOGENESIS OF ALZHEIMER'S DISEASE - FACTS AND HYPOTHES]

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