Clinical Neuroscience

[Neuroradiological Division in the European Union]

BARSI Péter

MARCH 25, 2009

Clinical Neuroscience - 2009;62(03-04)

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Clinical Neuroscience

[State of the art neurointerventional treatment of intracranial vascular anomalies]

SZIKORA István, BERENTEI Zsolt, MAROSFŐI Miklós, KULCSÁR Zsolt, GUBUCZ István

[Haemorrhagic stroke is frequently caused by rupture of intracranial vascular anomalies. The role of minimally invasive therapy in the treatment of such lesions has increased dramatically within the past two decades. The purpose of this study is to summarize the pathology and clinical features of these anomalies and to overview the potential applications of neurointerventional techniques in their treatment. Endovascular therapy is the first choice of treatment for most intracranial aneurysms. Both pial and dural arteriovenous malformations are being treated by endovascular techniques, but the combination of different modalities (such as endovascular, direct surgery and radiosurgery) is frequently applied. Capillary malformations require surgical removal and venous anomalies do not allow for any type of invasive treatment. State of the art therapy of intracranial vascular anomalies require institutions equipped with appropriate imaging facilities and having equal access to both conventional neurosurgical and neurointerventional techniques with ample experience and case load.]

Clinical Neuroscience

[Plasticity of brain lateralization in epilepsy: fMRI studies]

KALMÁR Zsuzsanna, WOERMANN Friedrich, SCHWARCZ Attila, JANSZKY József

[Aims - This review is a summary of four studies investigating the effect of epileptic disturbance and other functional factors on the brain lateralization. Methods - Patients were investigated by functional MRI by using visual, sensorimotor, memory, and speech paradigms. Results - 1. Malformations of cortical development localized within speech centers induce contralateral speech reorganization in only 50% of cases. 2. Epileptic disturbance can induce a reorganization in language lateralization independent of the effect of lesion. 3. Bilateral epileptic activity can prevent a reorganization of memory functions contralateral to the seizure onset region. 4. Injury of the right upper limb can induce a left-to-right shift of language lateralization. Conclusions - Our results may have implication during neurorehabilitation process and neurosurgical interventions. Participation of malformations of cortical development in cognitive functions should keep in mind during surgery. Reorganization of speech- and memory functions should also be considered during operations of central nervous system.]

Clinical Neuroscience

[Interhemispheric asymmetry of diffusion parameters in the human brain]

WALTER Norbert, HORVÁTH Ildikó, VANDULEK Csaba, BERÉNYI Ervin, BOGNER Péter, TÓTH Lilla

[Our aim was to study the hemispheric asymmetry of the human brain through the simultaneous measurements of the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values within a homogeneous sample in regards to the gender, age and handedness. Method - Eleven young women were included in our diffusion study performed on a 1.5 T MR scanner. We calculated the ADC and FA values in nine-nine region of interest points of the brain. The diffusion values were measured symmetrically in the right and left hemisphere of the brain and were then statistically compared to detect interhemispheric asymmetry. Results - We did not find any significant differences between the data of the two hemispheres in regards to the ADC values. However, we detected a significant right sided asymmetry in case of the globus pallidus in FA values (p=0.04). Conclusion - Our results of our study of young women suggest that diffusion asymmetry does not appear in case of ADC values and only slightly (in one ROI in our study) in FA values.]

Clinical Neuroscience

[MR imaging of acute disseminated encephalomyelitis and multiple sclerosis in children. A review (in English language)]

PATAY Zoltán

[Inflammatory diseases of the central nervous system (CNS) are relatively rare in children, but their relevance to public health is considerable due to frequent and significant long term morbidity and even mortality. As in adults, acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) and their variants are the most common entities in this group of pathologies in the pediatric patient population. Recent efforts have focused on establishing standardized diagnostic criteria schemes to facilitate the diagnosis and differential diagnosis of these diseases, however especially with multiple sclerosis those have not been fully validated yet for disease occurring in children. In recent decades the role of MRI has been constantly increasing in the diagnostic work-up of suspected inflammatory diseases of the CNS as well as in the follow-up of patients with confirmed disease. Currently, MRI is the first-line diagnostic imaging modality in ADEM and MS and is fully integrated in the most widely used diagnostic criteria schemes, but it has a key role in clinical therapeutic research trials as well. This paper provides an update on the current concepts and strategies of MRI in inflammatory diseases of the CNS, as well as a review of the imaging semiology of the various disease entities and variants with emphasis on clinical and imaging particularities relevant to the pediatric patient population.]

Clinical Neuroscience

[Application of diffusion weighted imaging in neuroradiology]

BARSI Péter

[Diffusion weighted magnetic resonance (MR) imaging is available on all modern MR scanners. It depicts the motion of water molecules in the brain tissue and intracranial foreign tissues and provides information on changes in the proportion of intra- and extracellular space and the characteristics of foreign intracranial tissues and fluids. It is of utmost importance eg. in the diagnostics and differential diagnostics of acute ischaemic brain lesions, the diagnostics of inflammatory brain processes and in the differential diagnostics of intracranial space-occupying lesions. The examination method of short scanning and post-processing time must be completed with the apparent diffusion coefficient (ADC) maps and it is indispensable in the everyday neuroradiological diagnostics. Diffusion tensor imaging and tractography are able to depict the white matter tracts. They require a longer scanning and post-processing time and have several technical problems yet to be solved, but they provide help in their current state e.g. in the surgical planning of intracranial space-occupying lesions.]

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Clinical Neuroscience

The prevalence of sarcopenia and dynapenia according to stage among Alzheimer-type dementia patients

YAZAR Tamer, YAZAR Olgun Hülya

Aim - In this study, the aim was to identify the prevalence of sarcopenia and dynapenia according to disease stage among Alzheimer-type dementia (AD) patients and collect data to suggest precautions related to reducing the disease load. Method - The study was completed with 127 patients separated into stages according to Clinical Dementia Rating Scale (CDR) criteria and 279 healthy volunteers aged 18-39 years and 70-80 years abiding by the exclusion criteria who agreed to participate in the research. Our prospective and cross-sectional study applied the CDR and mini mental test (MMSE) to patients with disorder in more than one cognitive area and possible AD diagnosis according to NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association) diagnostic criteria. The patient and control groups had skeletal muscle mass index (SMMI), muscle strength and physical performance assessed with sarcopenia diagnosis according to European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria. Results - In our study, in parallel with the increase in disease stage of AD patients, the prevalence of sarcopenia (led by severe sarcopenia) and dynapenia was higher compared to a control group of similar age. Conclusion - In chronic, progressive diseases, like AD, identification of changes in parameters, like muscle mass and strength and reductions in physical performance in the early period, is important for identification and to take precautions in the initial stages considering the limitations of the preventive effects of treatment applied after diagnosis of AD.

Clinical Neuroscience

Anterior cerebral artery infarcts; two years follow-up study

LÜTFÜ Hanoglu, ELMIR Khanmammadov, SEMA Demirci, ÜMMÜHAN Altin, DURSUN Kirbaş, TAHA Hanoglu, BURAK Yulug

Objectives – Anterior cerebral infarct (ACA) infarcts are reported very rare that is due to the compensatory collateral circulation provided by the anterior communicating artery. There are very few studies reporting the long-term follow-up results of ACA infarcts regarding their aetiology, clinical features and prognosis. Most studies reported in the literature vary between several months to one year. Patients and methods – A total of 27 patients with ACA infarcts were registered (14 women and 13 men). The mean age of the patients was 68.5 (age range: 45–89 years). Results – Bilateral ACA infarcts were reported in four patients (14.8%), right ACA infarct in 11 (40%) patients and left ACA infarct in 12 patients (44%). During the initial examination 15 patients (55.5%) were found to have apathy, 13 patients (48%) had incontinence, nine patients (33.3%) had primitive reflexes, 11 patients (40.7%) had aphasia, while six patients (22.2%) were found to suffer from neglect. At the end of one-year follow-up, five patients (22.7%) were reported to have apathy, 6 patients (27.2%) had incontinence, one patient (4.5%) had primitive reflexes, while one patient (4.5%) was found to have permanent aphasia, and no patients was found to suffer from neglect. Conclusion – Here we present our clinical data regarding the aetiology, specific clinical characteristics (including the speech disorders) and prognosis of 27 patients with ACA infarcts during a relatively longer follow-up period (3 months – 30 months) in compared to previous literature. We show that there are differences in the etiological factors of ACA infarcts between the Asian and European communities. Regarding speech disorders which are frequently reported during ACA infarcts, our study results are in agreement with other studies suggesting that this clinical picture is more than a real aphasia and associated with general hypokinesia and reduction in psychomotor activity.

Hungarian Radiology

[Interventional neuroradiological treatment of a symptomatic basilar artery stenosis in the background of recurrent brainstem transient ischemic attack]

LOVÁSZ Rita, NÉMETH Csilla, LÁZÁR István, VALIKOVICS Attila

[INTRODUCTION - Symptomatic stenosis of the basilar artery carries high risk of brainstem stroke. In case of acute thrombotic occlusion of the basilar artery the mortality is over 70%. Besides best medical treatment, angioplasty was employed for 30 years previously, but the results were only acceptable after the advent of flexible intracranial stents. We report our case to call attention to the availibility of this interventional neuroradiological procedure. CASE REPORT - A 64 years old male patient was admitted to our hospital with intermittant diplopia. 90% stenosis of proximal basilar artery was reported by DSA. After balloon dilatation, intracranial stent was placed into the lesion. Symptoms have not recurred three months following the intervention. Control TCD and MR-angiography were performed, and good blood flow ratio was detected in the vertebrobasilar system. CONCLUSION - In the background of recurrent brainstem TIA a basilar artery stenosis has to be searched because the development of a definitive brainstem stroke can be prevented by interventional neuroradiological procedure.]

Hungarian Radiology

[Board meeting of the Educational Committee of the European Society of Radiologists]

HARKÁNYI Zoltán

Hypertension and nephrology

[Enjoyable and invisible risk: salt The role of the Hungarian Hypertension Society in the National Salt Intake Lowering Program: STOP-SÓ]

KISS István

[Cardiovascular disease accounts for more than 50% of Hungarian mortality and hypertension accounts for almost 50% of coronary heart disease and for more than 60% of stroke. High salt intake increases blood pressure and major and sustained consumption may cause high blood pressure. In Hungary more than 2.5 million people have hypertension and among them only 44% have their blood pressure under 140/90 mm Hg. Achieving target blood pressure is difficult as salt intake of the Hungarian population is higher than that recommended in every age group. Blood pressure control consists of proper combination of medical treatment and of nonmedical procedures. Among non-medical procedures weight loss, increase of physical activity, Mediterranean diet and decrease of salt intake are of value in blood pressure lowering. A daily salt intake of less than 6 grams is recommended in the Hungarian guideline and in the European one the recommendation is more rigorous. However in Hungary average salt intake is 18 grams among men and 14 grams among women. Responsibility of the individual person is inevitable in preserving health and preventing disease. A perfect example for this is the change of salt intake habits as it is demonstrated that decreasing salt intake results in the decrease of blood pressure. A daily decrease of 5 grams in salt intake results in 23% less stroke and 17% less cardiovascular disease. The Hungarian Society of Hypertension has joined among the first to the Hungarian Salt Intake Decreasing Programme and thus its activity is aimed at strengthening the public health subset of the Hungarian Cardiovascular Programme.]