Clinical Neuroscience

[On extrapyramidal side effects of neuroleptic treatments and their prevention with promethazine]

ORTHMAYR Alajos1, SZILÁGYI Katalin1

JULY 01, 1960

Clinical Neuroscience - 1960;13(07)

[We have discussed the common brainstem origin of extrapyramidal movement poverty and dyskinesias during neuroleptic treatments based on literature and our own observations. We found correlations between these phenomena and the structure of the compounds, dose size, duration of administration and familial or acquired weakness of extrapyramidal cells. Co-administration of chlorpromazine and reserpine reduces such side effects through their antagonistic effects on pulsus and peristaltica, and their synergistic effects enhance the psychic effect by eliminating turbulent phasis and promoting reintegratio. Extrapyramidal side-effects are more frequent, but with a small dose of promethazine it has been possible to prevent or eliminate extrapyramidal movement disorders induced by the combined or single administration of different neuroleptics, and even dyskinesias, in addition to the usual antiparkinsonian agents, and, as a phenothiazine derivative, to enhance the effect of neuroleptics on the psycho.]

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  1. Országos Ideg-és Elmegyógyintézet II/A Férfi Osztálya

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Clinical Neuroscience

[Clinical experiences with Tofranil]

ANGYAL Lajos, FENYVESI Tamás

[1. The study reports 135 cases treated with Tofranil, 119 of them in the depression group and 16 in the schizophrenia group. 2. In endogenous depression, the treatment led to a complete cure in 68% of patients and to a substantial improvement in a further 12%. In psychoreactive depression, the cure was 45% and the substantial improvement 19%. In one case of suicide with lethal outcome, we emphasise the need for increased surveillance and careful selection of cases for outpatient treatment. 3. With the help of a timely initiated T. cure, the incipient depressive phases of several patients were reduced. One hypertensive patient's severe depression induced by chronic reserpine treatment was completely relieved by T. in four weeks. 4. The only psychiatric basis of endogenous depression, the pathological depressive state, T. - treated in about 4/5 of cases - is cured. The resolution of the pathological depressive state is accompanied not only by the disappearance of the vital depressive symptoms, but also by the disappearance of the secondary psychiatric symptoms of depression, often "abruptly", without any psychiatric intervention. 5. The results are considerably less favourable in cases where the depressive syndrome develops on the basis of organic disorders. 6. In 19 schizophrenic patients, T has been shown to be ineffective, with severe psychiatric complications including the onset of agitation. 7. Apart from the insignificant vegetative side-effects already described in other publications and the moderate eosinophilia observed in 37% of cases, the authors found no adverse somatic side-effects of T. and, in their opinion, no contraindication to the use of T. in depressive cases. In patients of the affective form, overdosage, or normal dosage in the case of special personal disposition, may lead to the occurrence of maniform agitation of varying degrees. In the case of a depressive syndrome or schizophrenic inhibition developing on an organic basis, the underlying disorder may be triggered by T. ]

Clinical Neuroscience

[Ossified subdural haematomas ]

ÁFRA Dénes

[The author reports on two subdural haematomas of chronic, calcified and ossified subdural haematomas diagnosed alive and successfully operated. After a literature review, he emphasizes the extreme rarity of the findings, while at the same time drawing attention to the importance of clinical and pathological observations that can be of value in the pathogenesis of subdural haematoma. After a detailed description of the pathological course of the two patients and the surgical and pathological findings, the cases are analysed from a clinical and pathological point of view in comparison with the literature. Histopathological examination of ossified subdural haematomas reveals a progressive degenerative phenomena based on connective tissue organization, which requires many years of both our own and literature experience. There is no specific, particular theory or explanation for the process of calcification and ossification, but the author classifies the process as dystrophic calcifications or metaplastic ossifications. This only shows the persistence of the haematoma over many years - but with balanced intracranial dynamics. The true subdural location of the haematoma and the secondary organisation of the haematoma are supported by the macro- and microscopic independence of the intact dura and bony haematoma from its immediate environment. These observations are valid against rather than for the inflammatory, pachymeningitis theory. ]

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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.

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Cases of inborn errors of metabolism diagnosed in children with autism

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Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

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

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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

[The role of sleep in the relational memory processes ]

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[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

Clinical Neuroscience

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