Clinical Neuroscience

[ONE-AND-A-HALF SYNDROME - TWO CASES]

ILNICZKY Sándor, KAMONDI Anita, VÁRALLYAY György, GAAL Barbara, PALÁSTI Ágnes, GULYÁS Szilvia, SZIRMAI Imre

NOVEMBER 30, 2007

Clinical Neuroscience - 2007;60(11-12)

[One-and-a-half syndrome is characterized by combination of the clinical features of unilateral horizontal gaze palsy and internuclear ophthalmoplegia. The common symptoms are double vision and oscillopsia. The lesion is located in the paramedian pontine reticular formation, involving the centre of horizontal gaze and medial longitudinal fasciculus. More extensive brainstem damage may result in additional neurological signs. The most frequent underlying diseases are vascular insults, multiple sclerosis, and brainstem tumor. We present two cases of one-and-a-half syndrome. Both patients had lacunar infarction in the paramedian pontine tegmentum, revealed by MRI. The first patient had isolated eye movement disorder, while the second had additional nuclear-type facial paresis. In the first case brainstem evoked potentials indicated brainstem damage, in the second patient it was normal. Ocular symptoms improved within some days in both patients.]

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[HUMAN PRION DISEASES: THE HUNGARIAN EXPERIENCE]

KOVÁCS Gábor Géza, BAKOS Ágnes, MITROVA Eva, MINÁROVITS János, LÁSZLÓ Lajos, MAJTÉNYI Katalin

[Background - Sporadic Creutzfeldt-Jakob disease is the most frequent human prion disease. Genetic forms are associated with mutations in the human prion protein gene (PRNP) and thought to comprise 5-15% of cases. Acquired forms include iatrogenic and variant Creutzfeldt-Jakob disease. The latter is associated with the bovine spongiform encephalopathy. We recently reported the high incidence of genetic Creutzfeldt-Jakob disease in Hungary. Materials and methods - In the present study we summarize the results of a widened investigation comprising Creutzfeldt-Jakob disease cases collected in the National Institute of Psychiatry and Neurology, Hungary in the last 12 years. We examined the disease forms and their geographical distribution. Results - Our study involved 155 patients. The four major results are as follows: 1. In Hungary we detected only sporadic and genetic forms of human prion disease, while iatrogenic and variant Creutzfeldt-Jakob disease were not observed. 2. The proportion of genetic prion disease (E200K mutation), similarly to Slovakia, is higher than reported worldwide. Our observations indicate that at least every third case is genetic Creutzfeldt-Jakob disease. The mean incidence of genetic Creutzfeldt-Jakob disease (0.42/million) is unusually high. Especially the year 2006 was striking when the incidence of genetic Creutzfeldt-Jakob disease was 1.4/million. 3. More than half of genetic Creutzfeldt-Jakob disease cases lack a positive family history. 4. Some counties and the eastern part of Hungary shows elevated incidence of human prion disease. Conclusions - Differences in the geographical distribution may be related to migration and historical relationship with the Slovakian population. Based on the increased incidence of E200K mutation, genetic testing of the PRNP is recommended in all cases with atypical neuropsychiatric disorder or suspicion of prion disease.]

Clinical Neuroscience

[CATHODAL TRANSCRANIAL DIRECT CURRENT STIMULATION OVER THE PARIETAL CORTEX MODIFIES FACIAL GENDER ADAPTATION]

VARGA Edina Tímea, ELIF Kaya, ANTAL Andrea, ZIMMER Márta, HARZA Irén, WALTER Paulus, KOVÁCS Gyula

[Previous studies have observed that prolonged adaptation to a face will bias the perception of a subsequent one. This phenomenon is known as figural or face after-effect. Although currently the topic of face adaptation enjoys utmost popularity, we still don't know much about the neural process underlying it. The aim of the present study was to determine, using transcranial direct current stimulation (tDCS), how the retinotopically organised primary visual cortex (V1) and higher-level, non-retinotopic right lateral temporo-parietal areas interact with facial adaptation processing. Seventeen healthy subjects recieved 10 min anodal, cathodal or sham stimulation over these areas during a facial adaptation task. Cathodal stimulation of the right temporo-parietal cortex reduces the magnitude of facial adaptation while stimulation over the V1 results in no significant effects. These data imply that mainly lateral temporo-parietal cortical areas play role in facial adaptation and in facial gender discrimination, supporting the idea that the observed after-effects are the result of high-level, configurational adaptation mechanisms.]

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[BILATERAL “OVER THE TOP” DECOMPRESSION THROUGH UNILATERAL LAMINOTOMY FOR LUMBAR AND THORACIC SPINAL CANAL STENOSIS]

BANCZEROWSKI Péter, LIPÓTH László, VERES Róbert

[Objective - The standard surgical procedures used in degenerative thoracic and lumbar spinal canal stenosis allows decompression of the neural structures by unroofing the spinal canal, often resulted in destruction or insufficiency of facet joints, sacrifice the interspinosus/supraspinosus ligament complexes and stripping of the paraspinal muscles altering an already pathologic biomechanical milieu causing segmental instability. Various less invasive techniques exists to save the integrity and prevent the instability of the spine and allow decompression of neural structures located in the spinal canal. The authors discusses the experiences with technique of unilateral laminotomy for bilateral decompression. Methods - The unilateral laminotomy for bilateral decompression technique was performed at 60 levels in 51 patients to decompress the symptomatic degenerative stenosis of the thoracic and lumbar spinal canal. The inclusion criteria were used as follows: symptoms of neurogenic claudication and/or radiculopathy, myelopathy, neuroimaging evidence of degenerative stenosis and absence of instability. Symptoms were considered refractory to nonsurgical conservative management or myelopathy was detected. Results - The distribution of mostly affected segments were the L 4-5 (45%) and L3-4 (28.4%). Neurogenic claudication and walking distance improved during the follow up period in all patients. Seven patients (13.73%) reported excellent, 32 (62.74%) good, 12 (23.53%) fair outcome and no patient a poor overall outcome. The low back pain was the major residual postoperative complaint. 25 (49%) patients were very satisfied with their outcome, 23 (45.1%) were fairly satisfied, 2 (3.9%) were not very satisfied and 1 (2%) patients was dissatisfied. Conclusion - The unilateral laminotomy for bilateral microdecompression technique minimizes resection of and injury to tissues not directly involved in the pathologic process, while affording a safe and through decompression of neural structures located in a degeneratively stenotic spinal canal.]

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