Clinical Neuroscience

[Paroxysmal kinesigenic dyskinesia]

VADÁSZ Dávid, KLIVÉNYI Péter, VÉCSEI László

JANUARY 30, 2011

Clinical Neuroscience - 2011;64(01-02)

[Paroxysmal kinesigenic dyskinesia (PKD) is a rare neurological disease and the diagnosis is based on case history and clinical features. Despite of simply diagnostic criteria, the recognition of the disease is sometimes delayed. The involuntary movements in PKD lead to anxiety, social isolation, trauma and worsens the quality of life. To establish the diagnosis many other paroxysmal syndromes have to be excluded. The disease responds to antiepileptic therapy well. The genetic background of the familiar cases is not known. Here we present a 19 year-old patient with PKD and review the current literature. Our patient’s events were triggered by sudden movements and last several seconds. His physical and neurological examinations were normal and responded well to carbamazepine therapy.]

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

[Tolosa-Hunt syndrome]

PÉTERFI Anna, ZÁDORI Péter, SÜTŐ Gábor, HORVÁTH Gyula, KOPA János

[Both men and women are affected by the rare disease called Tolosa-Hunt syndrome. We don’t know exactly what causes it to evolve. It is usually put into the categories of either idiopathic inflammation or pseudotumor. Its patological feature is a non-specific inflammatory process with fibroblastic, lymphocytic, plasmocytic infiltration, which can be found, for the most part, in the wall of the sinus cavernosus. Granulocytic and giant-cell infiltrations have been described too. The possibility of autoimmune disease has also come up. In our current study we describe the case of a female patient who recovered with the help of a steroid therapy. Through examining her, we also found immunological alterations, which should urge us to thoroughly examine the further observations of this kind.]

Clinical Neuroscience

[Dinamics of craniopharyngeomas reduction after Yttrium-90 colloid brachytherapy]

KOLUMBÁN Zsuzsa, BÁLINT Katalin, JULOW Jenő

[Objective - The aim of this study is to reveal the long-term effect of Yttrium-90 colloid radioisotope brachytherapy applied for the treatment of cystic craniopharyngiomas. To provide a mathematical expression that can describe the cyst reduction as a function of time in an accurate matter. Methods - Fourteen cystic craniopharyngiomas were selected for intracavital irradiation with stereotactically implanted beta-emitting radioisotope Yttrium-90 silicate colloid. The cumulative dose aimed at the inner surface of the cyst wall was ranging between 180-300 Gy. Volumes of the cysts were measured on image-fused control CT/MRI images for a 28-month period. Dose planning was done with our own software, while stereotactic calculations, volume calculations and image fusion were done with the BrainLab Target 1.19 software. Mathematical and statistical computations were carried out with the Matlab numeric computation and visualization software. To determine the volumes, the control images were fused with the planning images. Results - Relative volumes normalized with respect to the volume of cysts before irradation were determined from the patients’ measured data, the mean values of volumes were calculated, then a polynomial was fitted to the mean values using the polynomial curve fitting method. We have found that the dynamics describing the reduction of cysts can be expressed mathematically by the polynomial V=93.627-18.091t+1.473t2-0.054t3+0.0007t4, where „t” denotes the time in months passed after irradiation. The accuracy of our results was verified by correlating the predicted data with the measured ones. Conclusions - Our long-term results support the view, that intracavitary Yttrium-90 irradiation is a non invasvive and very effective method for treatment of craniopharyngioma cysts. The derived polynomial helps to 1. design the best treatment, 2. follow up patients’ condition and 3. plan a reirradiation if necessary.]

Clinical Neuroscience

[Some thoughts about the presumed death of classical neurology and the neurology to come]

ERTSEY Csaba

[In my opinion Hungarian medicine, and not just neurology, is in a critical state. This is the consequence of various factors, such as the overemphasizing of medicine’s economic aspects, the malfunctions of patient care caused by inadequate source allocation, and the misinterpretation of the doctors’ role by the society. The vastly increased knowledge base and the huge amount of information we can gather about our patients are an unparalleled chance, rather than a deathly wound, for neurology as a discipline. The challenge the future’s neurology has to face is high-quality patient care, which necessitates dedicating the necessary time for patients, rationally using our ever-increasing diagnostic arsenal, and continuously updating our knowledge about the therapeutic possibilities.]

Clinical Neuroscience

[Vascular compression syndromes of the cranial nerves]

KUNCZ Ádám, VÖRÖS Erika, BARZÓ Pál

[The blood vessels which are running nearby the cranial nerves and the brainstem can be elongated; curves and loops of the vessels may develop mostly due to the degenerative alterations of ageing and these vessels can compress the surrounding neural elements. The authors report a review of vascular compression syndromes based on the literature and their own experience. The typical clinical symptoms of the syndromes subserving the proper diagnosis, the pathomechanism, the significance of imaging especially the magnetic resonance angiography, the experience with the surgical technique of microvascular decompression which is the only causal treatment of the syndromes are discussed. In cases of non-responsible medical treatment the microvascular decompression should be the eligible treatment in certain syndromes (trigeminal and glossopharyngeal neuralgia, hemifacial spasm) for it is a highly effective and low risk method.]

Clinical Neuroscience

[World of agression]

RAJNA Péter, HÁRDI István

All articles in the issue

Related contents

Clinical Neuroscience

[Interdisciplinary approach of vestibular system impairment]

PONGRÁCZ Endre

[In the first part of this review the definition of vertigo/dizziness was discussed. The major difference between the two signs is the exsistence of the direction, which is specific for vertigo. Dizziness is a frequent complaint in the clinical practice. Its frequency is increasing with advance of age, to intimate the play of declining cognitive process in the pathogenesis of its. The popular health significance of vertigo is in the rowing number of the patients. The onset of the most cases with acute vertigo appears between secundums and minutes so the patients will be provided in circumstances of emergency department. First of all three form schould be take into account: neuronitis vestibularis, benign paroxysmal positional vertigo and Meniere syndrome. Without tipical periferal signs of vertigo, central cause should be searched, principally stroke (lysis possibility). The differential diagnose of the different dizzeness/vertigo forms according to the elapsed time of the onset or congenital and acquired nystagmus was created in tables. The recommendations of the therapy of acute and chronic dizziness/ vertigo syndroms are, lack of results of evidence based trials doubtful. The more often used drugs based on clinical trials are discussed as vinpocetine, betahistine and piracetam. The in vitro and in vivo data suggest that the last molecule is eligible to use both in periferal and central type of vertigo syndroms.]

Hypertension and nephrology

[Hypertension and atrial fibrillation. Part 2. Basic methods of screening atrial fibrillation]

KÉKES Ede

[Early detection of PF, especially short-term “paroxysmal aritmia”, is very important primarily in older individuals (over 65 ys), especially those with heart disease, hypertension or diabetes. Two methods are known for the early detection of PF: In one (regular screening) making 12-lead ECG examination for individuals over the age of 65 at fix times. The other (opportunistic screening) means that every person over the age of 65, whenever he or she percieves any complains, the physician will experience the pulse of the patient and in case of arrhythmia the EKG is made.]

Clinical Neuroscience

NMDA-receptor associated encephalitis in a woman with mature cystic ovarian teratoma

VANYA Melinda, FÜVESI Judit, KOVÁCS A. Zoltán, GORGORAPTIS Nikos, SALEK-HADDADI Afram, KOVÁCS LÁSZLÓ, BÁRTFAI György

Introduction - N-methyl-D-aspartate receptor (NMDA-R) antibody-associated encephalitis has been reported in the international neurological literature to be associated with mature or immature ovarian teratomas (OTs). However, few cases of encephalitis were diagnosed in Hungary. In 2011 Hollody et al. described the first case of anti-NMDA receptor associated encephalitis in Hungary. Objective - Our aim was to present a case of NMDA-R antibody-mediated encephalitis in a woman with OT thereby providing information facilitating diagnosis of OT in women, who present with symptoms of encephalitis. Case - We report the case of a 25 year-old women, who developed NMDA-R -antibody associated autoimmune encephalitis and who displayed confusion, disorientation, a behavioural disturbance with agitation and features of paranoia and at least one reported generalized tonic clonic seizure and orofacial dyskinesia. Magnetic resonance imaging revealed a functional ovarian cyst measuring 3.3 cm, which was removed surgically and demonstrated histologically to be a mature cystic OT. The serum was positive for antibodies to NMDA receptors. Following intravenous immunoglobulin treatment, oophorectomy and a 5-day course of plasma exchange, followed by corticosteroid and azathioprine immunosuppressive therapy, the patient displayed a significant clinical improvement. Conclusion - Cystic teratomas are common benign ovarian lesions in women of reproductive age. Although the association of OTs and NMDA-R antibody-associated encephalitis has been described in the international neurological literature, this relationship needs to be considered from on the interdisciplinary aspect by the health care providers.

Clinical Neuroscience

[Validation of the Hungarian Unified Dyskinesia Rating Scale]

HORVÁTH Krisztina, ASCHERMANN Zsuzsanna, ÁCS Péter, BOSNYÁK Edit, DELI Gabriella, PÁL Endre, KÉSMÁRKI Ildikó, HORVÁTH Réka, TAKÁCS Katalin, BALÁZS Éva, KOMOLY Sámuel, BOKOR Magdolna, RIGÓ Eszter, LAJTOS Júl

[Background - The Unified Dyskinesia Rating Scale (UDysRS) was published in 2008. It was designed to be simultaneous valid, reliable and sensitive to therapeutic changes. The Movement Disorder Society organizing team developed guidelines for the development of official non- English translations consisting of four steps: translation/back-translation, cognitive pretesting, large field testing, and clinimetric analysis. The aim of this paper was to introduce the new UDysRS and its validation process into Hungarian. Methods - After the translation of UDysRS into Hungarian and back-translated into English, it was reviewed by the UDysRS translation administration team. Subsequent cognitive pretesting was conducted with ten patients. For the large field testing phase, the Hungarian official working draft version of UDysRS was tested with 256 patients with Parkinson’s disease having dyskinesia. Confirmatory factor analyses (CFA) determined whether the factor structure for the valid Spanish UDysRS could be confirmed in data collected using the Hungarian Official Draft Version. To become an official translation, the Comparative Fit Index (CFI) had to be ≥0.90 compared to the Spanish-language version. Results - For the Hungarian UDysRS the CFI was 0.98. Conclusion - The overall factor structure of the Hungarian version was consistent with that of the Spanish version based on the high CFIs for the UDysRS in the CFA; therefore, this version was designated as the Official Hungarian Version Of The UDysRS.]

Clinical Neuroscience

Inflammatory biomarkers in benign paroxysmal positional vertigo: A Turkey case-control study

AYSEL Tekeşin, ABDULKADIR Tunç

Objective - Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo. Inflammation is a hypothetic etiological factor in BPPV. The aim of this study was to evaluate inflammatory biomarker levels in BPPV patients and compare these with the healthy subjects. Materials and methods - This prospective case-control study was conducted with 114 newly diagnosed BPPV patients and age- and sex- matched 83 healthy subjects. The laboratory investigations included serum hemogram, full biochemistry profiles, vitamin levels, thyroid hormone profiles, high sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR). Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte to HDL-cholesterol ratio (MHR) values were calculated and compared between the patients and healthy subjects. Results - The mean age was 39.1 ± 12.4 years for patients, and 37.0 ± 11.9 for controls. Vitamin B12, hematocrit (Hct), creatinine, urea, and fT4 values, lymphocyte, total bilirubin, direct bilirubin and indirect bilirubin levels were significantly lower in BPPV patients (p ˂ 0.05), while HDL, SGOT, and ESR values were significantly higher. In the BPPV patients the mean NLR, PLR, and mean platelet volume (MPV) values were significantly higher than in the control subjects. Neutrophil, platelet, monocyte, MHR, and CRP values were similar in both groups (p ˃ 0.05). Conclusion - Our result suggests that NLR, PLR, MPV, ESR, and bilirubin levels should be taken into account as potential biomarkers of BPPV. As they are inexpensive parameters and widely available, they can be used in clinical practice for prediction of BPPV. However, further large-scale studies are required to confirm this relationship.