Clinical Neuroscience

[Periodic paroxysmal discharges with occlusion of the middle cerebral artery]

HALÁSZ Péter1, GŐDÉNY Sára1, HIDASI János1

JANUARY 01, 1969

Clinical Neuroscience - 1969;22(01)

[Cerebral aneurysms due to a hemispherical occlusion of the middle cerebral artery develop a specific EEG activity, consisting of alternating discharges, some of which are single periodic paroxysmal discharges and others which are a series of discharges connected by flat segments. Based on the functional specificity of the electrical phenomena and the electropathological correlations, the two types of alternating activity observed in this patient can be analogized with the two main types of periodic paroxysmal phenomena; suppression-burst activity showing periodic complexes (panencephalitis-like) and cortical denervation pattern. A common pathomechanism can be discerned in these EEG phenomena, in which the specific metabolic state of the vascularly damaged and denervated cortex plays a crucial role. ]


  1. Debreceni Orvostudományi Egyetem Ideg- és Elmegyógyászati Klinika



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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.

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Clinical Neuroscience

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Clinical Neuroscience

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Clinical Neuroscience

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