Clinical Neuroscience

[Persistent expansive-productive confabulatory image after contusio cerebri]

POHL Ödön1, HAITS Géza1

SEPTEMBER 01, 1967

Clinical Neuroscience - 1967;20(09)

[The authors describe a 35-year-old male patient who developed a specific expansive confabulosis after contusio cerebri, which persisted and even progressed after the other symptoms of amnestic syndrome had resolved. The patient was re-examined 21 months after his first admission: the confabulosis persisted and was embedded in the symptoms of personality development suggestive of post-traumatic encephalopathy. The authors refer to their previous communication describing the medical history of four of their patients. Their new case analysis confirms their earlier findings and provides a catamnestic data set for this rare form of posttraumatic confabulosis. ]

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  1. BOTE II. Neurológiai és Psychiatriai Klinika

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Clinical Neuroscience

[Effect of anxiety on Achilles tendon reflex semi-relaxation time]

FEJÉR Arthur

[In states of anxiety, the duration of the f. r. i. of the Achilles reflex decreases, although the decrease rarely reaches the extent of the decrease in f. r. i. induced by hyperthyroidism. Both placebo injections and exam situations cause a decrease in f.r.i., but the latter effect is several times greater than the former. In a patient in a state of anxiety, 10 mg. Frenolone i.m. 1 hour after the sedative effect, a significant increase in f.r. i. is observed. This effect is significantly greater than that observed in normal controls after administration of the same dose of the drug. In hyperthyroid patients, the f.r. i. of 10 mg. Frenolone hardly alters the effect. The different behaviour of normal controls and hyperthyroid subjects from anxious patients is presumably due to the fact that Frenolone only favourably affects the central arousal associated with anxiety. During psychopharmacon therapy of anxious neurotic and psychotic patients, a gradual elongation of f.r. i. is observed as the patients calm down. This provides an opportunity to objectively monitor the effect of the therapy. ]

Clinical Neuroscience

[Valium (Diazepam) effects on epileptic crises and certain epileptic mechanisms]

HALÁSZ P., MOLNÁR Gy., HIDASI J.

[In addition to the generally observed good effect, we observed one case in which Valium worsened the epileptic mechanism (case 6). This observation seems to contradict the many reports in the literature that Valium has a good effect in petit mal and spike-wave mechanism. However, a distinction should be made between the different spike-wave mechanisms. In our other patient (case 3) we also observed a beneficial effect of Valium in spike-wave mechanism. However, this latter case was a spike-wave variant, slow spike-wave pattern. However, our case 6 showed a classic 3 c/s spike-wave pattern with clinical absances. It is not clear from the literature whether Valium is effective in all 3 c/s spike-wave mechanisms. Further experience in this direction is needed. Apart from the neuroleptic effect, no other "side effects" were observed. ]

Clinical Neuroscience

[Data for the Autogen Training methodology and indicative questions]

KORONKAI Bertalan, HORVÁTH Szabolcs

[The authors outline the main factors involved in the development, practice and spread of AT. They briefly describe Schultz's classical method. They describe in more detail the methodology they developed, which they applied to groups of 6-10 patients and in which they attach great importance to suggestive support. They share their experience with AT treatment, which they find useful for AT indicatio: all personality types except H and I are suitable for learning the exercises. Of the psychic symptoms, mood disorders, feelings of insecurity, inner tension and anxiety in particular improved, and of the autonomic disorders, sweating, tremor, hypertension, enteral disturbances, insomnia and cephalgia responded most favourably. Based on their experience, they discuss the current and perspectivicus possibilities of AT in their department. In their opinion, a gradual diffusion of AT treatment can be expected due to its advantages over other psychotherapeutic methodologies and for the practical and theoretical reasons discussed. ]

Clinical Neuroscience

[Diffuse demyelinating giant cell reticulomascoma metastases ]

ÉDER Mária

[In a circumscribed case of metastatic reticulum sarcoma, severe oedema and demyelination were observed in both hemispheres. In the clinical picture, local symptoms attributable to the direct effect of the tumour were accompanied by bilateral hemisphaerial white matter lesions. In all cases of brain tumours, but especially in sarcoma metastases, bilateral symptoms should be considered not only bilateral tumour formation but also bilateral white matter oedema-necrosis.]

Clinical Neuroscience

[On current problems in psychiatric methodology]

PETHŐ Bertalan

[Science is a systematically structured system. Today, the scientific status of psychiatry is threatened by the lack of a unified system for the many different views and schools of thought. The main reason for this critical situation is the lack of clarity of methodological problems. The methodological problem, taking into account its historical development, can be briefly outlined as follows. ]

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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.

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

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

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

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]