Clinical Neuroscience

[Polarographic studies from brain water]

MÁTYUS László1, SCHÉDA Vilmos1

SEPTEMBER 01, 1969

Clinical Neuroscience - 1969;22(09)

[The authors performed qualitative protein analysis of cerebrospinal fluid from a Hungarian RADELKISZ-type polarograph in 158 patients. The criteria for normal curves were determined under the conditions described. An attempt was made to classify the abnormal curves and compare them with certain disease types. Lower than normal curves were obtained in endogenous psychoses and higher than normal curves in arteriosclerotic dementias, despite the fact that the protein content was within normal limits.]

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Clinical Neuroscience

[The relationship between kappa rhythm and temporal paroxysms]

HASZNOS Tivadar

[By kappa rhythm, we mean the potentials induced by the 9-12/sec. count in the temporal derivation. The interpretation of kappa waves is still not uniform. Darow et al. and Kennedy et al. regard it as an artificial rhythm, or at least as a rhythm which is never considered as a separate temporal rhythm on its own. According to their hypothesis - and this is supported by a number of studies - intense mental work is accompanied by an increase in muscle tone, which would also entail, among other things, the vibration of the eye-coils, and the latter would manifest itself as a kappa rhythm. ]

Clinical Neuroscience

[Recent studies in panencephalitis II. Electrophysiological observations]

GOMBI Róza, ÓVÁRY Imre, GŐDÉNY Sára, SORSZEGI Pál, KAPPÉTER István, BENKŐ Károly

[Our electrophysiological observations are in agreement with the literature, according to which the Radermecker complex is a multifocal phenomenon, predominantly arising and manifesting in the cortex and at the border of the cortical white matter (Cobb 1966, Bogacz et al. 1959, etc.). This is suggested by the fact of multiple intracerebral phase reversals and the regional appearance or absence of complexes, which we observed in our patient. Intracerebral drainage has been performed very rarely in patients with panencephalitis, and the data obtained are similar to ours. Authors who have studied deep eletrography do not confirm the hypothesis of a thalamic - diencephalic origin of the complexes. In the opinion of Bogacz et al., the complexes are similar to the 'isolation complexes' (Garcia Austt et al. 1957) of partially or completely isolated cortex, in other words, to the 'suppression-burst' complexes (Henry and Scoville 1962). As the panencephalitic disease process progresses, neurons in the cortex and other structures become partially or completely deafferented, and there is a tendency and potential for hypersynchronous abnormal activity of deafferented cells after the loss of the tone or excitatory state necessary for normal function, provided by impulses from specific and non-specific pathways.]

Clinical Neuroscience

[Data for the assessment of pneumoencephalograms (Diencephalosis and ventricular dilatation)]

VÁRNAI György, PEKÁR Aranka, SZEGEDY László, HAITS Géza

[Authors analysed pneumoencephalography recordings of 270 unselected patients with identical radiological and approximately identical insufflation technique conditions for the correlation of lateral chamber index, ventricular index III, and absolute values of lateral chamber and ventricular dilatation III. In 49 of their 49 patients with the symptom complex of ,,diencephalosis" (,,hypothalamopathy"), isolated or prevalent III ventricular dilatation was found in 24.4% (12 patients), whereas in 20.3% (45 patients) of their 221 non-diencephalotic patients, the above findings were obtained. They analyse in detail the criteria for the evaluation of ventricular dilatation and urge caution regarding the resulting diagnostic conclusions.]

Clinical Neuroscience

[Genetic significance of muscle enzymes]

LIPCSEY Attila, SZABADI Elemér, FEKETE Istvánné

[Enzyme assays were performed in patients with recessive x-linked dystrophia musculorum progressiva in four families and their family members. From a genetic point of view, the measurement of KFK activity is considered to be the most valuable. The method is well suited for the detection of vectors and in the preclinical phase of dystrophia musculorum progressiva.]

Clinical Neuroscience

[Data on o-Toluidines and enzymatic liquor-sugar determination]

ÚJVÁROSI Imre, RUSZ Sándor

[From comparative tests of O-Toluidines and enzymatic CSF sugar determination, the values obtained with the two methods did not show any significant difference. Given circumstances and options dictate which method is used for routine testing. For experimental tests, the enzymatic method is the appropriate method.]

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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

Atypical presentation of late-onset Sandhoff disease: a case report

SALAMON András , SZPISJAK László , ZÁDORI Dénes, LÉNÁRT István, MARÓTI Zoltán, KALMÁR Tibor , BRIERLEY M. H. Charlotte, DEEGAN B. Patrick , KLIVÉNYI Péter

Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.

Lege Artis Medicinae

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

FARSANG Csaba

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]

Clinical Neuroscience

Neuroscience highlights: The mirror inside our brain

KRABÓTH Zoltán, KÁLMÁN Bernadette

Over the second half of the 19th century, numerous theories arose concerning mechanisms involved in understanding of action, imitative learning, language development and theory of mind. These explorations gained new momentum with the discovery of the so called “mirror neurons”. Rizzolatti’s work inspired large groups of scientists seeking explanation in a new and hitherto unexplored area of how we perceive and understand the actions and intentions of others, how we learn through imitation to help our own survival, and what mechanisms have helped us to develop a unique human trait, language. Numerous studies have addressed these questions over the years, gathering information about mirror neurons themselves, their subtypes, the different brain areas involved in the mirror neuron system, their role in the above mentioned mechanisms, and the varying consequences of their dysfunction in human life. In this short review, we summarize the most important theories and discoveries that argue for the existence of the mirror neuron system, and its essential function in normal human life or some pathological conditions.