Clinical Neuroscience

[Polyarteritis nodosa manifesting as neuro-radiculo-myelitis]

KÖNYVES-KOLONICS László1, PÉLEY Domokos1, HARASZTI Antal1

JUNE 01, 1965

Clinical Neuroscience - 1965;18(06)

[Authors describe a monosystemic case of polyarteritis nodosa localized only to the nerves. Clinically, in addition to the typical general symptoms and the typical course of the disease, organ symptoms were observed only in the nervous system. Detailed pathological and histopathological examination was consistent with clinical signs. Typical pathological lesions were found in the brachial vaso-anatritis of the brachial plexus, the veins of the cerebellar cortex, the bridge and the upper segments of the spinal cord.]

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  1. Heves megyei Tanács Kórháza, ideggyógyászati és kórbonctani-kórszövettani osztály

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Clinical Neuroscience

[Changes in the fibre contingent and caliberspectrum of spinal anterior roots in amyotrophic lateral sclerosis]

SZENDRŐI Mária, BOZSIK György

[Authors have processed 88 spinal anterior peduncles from 10 ALS cases. The fibre count and caliber measurement data showed that the cervical and thoracic anterior roots were most affected. Lesions were more modest in the lower thoracic and lumbar segments. The reduction in the number of root fibres was very marked in some cases. In ALS, the caliberspectrum varies, with the decrease in the number of thicker fibres (8-10 Y) being the earliest and most significant.]

Clinical Neuroscience

[Cerebral blood flow studies using the isotope dilution method]

SZÁNTÓ József, GALLYAS Ferenc

[The authors present cerebral circulation data from a few patients in whom characteristic circulatory dynamics abnormalities were found, using their modified version of the isotope fluctuation circulation test method to demonstrate the performance of the method. The method allows a large number of circulatory data to be determined simultaneously (circulation times, blood flow through the brain, brain blood volume, cardiac output, circulating blood volume). From the shape and the relative position of the dilution curves, it is also possible to deduce circulatory dynamic abnormalities: e.g. thrombosis of the carotid intima-media, vascular malformations and, from the confusion in the arterial phasis, pathological processes of arterial origin in one hemisphere.]

Clinical Neuroscience

[The significance of orbital congestion in the diagnosis of closed head injury]

ÁFRA Dénes, NAGY Vilmos

[Parietal congestion occurred in 43 of 259 closed head injury cases 1-6 weeks after the accident. During the subacute phase, 9 of 44 intracranial haematomas presented with congestive papilledema, while 11 of 103 patients without a space-occluding haemorrhage presented with the same fundus lesion. In the chronic period congestion of the fundus always occurred in the presence of subdural haematoma with one exception. The examination findings of the injured patients without haematoma with congestion included moderate disturbance of consciousness, neurological nodal symptoms, corresponding EEG abnormalities and abnormal CSF values. The contrast studies performed gave normal images with two exceptions. Moderate vascular dislocation in one patient and marked vascular dislocation in the second patient on AP angiogram resolved after 14 days of contrast. The subacute subocular lesion can be interpreted as a symptom of diffuse or circumscribed posttraumatic cerebral oedema, which always plays a role in the clinical picture. The suspicion of intracranial haemorrhage necessarily requires a contrast study (carotid angiography). ]

Clinical Neuroscience

[Effect of local hypothermia on brain electrical activity. Application of Peltier effect cooling head ]

PÁSZTOR Emil, TOMKA Imre, DEÁK György

[1. The Peltier effect cooling head is suitable for localized but well-controlled surface cooling of the brain. 2. Based on theoretical calculations and practical measurements, the limits of the deep penetration of surface cooling are determined. 3. Provided new data on the effects of surface cooling on brain electrical activity and strychnine spike activity. 4. We investigated the effect of local cooling on epileptiform electrical activity during surgery in a patient with temporal epilepsy.]

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Clinical Neuroscience

A variant of Guillain-Barre syndrome after SARS-CoV-2 vaccination: AMSAN

TUTAR Kaya Nurhan, EYIGÜRBÜZ Tuğba, YILDIRIM Zerrin, KALE Nilufer

Introduction - Coronavirus disease 2019 (COVID-19) is a respiratory infection that has rapidly become a global pandemic and vaccines against SARS-CoV-2 have been developed with great success. In this article, we would like to present a patient who developed Guillain-Barré syndrome (GBS), which is a serious complication after receiving the inactive SARS-CoV-2 vaccine (CoronaVac). Case report – A 76-year-old male patient presented to the emergency department with nine days of progressive limb weakness. Two weeks prior to admission, he received the second dose of CoronaVac vaccine. Motor examination revealed decreased extremity strength with 3/5 in the lower extremities versus 4/5 in the upper extremities. Deep tendon reflexes were absent in all four extremities. Nerve conduction studies showed predominantly reduced amplitude in both motor and sensory nerves, consistent with AMSAN (acute motor and sensory axonal neuropathy). Conclusion - Clinicians should be aware of the neuro­logical complications or other side effects associated with COVID-19 vaccination so that early treatment can be an option.

Clinical Neuroscience

Acute transverse myelitis after inactivated COVID-19 vaccine

ERDEM Şimşek Nazan, DEMIRCI Seden, ÖZEL Tuğba , MAMADOVA Khalida, KARAALI Kamil , ÇELIK Tuğba Havva , USLU Ilgen Ferda, ÖZKAYNAK Sibel Sehür

Vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been rapidly developed to prevent coronavirus disease 2019 (COVID-19) pandemic. There is increasing safety concerns regarding COVID-19 vaccines. We report a 78-year old woman who was presented with tetraparesis, paresthesias of bilateral upper extremities, and urinary retention of one-day duration. Three weeks before these symptoms, she was vaccinated with CoronaVAC vaccine (Sinovac Life Sciences, China). Spine magnetic resonance imaging showed longitudinally extensive transverse myelitis (TM) from the C1 to the T3 spinal cord segment. An extensive diagnostic workup was performed to exclude other possible causes of TM. We suggest that longitudinally extensive TM may be associated with COVID-19 vaccination in this case. To the best of our knowledge, this is the first report of longitudinally extensive TM developing after CoronaVac vaccination. Clinicians should be aware of neurological symptoms after vaccination of COVID-19.

Clinical Neuroscience

Life threatening rare lymphomas presenting as longitudinally extensive transverse myelitis: a diagnostic challenge

TOLVAJ Balázs, HAHN Katalin, NAGY Zsuzsanna, VADVÁRI Árpád, CSOMOR Judit, GELPI Ellen, ILLÉS Zsolt, GARZULY Ferenc

Background and aims – Description of two cases of rare intravascular large B-cell lymphoma and secondary T-cell lymphoma diagnosed postmortem, that manifested clinically as longitudinally extensive transverse myelitis (LETM). We discuss causes of diagnostic difficulties, deceptive radiological and histological investigations, and outline diagnostic procedures based on our and previously reported cases. Case reports – Our first case, a 48-year-old female was admitted to the neurological department due to paraparesis. MRI suggested LETM, but the treatments were ineffective. She died after four weeks because of pneumonia and untreatable polyserositis. Pathological examination revealed intravascular large B-cell lymphoma (IVL). Our second case, a 61-year-old man presented with headache and paraparesis. MRI showed small bitemporal lesions and lesions suggesting LETM. Diagnostic investigations were unsuccessful, including tests for possible lymphoma (CSF flow cytometry and muscle biopsy for suspected IVL). Chest CT showed focal inflammation in a small area of the lung, and adrenal adenoma. Brain biopsy sample from the affected temporal area suggested T-cell mediated lymphocytic (paraneoplastic or viral) meningoencephalitis and excluded diffuse large B-cell lymphoma. The symptoms worsened, and the patient died in the sixth week of disease. The pathological examination of the presumed adenoma in the adrenal gland, the pancreatic tail and the lung lesions revealed peripheral T-cell lymphoma, as did the brain and spinal cord lesions. Even at histological examination, the T-cell lymphoma had the misleading appearance of inflammatory condition as did the MRI. Conclusion – Lymphoma can manifest as LETM. In cases of etiologically unclear atypical LETM in patients older than 40 years, a random skin biopsy (with subcutaneous adipose tissue) from the thigh and from the abdomen is strongly recommended as soon as possible. This may detect IVL and provide the possibility of prompt chemotherapy. In case of suspicion of lymphoma, parallel examination of the CSF by flow cytometry is also recommended. If skin biopsy is negative but lymphoma suspicion remains high, biopsy from other sites (bone marrow, lymph nodes or adrenal gland lesion) or from a simultaneously existing cerebral lesion is suggested, to exclude or prove diffuse large B-cell lymphoma, IVL, or a rare T-cell lymphoma.

Clinical Neuroscience

[Current questions of multiple sclerosis: the secunder progressive form of the disease]

VÉCSEI László

[Recent data suggest that long-term worsening is common in relapsing-remitting multiple sclerosis patients and is largely independent of relapses or new lesion formation on brain MRI. The current definition of secunder progressive multiple sclerosis is worsening of disability independent of relapses over at least 6-month interval. Early focal inflammatory disease activity and spinal cord lesion are predictors of very-long term disease outcomes in relapse - onset multiple sclerosis. The potential of PET imaging to visualize hidden inflammation in MS brain in vivo is an important contribution for better understanding the progression of the disease. Therefore, PET imaging is a promising tool in detecting the conversion from relapsing remitting multiple sclerosis to secunder progressive form of multiple sclerosis. Furthermore, neuro-axonal damage is the pathological substrate of permanent disability in different neurological disorders including multiple sclerosis. The neurofilament proteins have promise in this context because their levels rise upon neuro-axonal damage not only in the cerebrospinal fluid but also in blood. Patients with increased serum levels of neurofilament at baseline, independent of other clinical and MRI variables, experience significantly more brain and spinal cord volume loss over 2 years and 5 years of follow-up. The kynurenine-pathway abnormalities may be associated with the swich from early-mild stage multiple sclerosis to debilitating progressive forms of the disease. Analysis of these metabolites in serum may have application as multiple sclerosis disease biomarkers. Free radical action has been suggested as a causal factor in the illness. Increased free radical production and consumption of the scavenger molecules were found during the active phase of the disease. Based on the clinical findings (EXPAND Study) and pathomechanism of the disease siponimod is approved by the US Food and Drug Administration for the treatment of relapsing remitting forms of multiple sclerosis, to include secunder progressive multiple sclerosis with active disease, relapsing-remitting multiple sclerosis and clinically isolated syndrome.]

Clinical Neuroscience

Utilization of acute vascular imaging and neurointervention for acute ischaemic stroke patients in 20 Hungarian stroke centers

POZSEGOVITS Krisztián, SZABÓ Géza, SZUPERA Zoltán, NAGY Péter, NÉMETH László, KONDÁKOR István, TUSA Csaba, BERENTE László, SALACZ Pál, VÉCSEI László, SAS Katalin, SEMJÉN Judit, NIKL János, SZAPÁRY László, KAKUK Anikó, RÓZSA Csilla, HORVÁTH Melinda, IMRE Piroska, KÖVES Ágnes, BALOGH István, MOLNÁR Sándor, FOLYOVICH András, AL-MUHANNA Nadim, BÉRES-MOLNÁR Katalin Anna, HAHN Katalin, KRISTÓF Piroska, SZÁSZ Attila Sándor, SZŰCS Anna, BERECZKI Dániel

Background - Acute mortality rate of stroke in Hungary is significantly higher than in Western Europe, which is likely to be partially attributable to suboptimal treatment. Subjects and methods - We examined the use of acute vascular imaging and mechanical thrombectomy for acute ischaemic stroke patients. We collected data on 20 consecutive patients from Hungarian stroke centres before 31st August 2016. Results - Out of the reported 410 patients, 166 (40.4%) underwent CT angiography and 44 (10.7%) had mechanical thrombectomy. Conclusion - Only about 1/3 of acute ischaemic stroke patients eligible for thrombectomy actually had it. The underlying reasons include long onset-to-door time, low utilization of acute vessel imaging and a limited neuro­intervention capacity needing improvement.