Clinical Neuroscience

[Rare angioproliferative tumors mimicking aggressive spinal hemangioma with epidural expansion]


JANUARY 30, 2012

Clinical Neuroscience - 2012;65(01-02)

[Background and purpose - We present two cases of angio-proliferative tumors that were misdiagnosed and treated as typical hemangiomas with epidural expansion. Materials and methods - Two middle-aged women presented with symptoms and radiological signs characteristic for aggressive hemangioma with epidural expansion. In the first case preoperative embolization and decompressive surgery with open transpedicular vertebroplasty was performed. Within less than a year, epidural recurrence of the tumor prompted for radical excision and corpectomy. The diagnosis after the histological studies and the further clinical evolution was metastasizing leiomyomatosis. No further recurrence occured during the next 6 years. In the second case percutaneous vertebroplasty was performed and complicated by epidural polymethyl-methacrylcate (PMMA) leakage, requiring urgent decompressive surgery. Histological study of the lesion raised the possibility of myopericytoma. This was confirmed 16 months later when complete vertebrectomy was performed due to severe epidural propagation of the recurring tumor. No further recurrence occurred in next the two years. Conclusions - Rare angio-proliferative tumors, like benign metastasizing leiomyoma and myopericytoma radiologically may resemble aggressive vertebral hemangiomas of the spine. Unlike hemangiomas, such tumors require radical removal due to their likely recurrence. As imaging studies may not be able to completely exclude such pathologies, bone biopsy and thorough histopathological studies are warranted prior to the therapeutic decision.]



Further articles in this publication

Clinical Neuroscience


RAJNA Péter, TAJTI János

Clinical Neuroscience

[Depression in neuropsychiatric diseases]


[Depression is frequently observed together with neurological disorders. Moreover this connection is bidirectional in the case of several neurological disorders, as depression can be either a comorbide syndrome or also a risk factor of them. Neurobiological background of depression involves neuroanatomical structures, their interconnected networks, disturbances of neurotransmitters, neurohormonal, neuroimmunological and neurotrophic changes, genetic background. Disfunction of these systems also plays a role in the pathogenesis of comorbid depression of neurological disorders. Interactions and clinical aspects of biological factors involved in the pathogenesis of depression in dementias, Parkinson’s disease, cerebrovascular disorders and epilepsy are discussed further. Depression as a result of neurobiological factors responsible for both neurological and psychiatric consequencies of these disorders, are often atypical as a clinical manifestation, however chracteristic for the particular neurological disorder. Evaluation of the biological backgound and clinical features of depression in neurological disorders makes the complex neuropsychiatric approach of these disorders possible.]

Clinical Neuroscience

[The clinical relevance of 1p19q codeletion of oligodendrogliomas at the Department of Neurosurgery in Debrecen]

KLEKNER Álmos, FEKETE Gábor, RENCSI Márta, MÉHES Gábor, SZABÓ Péter, BOGNÁR László

[Object - To determine the clinical relevance of 1p19q codeletion in case of patients treated between 2006 and 2008 with oligodendroglial tumor at the Department of Neurosurgery, University of Debrecen. Questions - Beside the traditional morphological investigations, methods of rapidly developing molecular pathology are also available for routine diagnostic procedures. Numerous studies confirm that the codeletion of the 1p and 19q alleles has a clinical relevance regarding the sensitivity for chemotherapy. In this study the connection between the 1p19q codeletion and clinical parameters was tested to evaluate the prognostic role of this genetic alteration in neurosurgical patients. Methods, clinical data - In the present study experiences about the clinical relevance of 1p19 codeletion is summarized. Between 2006 and 2008, 28 patients with brain tumor containing oligodendroglial component was tested for 1p19q codeletion. The result of the analysis was compared with clinical data such as tumor localization, extent of resection, histological grade, presence of astrocyte component, time of first recurrence, age and gender. Furthermore, the potency of 1p19q codeletion as a prognostic factor for chemosensitivity by analyzing the data of patients who underwent different treatment protocols was also evaluated. Results - Our results suggest that 1p19q codeletion can be valued as a positive prognostic factor, which is concordant with the results available in the literature. We also found positive correlation with oligodendroglial component, recurrence free survival of grade III tumors, sensitivity to chemoand radiotherapy, and inverse correlation with histological grade and age was detected. Conclusion - Though the 1p19q codeletion is currently not the part of the routine patient management, based on our study we found it appropriate for clinical use as a prognostic factor, and its predictive role in establishing oncotherapy can be also discussed.]

Clinical Neuroscience

[The validation of the hungarian version of the Dimensional Yale-Brown Obsessive-Compulsive Scale]

HARSÁNYI András, CSIGÓ Katalin, RAJKAI Csaba, DÖME László, DEMETER Gyula, RACSMÁNY Mihály

[Background - The Obsessive-Compulsive disorder (OCD) has a complex phenotype, which can be summarized by using a few consistent and temporally stable symptom dimensions. The dimensional approach derived from the systematic factor analytic studies of OCD symptoms. In 2006, a new psychometric scale was created by M.C. Rosario-Campos and her colleague, the Dimensional Yale- Brown Obsessive-Compulsive Scale (DY-BOCS). This scale measures the presence and severity of obsessive-compulsive (OC) symptoms within six distinct dimensions. The Hungarian translation of the test and preliminary results were published in 2009. Purpose - The objective of this recent study was two folded: on one hand, our goal was to validate the Hungarian version of the DY-BOCS on a larger sample size. On the other hand, we wanted to publish our results gained by the Hungarian version of the test in English. Methods - We assessed 30 Hungarian patients diagnosed with OCD by DSM-IV. Reliability and validity of the expert and of the self-report were estimated. Results - Self-report and expert ratings were highly correlated. The global DY-BOCS score was well correlated with the total Yale-Brown Obsessive-Compulsive Scale score. The internal validity of the symptom dimensions and the global severity score were high. Divergent validity was also good. Conclusion - These results indicate that the Hungarian version of the DY-BOCS is a reliable and valid clinical tool.]

Clinical Neuroscience

[Mutation analysis of alpha-galactosidase A gene in Hungarian Fabry patients]

LÁSZLÓ Aranka, TÖRÖK László, RAFFAI Sarolta, TÖRÖK Éva, SALLAY Éva, ENDREFFY Emőke, MORVAI László, AMSTEL Ploos Van JK

[Aim was to detect the mutations of alpha-galactosidase A gene in two Hungarian Fabry patients. Methods - Mutation analysis was performed by polymerase chain reaction (PCR) sequencing of the seven exons and adjacent introns of the alpha-galactosidase A gene. Results - Case 1. (19 y. male patient) Mutation analysis was done for alpha-galactosidase gene, a missence mutation has been identified in the 5th exon, the aspartic acid at codon 266 has been substituted by a tyrosine (notation D266Y) due to a G-T transversion at position 10287 of the alpha GAL-A gene. Case 2. (28 y. male Fabry patient) The GAL-A mutation has been proven to be R220X mutation in exon 5 of the alpha-galactosidase A gene.]

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[Vertebroplasty and kyphoplasty in the clinical practice]


[Osteoporosis affects about 600 thousand women and 300 thousand men in Hungary. The fractures give the illness its significance, among them 30-40 thousand vertebral fractures occur annually. One fifth of the patients suffering from vertebral compression fracture (VCF) sustaines an other VCF within a year. The intense pain can not always be controlled under conservative care and an efficient and fast intervention is needed to restore the quality of life of the patients. The cement augmentation (vertebroplasty or kyphoplasty) may help in days. The authors wish to present for the colleagues the details of indication, technical questions of the procedures and their complications based upon the data of numerous operated cases. They emphasize that osteoporotic patients sustained a VCF need complex care and nurture. They also mention that the danger of fracture of a neighbouring vertebra is increased due to the rigidity of the cemented one.]

Clinical Neuroscience


KASÓ Gábor, HORVÁTH Zsolt, KÖVÉR Ferenc, EZER Erzsébet, DÓCZI Tamás

[Vertebroplasty is a therapeutic image-guided procedure, consisting of an injection of acrylic cement through a bone biopsy needle into a vertebral body. Main indication for vertebroplasty is painful vertebral body compression fracture due to osteoporosis. The procedure is an efficient mean with high succes in pain release and prevention of further collapse of the treated vertebrae; however, the technique does not allow to realign the spine. Kyphoplasty was designed to adress the kyphotic deformitiy. It involves the percutaneous placement of an inflatable bone tamp into a vertebral body (VB). Restoration of VB height and kyphosis correction is achieved by inflation of the tamp with contrast material liquid. After deflation a cavitiy is created that eases the cement application. The most modern way of guidance in spinal surgery is neuronavigation - the use of frameless stereotaxy. The system reformats patient-specific CT images acquired prior surgery, performs image fusion with intraoperative plain X-ray. Before the operation, the surgeon may create surgical plan and simulate advancement of a virtual instrument along one or more surgical trajectories. During surgery, the system tracks the position of specialized surgical instruments. All three modalities mentioned above have been applied in the treatment of our patient suffered from multiple osteoporotic vertebral body compression fractures. Using kyphoplasty an almost total VB height restoration could be achieved. The pain relief was more than 50% after both operation.]

Clinical Neuroscience

[Percutaneous-transpedicular acrylat vertebroplasty for treatment of lumbar vertebral hemangioma - case report]


[The authors present the management of a patient suffering from lumbar vertebral hemangioma. Percutaneous transpedicular acrylate vertebroplasty was performed. This method has widely been used for the treatment of pathological vertebral bodies of different aetiology. A brief rewiev of the literature of previous and current methods is presented. A detailed discussion is given why vertebroplasty was used in contrast to the radiological investigation where the patient's hemangioma proved to be a non-agressive type. According to the authors' knowledge this is the first Hungarian publication of acrylate vertebroplasty for the treatment of vertebral hemangioma.]

Clinical Neuroscience

[Initial clinical experience with radio-frequency assisted percutaneous vertebral augmentation in the treatment of vertebral compression fractures]


[Purpose - Percutaenous Vertebroplasty (PVP) is effective in alleviating pain and facilitating early mobilization following vertebral compression fractures. The relatively high risk of extravertebral leakage due to uncontrolled delivery of low viscosity bone cement is an inherent limitation of the technique. The aim of this research is to investigate the ability of controlled cement delivery in decreasing the rate of such complications by applying radiofrequency heating to regulate cement viscosity. Method and material - Thirty two vetebrae were treated in 28 patients as part of an Ethics Committee approved multicenter clinical trial using RadioFreqency assisted Percutaenous Vertebral Augmentation (RF-PVA) technique. This technique is injecting low viscosity polymethylmethacrylate (PMMA) bone cement using a pressure controlled hydraulic pump and applying radiofrequency heating to increase cement viscosity prior to entering the vertebral body. All patients were screened for any cement leakage by X-ray and CT scan. The intensity of pain was recorded on a Visual Analog Scale (VAS) and the level of physical activiy on the Oswestry Disability Index (ODI) prior to, one day, one month and three months following procedure. Results - All procedures were technically successful. There were no clinical complication, intraspinal or intraforaminal cement leakage. In nine cases (29%) a small amount of PMMA entered the intervertebral space through the broken end plate. Intensity of pain by VAS was reduced from a mean of 7.0 to 2.5 and physical inactivity dropped on the ODI from 52% to 23% three months following treatment. Conclusion - In this small series controlled cement injection using RF-PVA was capable of preventing clinically hazardous extravertebral cement leakage while achieving outcomes similar to that of conventional vertebroplasty.]