Clinical Neuroscience

[Rare symptom of cervical vertebral chordoma]

HAFFNER Zsolt1, DÖMÖTÖR László1, VACZÓ György1

DECEMBER 01, 1961

Clinical Neuroscience - 1961;14(12)

[A 60-year-old man with a cervical chordoma, the clinical picture of which was fluctuant and the diagnosis of which could only be clarified by histopathological examination. Contrary to previous literature, reactive marginal sclerosis was detected in vertebra C III, with the chordoma as the primary cause. This case confirms the phenomenon that the clinical picture of vertebral chordoma is atypical and thus difficult to diagnose clinically. ]


  1. Fővárosi István Kórház Ideggyógyászati, Kórbonctani és Röntgenosztálya



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Clinical Neuroscience

Entwicklung – Reaktion — Prozess

NIKOLA Schipkowensky

In dieser Begriffsbestimmung wird die Untrennbarkeit des somatischen und psy chischen Lebens in den Vordergrund gestellt, was allerdings nicht besagen will, sie seien identisch. Schon dadurch ist aber unterstrichen, dass die Materie das Primäre ist, der Geist — das Sekundäre ; denn Form ohne Inhalt ist undenkbar. Das Bewusstsein, als höchste Form menschlichen Daseins, darf man nicht als ein blosses Epiphänomen seines Organs hinstellen. Die psychische Tätigkeit wird zwar vom Grosshirn geleistet, sie ist aber in ihren Inhalten und in ihrer logischen Gliederung von der objektiven Wirklichkeit deter miniert, deren subjektive Abbildung sie darstellt. Die Definition verweist ferner auf den biologischen Ursprung der menschlichen Persönlichkeit, deren weitere Entwicklung auf der Verbindung von unbedingten Reflexen mit der Er arbeitung kompliziertester dynamischer Stereotypen zeitlicher Verknüpfungen beruht. Schliesslich setzt diese Definition auch die Untrennbarkeit von Psychi atrie und Neurologie voraus : Sie sind einheitliche Glieder der einen medizi nischen Wissenschaft.

Clinical Neuroscience

[On surgical indications for metastases of spinal carcinoma]


[Based on our experience with 40 patients with spinal metastases, we do not refrain from operating on single nodal spinal metastases and paraplegia alone is not a contraindication. The indication for surgery and the expected results depend mainly on the histological and biological characteristics of the primary tumour, the course of the disease and the general physical condition of the patient. Based on the catamnestic evaluation of operated and non-operated patients, surgery can be recommended. Since the severity of compression or paresis is significant in the postoperative outcome, early surgery is desirable. ]

Clinical Neuroscience

[Multiple sclerosis and generalised reticulosarcoma combined case]

PAPP Mátyás, KIRÁLY Ferenc

[A 63-year-old patient had multiple sclerosis for about 20 years, which progressed in relapses. 8 months before his death, he developed generalized lymph node enlargement. Autopsy and histopathological examination showed generalized reticulosarcoma throughout the body and diffuse soft tissue and perivascular tumour proliferation in the central nervous system. With minor exceptions, the pia-glia membrane inhibited spread into the neural tissue everywhere except in the corpus pinealea, which may be attributed to the specific biological behaviour of the corpus pinealea in the face of pathological processes. In the central nervous system, in addition to the tumoral proliferation occupying the perivascular spaces, we found multinodular marrow neoplasms, which correspond in their location and histological features to old multiple sclerosis foci. On the basis of the histological picture and the clinical course, the described case must be considered as an accidental encounter of two separate diseases. ]

Clinical Neuroscience

[Spiractin electroencephalography tests]


[Studies with Spiractin have shown that: 1. in addition to its effect on the respiratory center, it has an excitatory effect on the diffuse activating system of the brainstem. 2. it can be used as a provoking agent in electroencephalography of patients with epilepsy (especially in children). 3. It may also occasionally cause generalized seizures, which should be kept in mind in cases of epilepsy.]

Clinical Neuroscience

[Report on the EEG training course in Marseille ]

WALSO Róbert

[The author reports on the EEG course in Marseille, organized by the International Federation of Societies for EEG and Clin. Neurophysiology" in Marseille from 28 August to 2 September 1961.]

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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

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Clinical Neuroscience

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

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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.

Journal of Nursing Theory and Practice

[Assessing Quality of life of Women with Cervical Cancer After Treatment]


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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.