Clinical Neuroscience

[Reactivity, pharmacological influence and association with respiration of the periodic eeg complex in subacute panencephalitis]

FENYŐ Egon1, HASZNOS Tivadar1

MARCH 01, 1963

Clinical Neuroscience - 1963;16(03)

[1. The stimuli we used could not influence the shape or periodicity of the periodic complexes. It appears that periodic eeg phenomena in penencephalitis can no longer be provoked by external stimuli when periodicity is stable. 2. No rapid activity typical of the initial stage of barbiturate anaesthesia was seen in any of our patients after intravenous Evipan. The lack of rapid activity in response to Evipan is associated with panencephalitic cortical lesions. 3. After Megimide injection, spasm potentiation initially occurred only in the section corresponding to the periodic complex. On this basis, it seems reasonable to conclude that the periodic complex represents a state of increased excitability that facilitates the appearance of spasm potentials. 4. There is a statistically highly significant difference between the number of eeg complexes occurring with increased frequency during the inspiratory and expiratory phases. If we assume that the firing of inspiratory and expiratory bulbopontine neurons facilitates the emergence of the panencephalitic eeg complex, it is reasonable to conclude that the primary anatomical lesion responsible for the emergence of the periodic complex may be the bulbopontine phase of the formatio reticularis, or at least a system intensely related to it. 5. In some cases, intravenous Relaxil G caused the characteristic periodicity of the curve to disappear and the diffuse polymorphic deltaic activity characteristic of end-stage panencephalitis to develop. The Relaxil effect suggested that the structure controlling the autorhythmicity of the periodic complex may be the diffuse thalamic system. Thus, the presence of a periodic complex implies the relative integrity of the diffuse thalamic system. 6 We have discussed the differences between the panencephalitic periodic complex, the K-complex and the Forbes' secondaerial response and, on the basis of these differences, we believe that the periodic complex cannot be identified with either the Forbes' secondaerial response or the K-complex.]

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  1. Budapesti Orvostudományi Egyetem Neurológiai Klinikája

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Clinical Neuroscience

[Text analysis of the diary of a schizophrenic patient ]

KUNCZ Elemér, THORDAI István

[Authors examine the diaries of 33-year-old female patients - 70 handwritten pages spanning a year - which can be used to track phases of immersion in a world of closed, autistic experience and self-medication tendencies. They find that, on the one hand, the diary as a form corresponds to a written monologue by which the patient, isolated from the outside world, deceives his own solitude, and, on the other hand, a certain striving for autonomy and the role of self-preservation tendencies can be discerned in the bizarre turns of phrase and conceptual changes.]

Clinical Neuroscience

[Amnesticus syndrome due to Härtel's alcohol injection ]

PAP Zoltán, ADLER Péter

[We reported a patient with severe trigeminal neuralgia in whom, by Härtel's method, part of the alcohol given into the Gasser's duct was presumably introduced into the cisterna chiasmatis and caused sterile meningitis, with encephalitis in the infundibulum area and severe damage to the mammillary bodies. This resulted in acute unconsciousness, febrile delirium, a slowly recovering foggy state of consciousness and a permanent amnestic syndrome. However, neuralgia - except for the unpleasant sensation of phonia, which still exists in branch I, has disappeared. The case is interesting not only from a psychological point of view, because of the memory disturbance, but also because of the lessons to be drawn from it. Although Dandy and Frazier-Spiller's trigeminal surgery cannot be said to be completely without risk, not to mention Sjöquist's intramedullary tractotomy, the situation is really different today from what it was in Fedor Krause's time. Härtel's confident statement, quoted above, made in 1924, has lost much of its legitimacy today. His proposal for surgical interventions, like Kirschner's electrocoagulation, was restricted to a narrower field. Despite the undoubtedly positive results, its use must always be accompanied by undesirable consequences. Its recommendation should therefore be limited to patients who are not suitable for or do not agree to intracranial surgery and who cannot be made painless by other means. ]

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[Dr. Adolf Juba]

PÉTERFAI János

[The author gives an account of the life and work of Dr. Adolf Juba.]

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[Glioma behaviour in tissue culture]

PÁLYI Irén, TÓTH Géza, CSÁKY László, ÁFRA Dénes, ZOLTÁN László

[1. In tissue cultures of gliomas after a single high dose of 6000 r., phosphorus metabolism was investigated 6 and 22 h after irradiation. 2. After irradiation, glioma cultures showed higher activity in the acid-soluble phosphorus fraction than controls. The lipid and DNA fractions, on the other hand, had lower activity compared to controls. 3. Normal tissues show no consistent changes in their phosphorus metabolism after a single high dose of radiation. ]

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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.

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Cases of inborn errors of metabolism diagnosed in children with autism

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Clinical Neuroscience

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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

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Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]