Clinical Neuroscience

[Some modern socio-psychiatric therapeutic approaches]

FÜREDI János1

MARCH 01, 1966

Clinical Neuroscience - 1966;19(03)

[Drawing on his experiences in Australia and England, the author describes modern forms of extra-hospital treatment for the mentally ill and praises their usefulness and justification. He highlights the transformative impact of new forms of treatment on public opinion and domestic initiatives. ]

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  1. Országos Ideg- és Elmegyógyintézet Tbc osztálya

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Clinical Neuroscience

[Data on traumatic confabulosis]

POHL Ödön, HAITS Géza

[In four cases, the authors describe a particular form of post-traumatic confabulosis in which confabulosis persisted for a long time after the regression of the cardinal symptoms of amnestic syndrome, and became the leading symptom of the disease. The specific state of consciousness of these patients, which cannot be characterized by the classical psychopathology types of pathological alterations of consciousness, is discussed in detail, and the pathomechanism of the phenomena described is examined. ]

Clinical Neuroscience

[Cerebellar degeneration in neonatal hyaline membrane disease]

SCHÉDA Vilmos

[The author studied the brains of 12 infants who died of hyaline membrane disease. He found the cerebrum intact, while in the cerebellar cortex he found characteristic lesions, partial or complete absence of Purkinje cells and an increase in Bergmann cells. The lesions are thought to be anoxic in origin. ]

Clinical Neuroscience

[Data on spontaneous aliquorrhoea, - 3 cases]

ZAPPE Lajos, ÁFRA Dénes

[The authors present the case histories of three patients with spontaneous aliquorrhoea. In case I, the symptoms developed with tremendous rapidity ; the cerebrospinal fluid deficiency was associated with a picture of severe vasoanoxic brain damage. In cases II and III, the chronic onset was suggestive of a brain tumour ; the congestion of the orbits in the third patient was strongly suggestive. The diagnosis was confirmed in all three cases by a long follow-up and multiple control examinations. All three patients were cured, essentially with the use of fluid therapy and vasodilator drugs. Authors, based on the clinical features of their cases and anatomical and physiological data from the literature, attempt to explain the pathomechanism of aliquorrhoea on the basis of a unified hypothesis. In their hypothesis, they give an important role to pathological reflexes triggered by a decrease in CSF pressure due to accidental causes. They explain the persistence and deepening of the disorder and the different degrees of cerebral and ocular pathology. CSF hypotension and aliquorrhoea are not considered either as a disease or as a syndrome, but as a specific type of vegetative reaction. ]

Clinical Neuroscience

[Ocular fundus lesions in cases of panencephalitis nodosa]

SZABADI Elemér, OLÁH Imre

[In 130 cases of panencephalitis nodosa, abnormal orbital lesions were found in 61 patients (47%), 39 (76.5%) of 51 cases in the Neurology Clinic. In 79 and 76% of the fundus lesions, respectively, the papilla and 21-24% of the extrapapillary lesions were visible. In 14 cases, yellowish-white dots similar to old-age lipoid deposits were observed near the aequator. No parallel between the course of panencephalitis and the fundus image can be drawn on the basis of previous studies.]

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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.

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[Vaccines against COVID-19 pandemic]

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[The rapidly spreading SARS-CoV2 respiratory virus has evoked an epidemic with serious aftermath around the world. In addition to the health effects, the global economic damage is actually unpredictable. At the same time, the pandemic has launched a series of unprecedented collaborative scientific research, including the development of vaccines. This study summarizes up-to-date information on vaccines, immune memory, and some emerging clinical effects.]

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[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]

SZAUDER Ipoly

[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]

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

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]