Clinical Neuroscience

[Spontaneous intracerebral haematomas surgical treatment]

ÁFRA Dénes1, OROSZ Éva2

AUGUST 01, 1963

Clinical Neuroscience - 1963;16(08)

[The authors report the results of surgical treatment of 28 spontaneous intracerebral haematomas. In 12 cases, the cause of the haemorrhage was hypertonic arteriosclerosis based on clinical investigations; in 2 juvenile patients the haemorrhage was due to a microangioma undetectable by angiography, while in the other cases the aetiology was unknown. The cases were classified into 3 groups according to onset and course : 1. pseudotumoral or chronic form, 2. apoplectiform onset and 3. subarachnoid haemorrhage. The distribution of haematomas according to localisation was as follows: frontal 5, temporal 8, capsular 5, trigonal 9, cerebellar 1. Of the 28 patients, 5 died (18% surgical mortality). Of the 10 patients operated on within two weeks, 4 died, and of the 18 operated on later, 1 died. Despite the strikingly better results of late surgery, categorical avoidance of early intervention is not possible, but requires individual assessment of the surgical indicatio, especially in acute fasciitis. ]

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  1. Országos Idegsebészeti Tudományos Intézet
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Clinical Neuroscience

[Cholinesterase activity of subdural haematomas]

ÁFRA Dénes, WOLLEMANN Mária

[The authors report on cholinesterase enzyme activity assays of operated subdural and intracerebral haematoma specimens. By determining the cholinesterase and acetylcholinesterase activity of the fluid obtained at surgery, they attempted to draw parallels between enzyme activity and the time of haematoma persistence. The results showed that the fluid content of the capsular haematoma is not stable from the time of formation. The variation in the activity of the two enzymes studied suggests the possibility that the fluid content is continuously replenished, presumably by transudation.]

Clinical Neuroscience

[Our experience with Parkazine and its combination with other antiparkinsonian medicines]

DOBI Sándor

[Following Klimes' positive experience with outpatients, we have also had positive experience with Parkazine in hospital, which is mostly more severe. We have experienced a pronounced antitremor effect and we have experienced what was definitely an advantage over other previous drugs, that it also has a significant antitremor effect. This anti-tremor effect, which is all the shorter the patient's anamnesis, is the main advantage of Parkazine and justifies its use in all cases of Parkinson's syndrome. In addition to its beneficial effects on tremor and rigor, it also significantly improves akinesia through rigor reduction, without affecting primary motor impulsion. The latter should be classified as psychic symptoms, which are not affected by parkazine. Nevertheless, it does have a significant secondary psychic effect, which can be attributed to an improvement in the ability of helpless tremor patients to move and a reduction in tremor, by which the emotional afficiability of patients is also reduced. To influence the autonomic phenomena, which are a sub-symptom of Parkinson's syndrome and which greatly impair social integration, the drug can be preferably combined with belladonna derivatives, in our experience most notably Bellafit. This implies, accepting the different localisation mechanisms of the main components of PD, that Parkazine targets the areas involved in the generation of PD tremor and rigorous tonicity. ]

Clinical Neuroscience

[Analysis of symptomatic epipharyngeal tumour cases with trigeminal neuralgia]

LUKÁCS Kornél

[After describing the cases of three patients with epipharyngeal tumours, I will summarise the symptomatology of epipharyngeal tumours, emphasising the so-called latent phase, when only the elevation of pain to organic status and the correct evaluation of the otological complaints can help to establish an early diagnosis.]

Clinical Neuroscience

[Nervous system of engine builders working on assembly lines]

BÁLINT István, HÓDOS Tibor

[By means of modern technology and organization of work, the effect of stress on the nervous system caused by factors outside the objective nature of the work process can be substantially reduced in the case of production on the production line. The success of the measures aimed at reducing the strain on the nervous system of people working on the production line can only be increased if the stress situation resulting from the nature of the work process is changed. Since the repetitive and uniform manipulations during the bound work process primarily require an adaptation of the individual tempo and rhythm within narrow limits, the nervous system load on the working person is reflected in the mental performance of the adaptation at the given moment of time. The investigations concerning time perception have shown the necessity of improving the working conditions in two areas with regard to the further reduction of the nervous system load: 1. in order to further limit monotony, the linking of the tasks on the production line must be regulated in a new way, 2. in order to facilitate time adaptation, more micro-breaks must be inserted between the individual tasks on the production line than before.]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

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.

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

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Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

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Clinical Neuroscience

Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias

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In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.

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