Clinical Neuroscience

[Structural analysis of Wahnstimmung]

IRÁNYI Jenőné1

MAY 01, 1959

Clinical Neuroscience - 1959;12(05)

[In our cases, we provided a psychopathological analysis of Wahnstimmung in the light of a structural approach. The regression symptoms of the relational structure are prominent in the state picture. The emotional polarization disorder due to the lack of differential inhibition results in total perplexity, anticipatory uncertainty, ambivalence that generally colours psychic events. The symptoms are accompanied by phenomena triggered by a reduction in psychic energy and regression of cognitive and adaptive structures. In cases where the structural regression symptoms are accompanied by an energetic insufficiency, the condition is stuck in a state of pathological imbalance constituting the delirium. The striving for a new pathological state of equilibrium manifests itself in the personality's effort to correct itself in the face of pathological symptoms. In such cases, new dynamic stereotypes are seen to develop in the form of secondary pathological cognitive structures, in the form of positive or negative misconceptions. ]

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  1. Budapesti Psychiatriai Klinika

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Further articles in this publication

Clinical Neuroscience

[About Lissauer's apperceptive blindness]

SIMONYI Gusztáv

[A 59-year-old patient with Alzheimer's disease slowly developed object agnosia, prosopagnosia, spatial disorientation, and apraxia of dressing over five years. There is evidence of visual analyser disability, left hemianopsia, visual loss. In projection at distance and angle of tachystoscopic examination, paralysis of the Bálint gaze. In addition, progressive dementia. None of the usual symptoms of colour agnosia or colour naming disorder, and no aphasia in any other way. These are the symptoms analysed by the author, who does not yet see any justification for dropping the traditional concept of agnosia, which has been a matter of debate in the literature in recent years.]

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[Central nervous system metastases from malignant melanoma ]

LEEL-ŐSSY Lóránt, TÖRÖK Pál

[The authors provide a clinicopathological description of five CNS m. m. metastases and, in their assessment, conclude : 1. CNS metastases of m. m. occur in 8-12% of other malignant tumour metastases. 2. They draw attention to the danger of removing naevi and melanomas. 3. The most common clinical presentation is subarachnoid haemorrhage. Symptoms of multiple metastasis are often difficult to recognise. 4. The need for neurosurgical intervention is emphasized in the presence of symptoms suggestive of a nodule. The tissue picture suggests a neuroectodermal origin of melanoma. They seek to explain the pathomechanism of the frequent subarachnoid haemorrhage and address the mode of metastasis.]

Clinical Neuroscience

[Effect of vasomotor reflexes on abnormal electroencephalogram]

HASZNOS Tivadar

[A review of our data and a comparison with the literature shows that in our patient population, only a relatively small percentage of activation procedures described by others have been successful. The large number of patients included in our study precludes us from explaining negative cases by statistical variance. In particular, it is difficult to explain the ineffectiveness of apnce, because while in carotid compression it is conceivable that the pressure was not applied in the right place and with the right force, in the patient who underwent apnce we were able to check in all cases that the patient complied with our request. Based on the negative results, the activation methods listed were no longer used indiscriminately in all patients. Carotid artery compression and oculo-cardiac reflex are performed in patients where it is necessary to differentiate between syncope and sacer. In vascular pathologies, amyl nitrite inhalation will continue to be performed. This is a relatively difficult EEG diagnostic problem and the small number of positive cases justifies the use of this test. Evipan is routinely used in combination with hyperventilation. This has the distinct advantage, in our opinion, of achieving the same effect with a relatively low dose of Evipan, which is therefore harmless, as compared to deeper anaesthesia, which requires a higher dose, or other more prolonged methods that are more likely to have complications.]

Clinical Neuroscience

[Formation of an ophthalmo-otoneurology working group]

[The author reports on the ophthalmo-otoneurological working group established on 25 March 1959 at the headquarters of the Medical-Health Trade Union, within the framework of the "Pavlov" Neurological Specialist Group.]

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Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

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Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

Clinical Neuroscience

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[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

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.

Lege Artis Medicinae

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Lege Artis Medicinae

[Second game, 37th move and Fourth game 78th move]

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[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]