Clinical Neuroscience

[Studies in paroxysmal niyoplegia]

BEKÉNY György1, HASZNOS Tivadar1, SOLTI Ferenc2

JANUARY 01, 1960

Clinical Neuroscience - 1960;13(01)

[Authors describe a sister pair with hypokalemic paroxysmal paralysis. In a 22-year-old male patient, a spontaneous paralytic attack of paralysis was observed on the first day with potassium movement towards the musculature and on the second day towards the extracellular space. During the paralysis, muscle biopsy K levels increased by 8%. EEG showed only a slight slowing during the seizure even with a serum K content of 1.9 maequ. During the paralysis, muscle mechanical excitability was increased, as detected by EMG. Aclosterone excretion was increased during the seizure. Meteorological factors may have played a role in triggering the seizure. Authors report ECG and circulatory studies in two patients.Neither patient had persistent muscle weakness. However, EMG findings in both cases showed myogenic lesions and muscle biopsy showed vacuolar lesions and atrophy of muscle fibres. Authors review the literature on potassium challenge, aldosterone secretion, EEG, EMG, ECG and circulatory studies of paroxysmal paralysis.]

AFFILIATIONS

  1. Budapesti Neurológiai Klinika és a Budapesti I. sz. Belklinika
  2. Budapesti Neurológiai Klinika és I. sz. Belklinika

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Clinical Neuroscience

[Electroencephalographic studies in psychosis during Antaetliyl treatment]

PERTORINI Dezső, VELOK Gyula

[An An. psychosis in a premorbid schizothymic sensitive psychopathic alcoholic patient was described. EEGs recorded during psychosis showed lesions consistent with those observed in symptomatic psychosis. In addition to toxic factors, vegetative symptoms accompanying the specific affective state played a role in the onset of psychosis, and the premorbid personality gave the psychosis its presentation. The specific ego disturbances observed in the first phase of psychosis seem likely to be related to the premorbid psychopathic personality on the one hand and to the nodal parietal lesions, which can be followed by electroencephalographic abnormalities on the other.]

Clinical Neuroscience

[The effect of changes in skin temperature in the external environment on the skin temperature of schizophrenics]

KASSAY György, MÁTHÉ Valéria

[Authors investigated the skin temperature of young schizophrenics with different behavioural (calm, contactable, inhibited, disturbed, agitated, heboid) forehead, two cheek and chin skin temperatures between 20.0-26.0 C°, with temperature ranges of 0.5, 1.0, l.5°, and l.5°, respectively, while keeping different factors affecting skin temperature constant. The greatest variation in skin temperature values was observed at external temperatures of 21.5° to 22.5°. The variability of values is smaller at lower and higher temperatures. In all external temperature ranges, the values for the right side of the face were the most variable (all patients were right-handed). Curves showing the distribution of skin temperature in relaxed, orderly patients are more regular, with less variation in skin temperature values than those for the whole patient. The authors conclude from their results that, under the given conditions, the variation in skin temperature values indicates different functional states of the nervous system in patients of different behavioural types and that the influence of the nervous system on peripheral vasomotor function is most pronounced at 21.5-22.5 C°. It is therefore recommended that such studies be carried out at the aforementioned external temperature, on the side corresponding to the dominant hemisphere. ]

Clinical Neuroscience

[A "specifically human structure" based on the functional organisation]

SZOBOR Albert

[In recent years, Nyirő's structural concept of psychic organizations has become known from several lectures and publications. There have also been several publications on the usefulness of structural organisationalism in psychological and psychopathological approaches. So far, experience has shown that in the explanation and analysis of psychological phenomena and pathologies, the decomposition of the psychic functio into three major organisational structures, the concept of cognitive, relational and adaptive organisatio, has been useful and can be applied in practice. On the other hand, the structuralist approach is necessarily dynamic, it can change and evolve - and it is evolving, as its creator's recent contributions demonstrate. These two properties: practical usability and potential for development, justify its being called a working hypothesis for the approach, subtle analysis and perhaps even 'understanding' of psychic phenomena.]

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

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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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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

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

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Clinical Neuroscience

A cross-sectional study on the quality of life in migraine and medication overuse headache in a Hungarian sample: understanding the effect of headache characteristics

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Previous studies using generic and disease specific instruments showed that both migraine and medication overuse headache are associated with lower health-related quality of life (HRQoL). The aim of our study was to assess HRQoL differences in migraineurs and in patients with MOH and to examine how headache characteristics such as years with headache, aura symptoms, triptan use, headache pain severity and headache frequency are related to HRQoL. In this cross-sectional study 334 participants were examined (248 were recruited from a tertiary headache centre and 86 via advertisements). The Comp­rehensive Headache-related Quality of life Questionnaire (CHQQ) was used to measure the participants’ HRQoL. Data showed normal distribution, therefore beside Chi-squared test parametric tests (e.g. independent samples t-test) were used with a two-tailed p<0.05 threshold. Linear regression models were used to determine the independent effects of sex, age, recruitment method, headache type (migraine vs. MOH) and headache characteristics (presence of aura symptoms, years with headache, headache pain severity, headache frequency and triptan use) separately for each domain and for the total score of CHQQ. Significance threshold was adopted to p0.0125 (0.05/4) to correct for multiple testing and avoid Type I error. Independent samples t-tests showed that patients with MOH had significantly lower scores on all CHQQ domains than migraineurs, except on the social subscale. Results of a series of regression analyses showed that triptan use was inversely related to all the domains of HRQoL after correction for multiple testing (p<0.0125). In addition, headache pain severity was associated with lower physical (p=0.001) and total scores (p=0.002) on CHQQ subscales. Based on the results, different headache characteristics (but not the headache type, namely migraine or MOH) were associated with lower levels of HRQoL in patients with headache. Determining which factors play significant role in the deterioration of HRQoL is important to adequately manage different patient populations and to guide public health policies regarding health service utilization and health-care costs.