Clinical Neuroscience

[Study trip to Czechoslovakia]

GÁLFI Béla

APRIL 01, 1961

Clinical Neuroscience - 1961;14(04)

[The author reports on his study trip to Czechoslovakia.]

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Clinical Neuroscience

[Childhood spinal tumours]

PÁSZTOR Emil, PARAICZ Ervin, SZÉNÁSY József

[Detection of spinal tumours in children and differential diagnosis are often difficult problems. We have described the specific difficulties and confounding factors in childhood, which are mainly based on anamnestic data and neurological examination and neurological assessment. However, the CSF passage and laboratory examination, as well as the X-ray, can in most cases be used as a basis for at least suspecting a tumour and referring the child to a specialist hospital. If surgery is not performed, but the suspicion of a tumour persists, regular check-ups, preferably by the same doctors, are essential. Even with contrast procedures, exploratory laminectomy may be necessary in some cases. Evidence of spinal cord compression, even in the case of a suspected malignant tumour, requires surgical intervention, and infancy is not a reason for delaying the procedure. It is known that the success of surgery depends primarily on the nature of the tumour and the preoperative status, but experience shows that good results can be achieved with surgery not only in cases of juxtamedullary benign gliomas but also in intra-medullary gliomas. Temporary improvement can also be expected from decompression in malignant extramedullary tumours, where the duration of improvement may be prolonged by appropriate X-ray irradiation. ]

Clinical Neuroscience

[Polyposis and palinopsia]

BEKÉNY György, PÉTER Ágnes

[Authors deal with two of the rarer visual illusions, polyopia and paliopsia. Polyopia or multiple vision is a spatial visualis persevaratio. It can be psychogenic or organic in origin. Organic polyopias can be subdivided into: 1. polyopias of ocular origin, 2. polyopias associated with nystagmus, 3. occipital (cerebral) polyopias. The authors describe examples of each of these three types. Palinopsia is a temporal visualis preservatio. The descriptions of palinopsia in the literature all show different features. In authors 3, palinopsia appeared as negative afterimages after prolonged television viewing. In case 4, a vascular laesio occurred in the area of the b. o. art. calcarina. During the improvement phase of cortical blindness and j.o. homonymous hemianopsia, polyopia, palinopsia, dysmorphopsia and spatial dysfunction were temporarily present. In our case, visual afterimages suggestive of an eidetic optotype were induced. The categorical inclusion of partial palinopias - i.e. projection to the adaequate location - is explained by the authors using Gestalt theory. Cerebral polyopia and palinopia are important occipital goitres. They are usually transient, part of a complex symptom complex. They are most often seen during the recovery phase of visual field damage, but radiatio optica laesio is not a prerequisite. The intimate relationship between polyopia and palinopsia is not only illustrated by case 4 of Pötzl (1954) and co-authors, where the two visual illusions occurred together. This relationship is also supported by the fact that polyopic subimages always occur in succession in time. The different polyopic phenomena are therefore based not only on spatial but also on temporal visual perseveration. Authors stress that one of the basic disorders of polyopia is palinopsic readiness. The latter is not identical with the prolongation of physiological afterimages. ]

Clinical Neuroscience

[Brain tumours and tumour cysts Cholinesterase activity]

WOLLEMANN Mária, ZOLTÁN László

[By determining the AcKE and BuKE activity of 100 brain tumors and 50 tumor cysts, it was found that significant shifts in enzyme activity occur at each tumor endpoint, which are characteristic of tumor type. ]

Clinical Neuroscience

[Treatment of status epilepticus with muscle relaxants and prolonged mechanical ventilation ]

KOMÁROMY László, SZÉKELY Ottó

[After touching on the pathophysiology and management of status epilepticus, the authors describe 3 cases in whom muscle relaxant and prolonged mechanical ventilation were used. Their experience is considered favourable.]

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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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Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

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[The role of sleep in the relational memory processes ]

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