Clinical Neuroscience

[The evolution of psychoneuroimmunology]

SOMOGYI István, SZEKERES György, SZENDI István

AUGUST 20, 2002

Clinical Neuroscience - 2002;55(07-08)

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Clinical Neuroscience

[Neuropsychological outcome following bilateral pallidotomy in patients with Parkinson's disease]

KOSZTOLÁNYI Péter, KÁLLAI János, BALÁS István, KARÁDI Kázmér, DÓCZI Tamás

[Introduction - Although significant improvement of motor function following bilateral pallidotomy for the treatment of Parkinsons's disease has been proved, the cognitive sequalae have not been clearly defined. There are recurrent loops interconnecting specific areas of the frontal cortex and the basal ganglia, suggesting the continuity or complementary functioning between these areas. Patients and methods - Pre- and postoperative cognitive function was evaluated in 19 Parkinsonian patients who underwent bilateral pallidotomy in order to clarify its effects on cognitive function. All patients were evaluated one day before the procedure and 12+ months after surgery using neuropsychological tests (Raven Progressive Matrices and Bergen Facial Recognition Test). Proper performance in these tests requires reasoning, abstraction and spatial memory, involving strongly the frontal functions. These functions could be described in terms of the ”working memory” concept. Hand Mental Rotation Test was used as comparing task not involving frontal functions. Scores were analyzed by Student’s t-test. Results - Modest improvement was observed in these cognitive functions as assessed by Raven Progressive Matrices (p<0.0688) and a significant change in the complex parts of Bergen Facial Recognition Test (p<0.0547; p<0.0468) was also noticed, but no change was registered in mental rotation tasks. Conclusion - Present data revealed that bilateral pallidotomy is associated with modest and long-lasting improvement in tasks involving the ”working memory”.]

Clinical Neuroscience

[Investigation of the dopamine dysregulation hypothesis of schizophrenia with neuroimaging techniques]

SZEKERES György, PÁVICS László, JANKA Zoltán

[The most elaborated biochemical concept of schizophrenia is the dopamine hypothesis. However, this classical theory is based on indirect observations. It has recently become possible to study this theory directly by means of advanced functional neuroimaging techniques, the development of specific radioligands and study protocols that are eligible to monitor dynamic changes in the neurotransmitter systems. According to the early concept, the essence of schizophrenia is the hyperactivity of the dopamine system. Nevertheless, this idea has gone through many modifications. In accordance with the modified dopamine hypothesis, the cognitive deficit and negative symptoms are related to the hypoactivity of the dorsolateral prefrontal cortex while the acute phasis of the disease associates with hyperactivity of the ventral striatal elements of the dopaminergic system. Between these dysfunctions there is causality via their exuberant connections. Beyond that, the interactions between the prefrontal and striatal anomalies implicate the involvement of other neurotransmitters than dopamine. Observations from model psychosis induced by N-methyl-D-aspartate antagonists and in vivo neuroimaging investigations in humans support primarily the role of glutamatergic system. Our developing knowledge about the neurochemical mechanism of schizophrenia can significantly affect therapeutic strategies as well.]

Clinical Neuroscience

[The molecular genetic control of bony developmental malformations affecting the craniocervical junction and the cervical spine]

DÁVID Károly, KASÓ Gábor, THOROGOOD Peter V, STEVENS John M, CROCKARD H Alan

[In this review a new interpretation of the origin of bony developmental malformations affecting the craniocervical junction and the cervical spine is presented based on recent advances in the understanding of embryonic development of the spine and its molecular genetic control. Radiographs, CT and MRI scans or CT myelograms of patients with Klippel-Feil syndrome were used for demonstration. Detailed clinical and radiologial analysis of these patients was published earlier [David KM, Stevens JM, Thorogood P, Crockard HA. The dysmorphic cervical spine in Klippel-Feil syndrome: interpretations from developmental biology. Neurosurg Focus 1999;6(6):1.]. Homeotic transformation due to mutations or disturbed expression of Hox genes is a possible mechanism responsible for C1 assimilation. Notochordal defects and/or signalling problems, that result in reduced or impaired Pax-1 gene expression, may underlie vertebral fusions. This, together with asymmetrical distribution of paraxial mesoderm cells and a possible lack of communication across the embryonic mid-line, could cause the asymmetrical fusion patterns. The wide and flattened shape of the fused vertebral bodies, their resemblance to the embryonic cartilaginous vertebrae and the process of progressive bony fusion with age suggest that the fusions occur before or, at the latest, during chondrification of vertebrae. The authors suggest that the aforementioned mechanisms are likely to be, at least in part, responsible for the origin of the bony developmental malformations affecting the craniocervical junction and the cervical spine.]

Clinical Neuroscience

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Clinical Neuroscience

[Percutaneous procedure for treatment of diseased vertebral bodies with different etiology: vertebroplasty]

KASÓ Gábor, STEFANITS János, KÖVÉR Ferenc, HUDVÁGNER Sándor, DÓCZI Tamás

[Percutaneous vertebroplasty is a radiologically guided invasive technique consisting of the injection of surgical cement into the diseased vertebral body. The procedure results in immediate pain relief and strengthening of the bone due to the polymerization process of the filling material hardening the vertebral body and preventing further collapse. This method is suitable for the treatment of osteoporotic vertebral fractures and of osteolytic vertebral body metastases without neurological signs, in multiple appearance as well. Authors present technical details of the procedure performed by bi-directional fluoroscopy and combined CT-fluoroscopy control as well as short-term experience obtained by treatment of 17 patients.]

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[SUCCESSFUL TREATMENT OF WHIPPLE'S DISEASE IN A PATIENT WITH LYMPH NODE ENLARGEMENT]

SOMOGYI Ágota, SZABÓ Tamás, KISHÁZI Péter, KISS Erika, ARATÓ Gabriella, PÁL Katalin, MADÁCSY László

[INTRODUCTION - Intestinal lipodystrophy, Whipple’s disease is an uncommon, chronic, systemic bacterial infection. It occurs predominantly in Caucasian males older than 40 years. The gastrointestinal tract is the most frequently involved organ, with clinical manifestations such as abdominal pain, malabsorption syndrome with diarrhea and weigth loss. Patient may present with low grade fever or fever of unknown origin, arthritis, lymphadenopathy, skin hyperpigmentation, endocarditis, pleuritis and peripheral and central neurological manifestations. Due to the wide variability of symptoms, the clinical diagnosis is very difficult and it is often made only years or even decades after the initial presentation. CASE REPORT - A 51-year-old Caucasian race man was admitted to the hospital with weigth loss and signs of subileus, referred for suspected lymphoma. After the exploratory laparotomy and lymphadenectomy the histological and the electron microscopical diagnosis was Whipple’s disease which was confirmed with histology from deep duodenal biopsy. Trimethoprim and sulfamethoxazole therapy for 6 months resulted in complete clinical and molecular biological healing. CONCLUSION - Clinical signs of Whipple’s dease are non-specific and may mimic Crohn’s disease, coeliac disease, amyloidosis, macroglobulinaemia, histoplasmosis, infection with non-tuberculotic mycobacterium in AIDS patients and lymphomas. Therefore, differential diagnosis is of critical importance. The natural evolution of the disease without treatment is always fatal. Trimethoprim and sulfamethoxazole for at least 1 year is usually considered adequate to eradicate the infection.]

Clinical Neuroscience

Novel structured MRI reporting system in neonatal hypoxic-ischemic encephalopathy - issues of development and first use experiences

LAKATOS Andrea, KOLOSSVÁRY Márton, SZABÓ Miklós, JERMENDY Ágnes, BAGYURA Zsolt, BARSI Péter, RUDAS Gábor, KOZÁK R. Lajos

Purpose - To develop an evidence-based, standardized structured reporting (SR) method for brain MRI examinations in neonatal hypoxic-ischemic encephalopathy (HIE) suitable both for clinical and research use. Materials and methods - SR template development was based on comprehensive review of the pertinent literature with the basic sections and subdivisions of the template defined according to MRI sequences (both conventional and diffusion-weighted, MR-spectroscopy (MRS), and T2*-weighted imaging), and the items targeted on age-related imaging patterns of HIE. In order to evaluate the usability of the proposed SR template we compared data obtained from the brain MR image analysis of 87 term and 19 preterm neonates with the literature. The enrolled 106 infants were born between 2013 and 2015, went through therapeutic hypothermia according to the TOBY criteria due to moderate to severe asphyxia and had at least one brain MRI examination within the first two weeks of life. Ethical approval was obtained for this retrospective study. Descriptive statistical analysis was also performed on data exported from the structured reporting system as feasibility test. Results - The mean gestational age of the study population was 38.3±2.2 weeks; brain MRI was performed on 5.8±2.9 day of life, hence in 78% of our patients after the conclusion of therapeutic hypothermia. Our main imaging findings were concordant to the pertinent literature. Moreover, we identified a characteristic temporal evolution of diffusion changes. Interestingly 18% (n=19/106) of the clinically asphyxiated infants had isolated axial-extraaxial haemorrhage without any imaging sign of HIE. Conclusion - In this article our approach of reporting HIE cases with our novel SR template is described. The SR template was found suitable for reporting HIE cases, moreover it uncovered time and location dependent evolution of diffusion abnormalities (and pseudonormalization, as well), suggesting its usefulness in clinical research applications. The high number of isolated intracranial haemorrhages, and the changing diffusion pattern emphasizes the importance of early imaging in HIE.

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TORNYOSNÉ BAGOSI Melinda, CSERNUS Mariann

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[A brief introduction about the primary care’s evolution is rather improving the clear sight since it supports our right judgement and helps to draw right consequences. Thus, we are able to realise more precisely our strategic aims, actual domestic problems, and the forced pathways indicated by the prevailing trends and the action radius of our reform endeavours. The present study shows hidden risks encoded in human resources, specialists’ services and shed light into the grey zone of remuneration. Indeed, the trends are alarming, the spaces are narrow for actions nevertheless we can escape our century old legacy by innovative solutions. While re-thinking totally the whole system nevertheless maintaining all immanent principles we can just in the short run revitalise our ailing primary health care. ]

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[Local importance of Hantavirus infections in mirror of the latest virological, epidemiological and clinical results]

NÉMETH Viktória, OLDAL Miklós, SEBÕK Judit, WITTMANN István, JAKAB Ferenc

[Hantaviruses are widespread infectious agents carried by different rodent species. The majority of them belongs to viral zoonotic pathogens, sometimes causing severe human infections. Hantaviruses inflict hemorrhagic fever with renal syndrome in Eurasia and supposedly in Africa, and hantavirus cardio-pulmonary syndrome in the Americas. The relationship between the virus and its host species is a result of a several million year co-evolution. Although virus replication is most intense in the infected rodents' lungs, these animals do not develop disease, instead they carry and spread the pathogens throughout their lifetime by body fluids. In the majority of infections, the virus gets into the human body by vaporization of rodent body fluids or by direct contact. In Europe, Puumala (PUUV) and Dobrava-Belgrade (DOBV) hantaviruses are the most abundant hantaviral infectious agents. There are numerous studies described the presence of different genotipes of hantaviruses circulating in Hungary. Although the number of clinical and epidemiolgical studies are limited, the medical importance - especially in a high risk population - of these viruses are unqustionable. There are a variety of methods to identify hantaviral infections. Molecular biological methods (RT-PCR) - also enabling genotyping - and virus neutralization tests proved to be the most reliable tools. The latter technique requires virus culturing, which can only be carried out in high-containment laboratories.]