Clinical Neuroscience

[The presentation of a transient hyperintense lesion with legionnaires disease in a patient, is it a coincidance or an incidental finding?]

KILIC Çoban Eda1, AKSOY Selma2, SAHIN Riza Ahmet3, UZUN Nuray3, GÖKYIGIT Münevver2

JANUARY 25, 2013

Clinical Neuroscience - 2013;66(01-02)

[Up to date the presentation of transient splenial lesions in corpus callosum were reported in diffusion weighted magnetic resonance imaging (MRI) only in epileptic patients and patients under antiepileptic therapy. A 41 year old male with no previous medical history was admitted to our clinic with symptoms of pneumonia. The neurological exam revealed stupor, but when awake his speech and orientation were normal. There were no meningeal irritation signs, cranial nerves, piramidal and cerebellar functions were normal. He had moderate respiratory distress and had bilateral rales in lower lobes while oscultating. Laboratory tests revealed high liver function levels and high acute phase reactants. Arterial blood levels showed hypoxemia. A brain MRI showed a hypointensity in the splenium of corpus callosum on T1 weighted images. There was markedly increased signal in this region on diffusion weighted imaging and hypointense on ADC. The lesion was slightly hyperintense on T2 and FLAIR weighted images. A repeat brain MRI was done 30 days after the initial study and showed a complete resolution of the splenial lesion. Transient splenial lesions can be seen due to different mechanisms in different clinical settings. It should be noted that these lesions are mostly reversible. Unnecessary therapies and procedures should be avoided in these lesions.]

AFFILIATIONS

  1. Bakirköy Mental Health Hospital, Neurology, Istanbul, Turkey
  2. Sisli Etfal Education and Research Hospital, Neurology, Istanbul, Turkey
  3. Sisli Etfal Education and Research Hospital, Infectious Disease, Istanbul, Turkey

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Clinical Neuroscience

[The significance of high-resolution ultrasonography in the diagnosis of peripheral nerve disorders]

SCHEIDL Erika, JOSEF Böhm, FARBAKY Zsófia, DEBRECZENI Róbert, BERECZKI Dániel, ARÁNYI Zsuzsanna

[High resolution ultrasonography is an emerging technique for the investigation of peripheral nerves and is increasingly used worldwide in the diagnosis of peripheral nerve disorders, however, until now it is not widespread in Hungary. According to the literature this method is especially useful in entrapment neuropathies, traumatic peripheral nerve injuries, tumors of the peripheral nerves and sonographically guided interventions. Ultrasonography allows precise morphological analysis and quantitative measurements of the nerves providing useful complementary information to electrodiagnostic data. In entrapment neuropathies ultrasound shows nerve swelling mainly proximal to the sites of compression and a focal change of echotexture. On longitudinal scan, an abrupt caliber change and spindle-like swelling of the compressed nerve segment can be seen. Evaluation of the anatomical background and visualisation of the postoperative and posttraumatic changes provide useful information for planning of the therapy. Ultrasound may be of significant help in localizing the pathological nerve segment when it is at an electrophysiologically inaccessible site or when substantial secondary axonal loss precludes precise electrophysiological localization and it might even show pathological changes when nerve conduction studies are normal. Contrary to electrophysiological investigation ultrasonography might discover neurotmesis in the akute phase of traumatic nerve injuries indicating the necessity of surgical intervention. We provide a summary of the main indications and further application areas of this method.]

Clinical Neuroscience

[Editorial message]

KINCSES Zsigmond Tamás

[Editorial message 2013;66(01-02)]

Clinical Neuroscience

[Aspirin and clopidogrel resistance: possible mechanisms and clinical relevance. Part II: Potential causes and laboratory tests]

VADÁSZ Dávid, SZTRIHA K. László, SAS Katalin, VÉCSEI László

[Recent meta-analyses have indicated that patients with vascular disease demonstrated by laboratory tests to be aspirin or clopidogrel-resistant are at an increased risk of major vascular events. The suggested mechanisms of aspirin resistance include genetic polymorphism, alternative pathways of platelet activation, aspirin-insensitive thromboxane biosynthesis, drug interactions, or a low aspirin dose. Clopidogrel resistance is likely to develop as a result of a decreased bioavailability of the active metabolite, due to genetic variation or concomitant drug treatment. Additional work is required to improve and validate laboratory tests of platelet function, so that they may become useful tools for selection of the most appropriate antiplatelet therapy for an individual patient. Improvements in antiplatelet treatment strategies in the future should lead to a reduction in premature vascular events.]

Clinical Neuroscience

[Blood lipid peroxidation, antioxidant enzyme activities and hemorheological changes in autistic children]

LÁSZLÓ Aranka, NOVÁK Zoltán, SZÕLLÕSI-VARGA Ilona, HAI Quai Du, VETRÓ Ágnes, KOVÁCS Attila

[Objectives - Early infantile autism is a severe form of childhood psychiatric disease with characteristic symptoms. Hyperserotoninaemia in 43.5%, lactic acidosis 43% and hyperpyruvataemia in 30% were biochemically demonstrated in autistic children. Our earlier results led to the postulation that a disequilibrium in the blood redox is involved in infantile autism; the oxidative loading and the antioxidant defending enzyme system were investigated together with the hemorheological parameters in infantile autism. Methods - Malonyl-dialdehyde (MDA) endproduct of lipid peroxidation and activities of the antioxidant enzymes: superoxide dismutase (SOD), catalase (C-ase), glutathione peroxidase (GP-ase) and reduced glutathione (GSH) were biochemically determined from plasma and red blood cells. Patients - The antioxidant specificities were investigated in plasma and red blood cell haemolysate from 25 infantile autistic children. Results - Significantly increased superoxide dismutase (SOD) (2.89 vs. 1.32 U/mg protein, p<0.01) and decreased glutathione peroxidase (0.620 vs. 0.910 U/mg protein, p<0.01) levels as well as catalase (0.463 vs. 4.948 BU/mg protein, p<0.001) activities were detected; while the plasma and erythrocyte lipid peroxidation and the reduced glutathione (GSH) levels did not change. The results of the investigated prooxidant and the antioxidant status provide evidence that there exists an oxidative stress in children with infantile autism. While investigating the hemorheological parameters of 25 infantile autistic patients, some characteristic pathological parameters were detected: the initial filtration rate (Fi) (0.72 vs. 0.75 p<0,01) and the clogging rate (CR) (1.926 vs. 2.912, p<0.01) values of red blood cells (RBC) decreased while the mean transit time (Tc) (8.93 vs. 7.39, p<0.001) increased suggesting reduced RBC deformability.]

Clinical Neuroscience

[Experiences with a self developed accelerometer]

VÉR Csilla, HOFGÁRT Gergely, SZIMA Gábor, KOVÁCS GÁBOR, NYISZTOR Zoltán, KARDOS László, CSIBA László

[Objective - In neurology the objective evaluation of improvement of paresis on every-day practice. The aim of this study was to develope and test a small 3-d acceleration measuring device and validate its usefulness. Patients and methods - We collected data from 17 mild and medium severity hemiparetic, bedridden acute ischaemic and hemorrhagic stroke patients and compared with data of 22 control subjects. The devices were attached to the paretic and non-paretic extremities and any movements (m/s2) and movement-durations were registered (24h). The data of movement-monitors were compared also with the changes of National Institute of Health Stroke Scale and European Stroke Scale. The electromiograph-sensor of polysomnograph has been used for validation. Results - Mild differences could be found in the use of dominant and non-dominant upper extremities of control persons. The control persons used their upper extremities more frequently than the stroke patients. Our data showed significant correlation with National Institute of Health Stroke Scale. Higher values on the scores were accompanied with less intensive use of extremities. We found a correlation between the consiousness level of patients and their activity of upper extremities. If the patients had severe consiousness disturbances they used significantly less their upper extremities. Conclusion - Our device sensitively detected the movement-differences between paretic and non-paretic extremities and can be used for quantitative evaluation of patient's neurological and consciousness status.]

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Marchiafava-Bignami disease: Report of three cases

GUNAY Gul, MESUDE Özerden, ZEYNEP Ozdemir, CAHIT Keskinkiliç, HAKAN Selçuk, BATUHAN Kara, AYSUN Soysal

Marchiafava-Bignami disease (MBD) is a rare alcohol-associated disorder characterized by demyelination and necrosis of the corpus callosum. We report three patients who had history of chronic alcoholism, different clinical presentation and MRI findings consistent with the diagnosis of Marchiafava-Bignami disease.

Clinical Neuroscience

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

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.

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

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

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

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