Clinical Neuroscience

[The relationship between limited responsibility and the nature of new offences]

BODA Lívia1, BAKONYI Ferenc1, SZABÓ Árpád2

JUNE 01, 1967

Clinical Neuroscience - 1967;20(06)

[We have raised the possibility of criminal-mental-iatrogenization and the need for criminal-mental-praeventio. We suggested that, in order to avoid the former and to achieve the latter: (a) the mental health expert's opinion, if he or she finds limited competence, should include a prognosis in addition to the diagnosis; or (b) introduce a new concept to identify those persons for whom, for example, limited sanity arises because of insanity, but who, because of the individual's mental capacity, in the medical judgment, cannot be expected to obtain the necessary result from a limited sentence. Our assumptions and recommendations are supported by statistical data from our Office's files and by quotations from the ETT's Judicial Committee's decisions of principle. ]

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  1. Igazságügyi Orvoszakértői Iroda
  2. Igazságügyi Orvosszakértői Iroda

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Clinical Neuroscience

[In the temporal lobe space-constricting processes psychiatric disorders]

RÓTH György

[The author analyses the psychiatric disorders observed in 58 cases of temporal lobe spatial constriction. These disorders occurred in 67% of the cases. On the basis of his own observations and recent research on the temporal lobe, he concludes that psychiatric disorders in temporal lobe constrictions are the result of damage to the structures located in this lobe, mainly those of the limbic system. He attributes only a secondary role to the general increase in intracranial pressure through diffuse damage to brain functions. It is noteworthy that the highest percentage of such symptoms was observed in the case of constrictive processes in the temporal lobe of the non-dominant hemisphere. ]

Clinical Neuroscience

Nachweis und Identifizierung von Autoimmunfaktoren bei der Multiplen Sklerose

SCHUMACHER K., ROSS J.

Elektrophoretische Untersuchungen zeigen durchweg einen Anstieg der Gammaglobulinfraktionen im Liquor während des akuten Stadiums der Krankheit. Immunelektrophoretische und chromatographische Untersuchungen bestätigen dies. Die Gamma-Globulinfraktionen steigen an. Immunelektrophoretische und chromatographische Untersuchungen bestätigen dies. Wenn das Gammaglobulin ansteigt, werden im Liquor Plasmazellen nachgewiesen. Diese Daten legen nahe, dass immunologische Prozesse an der Multiplen Sklerose beteiligt sind. Der Nachweis von Antikörpern gegen das ZNS-Antigen im Patientenserum scheint effektiv zu sein, denn Ross kann sie bei 40 % der Patienten ohne Selektion nachweisen. Seine Ergebnisse wurden von anderen bestätigt. Die Autoren versuchen, diese Antikörper zu identifizieren. Durch säulenchromatographische Trennung und Immunelektrophorese wurden die gesuchten Antikörper als 19 S-Gamma-Globulin oder IgM-Antikörper identifiziert. Die saure Hydrolyse und die elektrophoretische Analyse von Antikörper-Antigen-Komplexen aus Multiple-Sklerose-Serum und -Gehirnextrakten ergaben das gleiche Ergebnis. Kontrollstudien mit anderen 19 S-Gamma-Globulinen beim Menschen zeigen, dass die Spezifität nicht in Frage steht. Lamoureux und Borduas konnten während einer akuten Krankheitsepisode neben der Anhäufung von Gamma-Globulin auch eine Anhäufung von Gamma-M und Gamma-A-Globulin im Liquor nachweisen. Sie entdeckten eine zytotoxische Substanz aus den Gammaglobulinfraktionen, die Nerven- und Gliazellen in Gewebekulturen schädigte. Über die Art des Antigens ist wenig bekannt. Die Autoren gehen von mindestens zwei Arten von Antigenen aus, einem Lipid und einem Protein. Es ist noch nicht bekannt, ob der Serumantikörper ein autoaggressiver oder ein sekundärer Faktor ist.

Clinical Neuroscience

[Motorcycle Jackson seizures associated with compulsive naming ]

BENKE Bálint

[The author describes the case of a patient with epilepsy who developed Jackson seizures with forced feeding after a herniactomy. Based on the literature, he raises the problematic nature of the case and tries to find an explanation for this rare symptom association. ]

Clinical Neuroscience

Au sujet des phenomenes convulsifs au cours de la degenerescence hepato-lenticulaeires

GEORGIEV I.

Chez 7 patients atteints de dégénérescence hépato-lenticulaire, des phénomènes convulsifs ont été observés. Elle a été observée dès l'époque de Strümpell et a depuis été rapportée par des auteurs avec une incidence de 8-20%. Le diagnostic a été établi par des tests cliniques et biochimiques. L'hérédité a été détectée chez deux d'entre eux. Trois patients de sexe masculin et quatre de sexe féminin ont eu un suivi de 2 à 10 ans. Début de la maladie à l'âge de 9 à 14 ans. Type de crise : 4 GM, dont 1 a également présenté des crises jacksoniennes, 1 psychomotrice et 2 PM, Les crises surviennent à différents stades de la pathologie. Le mécanisme n'est pas entièrement compris. Ces patients représentent la variante épileptique du syndrome. Les lésions précoces du tronc cérébral frontal sont mises en évidence à la fois par la pathologie et l'EEG. Outre la dégénérescence hépato-lenticulaire, qui provoque principalement des atteintes fronto-pariétales, lenticulaires et cérébelleuses, on peut envisager un autre analogue de la maladie, qui est une maladie du système fronto-ponto-cérébelleux, avec une épilepsie fréquente et un tableau clinique similaire à celui de la dégénérescence hépato-lenticulaire : l'encéphalite hyperkinétique progressive. Cela fait de Dawson, van Bogaert et Pette une unité nosologique. Encéphalite de Döring. Les troubles micro-structurels et biochimiques restent à analyser.

Clinical Neuroscience

[Histophysiology of antidiuretic centres]

BARA Dénes

[The regulatory role of the supraopticoneurohypophyseal system in water balance has been known for decades. Initially, ADH was thought to be secreted by the pituitary glands of the nerve lobe and their activity was regulated by the supraoptic nerve.]

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Clinical Neuroscience

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

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

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.

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

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]