Clinical Neuroscience

[The use of the modified permanganate response in the early detection of neuronal constriction in early CSF diagnosis]

DÉNES Iván1, TUNKL Erika1, FARAGÓ András2

APRIL 01, 1965

Clinical Neuroscience - 1965;18(04)

[The described permanganate methodology seems to be a significantly more informative method than the usual CSF test in the diagnosis of neurovascular constrictions containing low mg% CSF. In the authors' opinion, it is not the protein amount or the accumulation of certain protein fractions that is responsible for this behaviour of the reaction, but the biochemical changes that occur as a result of the space-constricting process, which the authors aim to clarify further. ]

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  1. Orvostovábbképző Intézet Ideggyógyászati Tanszék
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Further articles in this publication

Clinical Neuroscience

[After twenty years]

JUHÁSZ Pál

[The experience of the past 20 years: in the face of our shortcomings and failures to we can continue our work in the hope of success.]

Clinical Neuroscience

[Investigation of neuromuscular synapses in muscle diseases]

STIPULA Magda

[From the muscle biopsy material of our clinic, the subneural apparatus of the myoneural junction was examined in 32 cases by the Koelle acetylthiocholine method, and the neural part by the Bielschowsky-Gross-Schultze method modified by Coers. The amount of material studied by these tests is small in relation to the number of biopsies performed in our clinic. However, also according to our previous results, we have seen that in ALS the subneural apparatus is relatively uniformly smaller, with variable size in the initial stage of dystrophia musculorum progressiva, with more large, hypertrophic forms, while in the later stage we find smaller, more irregular forms. Intramuscular nerve fibres showed irregular course, thinning in ALS, and irregular, degenerative axonal swellings in dystrophies. We do not want to draw any far-reaching conclusions from the material we have examined so far, but based on the literature and our initial experience, we see that further and more extensive studies in this direction are absolutely necessary to better understand the pathology of skeletal muscle. ]

Clinical Neuroscience

[Effect of local brain hypothermia on ECoG and experimental epileptiform activation]

PÁSZTOR Emil, TOMKA Imre, DEÁK György

[Monopolar corticographic drainage was performed in dogs with chloralose narcosis after extensive craniotomy mk.o. Cooling of the brain surface was performed with circumscribed cold fluid. Brain temperature was measured with a copper-constantan thermoelectric thermometer at a depth of 2-3 mm. The experiments yielded the following results : 1. Electrocorticographic recordings could not demonstrate that certain phases of brain hypothermia are associated with an increased excitability state; 2. A different relationship between the change in locally generated strychnine spike activation and the change in baseline activity during cooling and spontaneous warming was observed; 3. The brain electrical activity activated by Tetracor during cooling was similar to that in unactivated cases. 4. local brain cooling on either side does not significantly affect either the basal opposite-side activity or the opposite-side strychnine-spike activity activated with Tetracor or generated locally, but eliminates the opposite-side mirror focus. Therefore, local brain cooling can be used as a probe to determine the primary or secondary nature of the counter-side spike activity.]

Clinical Neuroscience

[Additions to the study of the schizophrenomimetic effects of phencyclidine. Based on a self-experiment with Elysion]

OSZVALD Péter

[The author describes in detail his sensory and psychic hallucinogenic experiences of a schizophrenic-like symptom cluster lasting several hours, induced by intravenous phencyclidine (Elysion). ]

Clinical Neuroscience

[lzonicotinic acid hydrazide poisoning effects on the central nervous system]

KAPPÉTER István, KAJTOR Ferenc

[In a patient taking 250 tbl of INH "as a replacement", after a single epileptic seizure, somnolons for 3 days, gradually improving bradypsychia for 1 month, other symptoms typical of epileptic character changes, and a slowing of brain electrical activity, epileptiform potentials, which settled after two months, were observed. This process was monitored by EEG, time-lapse studies, Rorschach tests. Our observations and the literature review suggest that epileptic and psychic changes are related to a disturbance of pyridoxine-GABA metabolism. We emphasize the difficulty of recognizing INH-intoxication and its prevention. ]

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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.

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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

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

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Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

Clinical Neuroscience

Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias

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In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]