Clinical Neuroscience


FEKETE Tamás Fülöp1, VERES Róbert1, NYÁRY István1

NOVEMBER 30, 2006

Clinical Neuroscience - 2006;59(11-12)

[Herniation of the meninges through a defect of the spinal canal is a spinal meningocele, and is usually located dorsally in the lumbosacral region. Meningoceles are usually part of a complex developmental disorder, or of a systemic disease, or it can be iatrogenic, as well. We report a very rare case of a true anterior thoracic meningocele.]


  1. Országos Idegsebészeti Tudományos Intézet, Budapest



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Clinical Neuroscience



Clinical Neuroscience


VARGA Hedvig, PÁRDUTZ Árpád, TAJTI János, VÉCSEI László, JEAN Schoenen

[Migraine is one of the most common neurological disorder affecting up to 14% of the population. The disease shows sexual dimorphism, thus gonadal steroids may play an important role in its patophysiology. One model of migraine headache is the systemic administration of nitric oxide (NO) donor nitroglycerin (NTG), which triggers a delayed attack without aura in many migraine patients but not in healthy volunteers. NTG is also able to activate the neurons of the caudal trigeminal nucleus in the rat. In our review we summarise the effect of NTG on the expression of some molecules, in the superficial laminae of the spinal portion of trigeminal nucleus caudalis, which play an important role in the pathomechanism of headaches, and the modulatory effect of chronic estradiol treatment. Our data show that NTG was able to modify all the examined substances in the caudal trigeminal nucleus, while chronic estradiol treatment abolished this effect. These data may help to understand the mechanisms by which estrogens influence trigeminal nociception and how nitric oxide triggers migraine attacks.]

Clinical Neuroscience


GÁRDIÁN Gabriella

[Huntington’s disease is an autosomal dominantly inherited progressive neurodegenerative disorder. The main symptoms are choreiform, involuntary movements, personality changes and dementia. Huntington’s disease is a member of a group of diseases caused by CAG repeat expansions. One research aim is to determine the earliest molecular changes associated with Huntington’s disease. There is no possibility for this in humans, but various early changes have been identified in an animal model of Huntington’s disease. They are constructed by excitotoxin causing striatal lesion, or mitochondrial toxins inducing energy impairment, or by generating transgenic mice.]

Clinical Neuroscience



[symptoms. In two thirds of the cases the cause is unknown, this is called “idiopathic peripheral facial palsy or Bell’s palsy”, but several different diseases have to be considered in the differential diagnosis. In this paper we reviewed the case histories of 110 patients treated for “peripheral facial palsy” in the Department of Neurology, Semmelweis University, Budapest in a five year period, 2000-2004. We studied the age, gender distribution, seasonal occurance, comorbidities, sidedness, symptoms, circumstances of referral to the hospital, the initial diagnoses and therapeutic options. We also discuss the probable causes and consequences of diagnostic failures. Results: the proportion of males and females was equal. There was no considerable difference between sexes regarding agedistribution. Of the 110 patients 106 was diagnosed with idiopathic Bell’s palsy, three cases with otic herpes zoster and one patient with Lyme disease. In our material, peripheral facial palsy was significantly more frequent in the cold period of late autumn, winter, and early spring. Diabetes mellitus and hypertension were more frequent than in the general population. 74% of the patients were admitted within two days from the onset of the symptoms. In 37% preliminary diagnosis was unavailable. In 15% cerebrovascular insult was the first, incorrect diagnosis, the correct diagnosis of “Bell’s palsy” was provided only in 16%. The probable causes of diagnostic failures may be the misleading symptoms and accompanying conditions. We examined the different therapies applied and reviewed the literature in this topic. We conclude that intravenous corticosteroid treatment in the early stage of the disease is the therapy of choice.]

Clinical Neuroscience


CSAPÓ Krisztina, BAJKÓ Zoltán, MOLNÁR Sándor, MAGYAR Tünde, CSIBA László

[The vascular diseases (myocardial infarct, stroke, peripheral occlusive disease) have a common pathophysiological background, the arteriosclerosis, that impairs the autoregulation of cerebral vessels, decreases the endothel mediated flow in the peripheral vessels. Therefore the assessment of the vascular damage or the follow-up of therapy need a complex and simultaneous approach. Currently the morphological and functional changes in the vascular system can be investigated with separated measuring systems, focusing either to cardiac or cerebral parameters (intermittent blood pressure measurement, ECG, cerebral blood flow by transcranial Doppler e.g.). Our purpose is to establish a complex non-invasive system for the simultaneous measurement and comparison of cardiac/cerebral/periheral hemodynamics. The hemodynamic parameters in hypertensive patients are examined with transcranial Doppler and cardiac monitoring during tilt-table test. Intima-media thickness, flow-mediated dilatation in brachial artery, augmentation index and pulse wave velocity are also measured. The measurement will be repeated after 6 and 12 months follow-up. Our preliminary results are similar to those found in the literature, that proves the reliability of our complex noninvasive hemodynamic system. It is assumed, that 12 months antihypertensive therapies with ACE inhibitors, calciumantagonist etc. might result in different effects on different vascular parameters. Our system enables the individualization of antihypertensive therapy.]

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Clinical Neuroscience



[Objective - The standard surgical procedures used in degenerative thoracic and lumbar spinal canal stenosis allows decompression of the neural structures by unroofing the spinal canal, often resulted in destruction or insufficiency of facet joints, sacrifice the interspinosus/supraspinosus ligament complexes and stripping of the paraspinal muscles altering an already pathologic biomechanical milieu causing segmental instability. Various less invasive techniques exists to save the integrity and prevent the instability of the spine and allow decompression of neural structures located in the spinal canal. The authors discusses the experiences with technique of unilateral laminotomy for bilateral decompression. Methods - The unilateral laminotomy for bilateral decompression technique was performed at 60 levels in 51 patients to decompress the symptomatic degenerative stenosis of the thoracic and lumbar spinal canal. The inclusion criteria were used as follows: symptoms of neurogenic claudication and/or radiculopathy, myelopathy, neuroimaging evidence of degenerative stenosis and absence of instability. Symptoms were considered refractory to nonsurgical conservative management or myelopathy was detected. Results - The distribution of mostly affected segments were the L 4-5 (45%) and L3-4 (28.4%). Neurogenic claudication and walking distance improved during the follow up period in all patients. Seven patients (13.73%) reported excellent, 32 (62.74%) good, 12 (23.53%) fair outcome and no patient a poor overall outcome. The low back pain was the major residual postoperative complaint. 25 (49%) patients were very satisfied with their outcome, 23 (45.1%) were fairly satisfied, 2 (3.9%) were not very satisfied and 1 (2%) patients was dissatisfied. Conclusion - The unilateral laminotomy for bilateral microdecompression technique minimizes resection of and injury to tissues not directly involved in the pathologic process, while affording a safe and through decompression of neural structures located in a degeneratively stenotic spinal canal.]

Clinical Neuroscience



[Two cases of uncommon manifestation of central nervous system sarcoidosis are reported. A 42 year-old man had a spinal cord sarcoidosis. MRI of the spinal cord showed myelopathy in the cervico-thoracic region, and the T2-weighted image showed increasing signal intensity. Neurological symptoms did not correllate with radiological abnormalities. Neurological manifestation was paucisymptomatic. Half a year later steroid and azatioprin therapy led to almost complet radiological and clinical regression. In the second case we present a 49 year-old woman who had left side internuclear ophthalmoplegia and the brainstem lesion. The patient was proven to have sarcoidosis. In this case no abnormalities were found in brain MRI. Neurological symptoms could not be detected by MRI, probably caused by brainstem parenchymal lesions consisting of microgranulomatosis that is sarcoid "brainstem encephalitis". Neurological symptoms improved after steroid treatment in this case too. In both of the cases pulmonary lymphadenopathy helped to diagnose sarcoidosis. In our cases there were interesting correllations between neurological symptoms and MRI abnormalities. At the spinal cord sarcoidosis the radiological abnormalities were more striking than the clinical manifestation. In the other case we found distinct brainstem symptoms but could not detect MRI abnormalities.]

Lege Artis Medicinae

[Pilomatrix carcinoma with a lymph node metastasis - First Hungarian publication of a rare case]

VAJDA Adrienne, LÉVAY Bernadett

[INTRODUCTION - Pilomatrix carcinoma is a very rare malignant tumour, which derives from hair matrix cells. The male:female ratio among patients is 4:1, the mean age of patients is 45 years. This tumour type is very aggressive and grows slowly. CASE REPORT - The authors describe the case of a 37-year-old man who presented in 2004 with an approximately 2×2 cm, compact lesion tumour in the lumbar region. The tumour was excised and diagnosed as carcinoma sebaceum on the basis of histological examination. Several weeks after surgery, a protruding, semi-spherical lesion with a diameter of 2 cm appeared in the scar. The patient was referred to our hospital for excision of this lesion and for assessing the possibility of Muir-Torre syndrome. The examinations did not indicate the presence of any internal tumours. The recurrent tumour was excised with a 2 cm intact margin. Histological examination confirmed the diagnosis of pilomatrix carcinoma. In 2005, two new tumours were excised and semithick skin was transplanted in several sessions. At an oncological follow-up examination in 2009, a 13×7 mm lymph node was felt in the righ inguinal region, which was found to be a metastasis of pilomatrix carcinoma on the basis of aspiration cytology. Surgical block dissection was performed, followed by postoperative radiotherapy at a dose of 25×2 Gy. At present, the patient is symptom- free. Thoracic-abdominal CT and clinical examination performed in early June 2011 did not indicate progression of the original disease. CONCLUSION - Pilomatrix carcinoma with a lymph node metastasis has not been previously reported in Hungarian. The diagnosis was established on the basis of histological examination, which was indispensable for successful treatment.]

Lege Artis Medicinae

[Successful chest-wall reconstruction after the resection of a chondrosarcoma using muscle-flap and polytetrafluorethylene mesh repair]

AGÓCS László, KOCSIS Ákos, TAMÁS Róbert, LÉVAY Bernadett, CSEKEŐ Attila

[INTRODUCTION - Approximately 30% of malignant, primary bone tumours are chondrosarcomas, which most frequently develop on the anterior chest wall. Patients who are treated with adequate surgical intervention recover, 10-year survival rate is 97%. Besides the aesthetic outcome, preservation of breathing functions is crucial. CASE REPORT - The 36-years-old patient presented with a large chondrosarcoma, which infiltrated the left chest wall (4-6th ribs, the parietal pleura and the underlying muscles). Surgical resection was performed by opening the left thoracic cavity, sparing the skin and the subcutaneous layer. Reconstruction of the chest wall’s stability was carried out with a 20×25cm, polytetrafluoroethylene alloplastic Dualmesh, and an extensive myocutaneous dorsal flap (including the latissimus dorsi and serratus anterior muscles) that was pedicled on the left thoracodorsal vessels. After a normal postoperative period, the patient was released with sufficiently expanded lungs. No tumour remission was detected on the follow-up CT examination at 6 months after surgery. CONCLUSION - This case demonstrates that radical resection of chest-wall tumours and the above described reconstruction method allows the avoidance of paradoxial respiratory movements and provides excellent functional and aesthetic outcomes.]