Clinical Neuroscience

[Tuberculosis in central nervous system]

MADARAS Sándor1, SZABÓ Árpád1, KORDÁS Mariann2, SZEIFERT György2

SEPTEMBER 20, 1993

Clinical Neuroscience - 1993;46(09-10)

[Two cases with neurotuberculosis are presented. One of them is a 55-year-old woman who was admitted to the hospital with a history of two months of epileptical fits of the left limbs. Signs of elevated intracranial pressure appeared. The CT examination revealed right fronto-temporal convexity space occupying lesion with several mass effect. At operation an ,en plaque" fronto-temporal tumour was extirpated. The second case had a history of 15 months with lower-back pain. One year later it radiated to both legs combined with progressive paraparesis and urinary incontinence. Thoraco-lumbar myelography revealed severe extradural compression of the spinal cord at the level of Th XI. Following Th X-XI-XII. laminectomy extradural necrotic tumour-like lesion was removed. The histopathological examination justified specific tuberculotical granulomas at both instances. The primary tuberculotical infection was not detected in any of the cases.]


  1. Marosvásárhegyi Megyei Kórház, Idegsebészeti Osztály, Marosvásárhely, Románia
  2. Országos Idegsebészeti Tudományos Intézet, Budapest



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Clinical Neuroscience

[Pharmaco-EEG investigation on sedative effect of antiallergic drugs. Setastin is a non-sedative antihistamina]

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[Effect of setastine on pharmaco-EEG was investigated in a double blind placebo controlled study in ten healthy volunteers. Changes caused by setastine were compared with those of two referent antihistamine drugs (chloropyramine and hismanal) having great differences in their sedative side effect. The themporo-occipital alpha per theta ratio was the most sensitive EEG marker in differentiating the two referent drugs. The EEG effect showed by setastine was very similar to that to hismanal and opposite to that of chloropyramine. In addition an increase of the total power and the power of beta was also measured. The latter changes might refer to an inherent EEG effect of setastine. EEG changes of setastine cannot be evaluated as signs of hypovigilance and the similarity of EEG effect of hismanal and setastine also supports the non-sedative nature of setastine estabilished by clinical studies. The pharmaco-EEG method utilized gives possibility for an objective investigation of psychotropic side effects of the particular drugs. ]

Clinical Neuroscience

[Efficacy of cinolazepam on insomnia generated under shift-work conditions]


[The efficacy of cinolazepam (a benzodiazepine with middle half life time and light pharmacological potential) on insomnia generated under shift-work conditions was investigated, and shown to be an efficent hypnotic. Cinolazepam (daytime dose 20 mg, night dose 40 mg) improved significantly both sleep and awakening quality: there were no hangover effects, drug provoked intrasleep or early morning insomnia. During the time cinolazepam was administered drug tolerance was not observed. The structure of cinolazepam-induced sleep could be characterised by shortened sleep latency, increase of deep slow wave sleep, improvment of sleep continuity and unchange of REM sleep parameters both during night- and daytime.]

Clinical Neuroscience

[Observation of embolic events during carotis constructive surgery]

RÓZSA András, ENZT László, JÁRÁNYI Zsuzsa

[The changes of middle cerebral artery circulation during carotid artery surgery in 65 patients were monitored, and the observed embolic events are discussed. Of the 65 patients, 37 were operated with shunt protection (group A) and 28 without (group B). In 31 of all cases 55 embolic events were noted. In 22 of the group A patients 37 embolic events were observed, one of them occured during the declamping of the external caruiid circulation. Eighteen emboli were observed in 9 of the Group B cases. There were embolic events in 5 cases due to external declamping. All the above mentioned embolic events occured without postoperative clinical sings.]

Clinical Neuroscience

[Experiences with carotid-doppler examinations on patients with arterial bypass operation on the lower extremities]


[Carotis-Doppler examinations were performed on 83 patients with severe, obliterative disease of the arteries of the lower extremities and on 96 age-matched controls without signs and symptoms. In the group with obliterative arterial disease, severe or moderate stenosis of the carotid arteries was found in 20 and 40% of the patients, respectively, whereas in the control group the proportion of moderate carotid-stenosis was 2% and no case of severe stenosis was found. The role of risk factors was also studied. Based on their results the authors suggest, that because patients with obliterative disease on the arteries of the lower extremities have higher risk for stenosis, ultrasound investigations and regular follow up of the carotid arteries are needed.]

Clinical Neuroscience

[Brachioradial syndrome: superficial radial neuropathy]

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[Damage of the superficial branch of the radial nerve represents a rare, and rarely recognized, mononeuropathy. The first three cases in the Hungarian literature are presented. The essential role of electrodiagnosis in detecting of the disease is stressed. Special attention should be paid to avoid any lesion which might result from improper patient-care.]

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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

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Lege Artis Medicinae

[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]


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.]

Lege Artis Medicinae

[A short chronicle of three decades ]


[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]