Clinical Neuroscience

[Tuberous sclerosis and Sturge - Weber disease co-incidence]

SZILÁRD János1, MÉSZÁROS Endre1

DECEMBER 01, 1968

Clinical Neuroscience - 1968;21(12)

[Data from an in vivo 14-year-old female patient with predominant symptoms of tuberous sclerosis and concomitant lesions suggestive of Sturge-Weber disease are presented, along with a family history of multiple neurological lesions and tumour formation. In the context of the co-detection of two very rare conditions, we wished to draw attention to the importance of dealing with neuroectodermal disorders. We also review the literature on the various dysgenetic abnormalities associated with the two disorders. ]

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  1. Szegedi Orvostudományi Egyetem Ideg- Elmekórtani Klinika

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Clinical Neuroscience

Principal stages in studying the problem of physiological mechanisms of mental activity in man

N. P. Bechtereva, A. Tchernysheva

Much of what happens in the brain during mental activity - especially in the most complex living tissue, the human brain - is still unclear. A major merit of the Pavlovian school is the elucidation of the physiological mechanisms that determine the diverse manifestations of the probable brain anatomofunctional schema of conditioned reflex activity, shedding light on the trait-, environment- and organism-dependent specificities of these mechanisms. An attempt has been made to adapt the conditional reflex methodology to humans in order to study higher nervous activity.

Clinical Neuroscience

[Seduxen treatment in certain neurological diseases (neurosis, pain, muscle spasm)]

LEHOCZKY Tibor

[Seduxen 5 mg tabl., produced by Kőbánya Pharmaceuticals, has been used in clinical therapeutic trials. Out of 100 patients in the ward, 77 were in different groups of neurasthenia, - neurosis, 7 patients were treated for pain caused by organic disease, 16 for muscle spasm and contracture. He discusses the 8 groups of neurasthenia-neurosis listed and finds that the highest improvement rates were in the reactiv and vasovegetative groups, 82.7% in the former and 83.3% in the latter. The overall improvement rate for all groups was 77.8%. The 75% improvement in neurasthenia anxiosa is highlighted, following the anxiolytic effect of diazepam highlighted by both foreign and national researchers. These results suggest that Seduxen is a very good tranquillant drug, which, at the right dose (3 X 14, 3 X 12, 3 X 1 tablets daily), has a sedative effect without side effects. Seduxen also has a direct analgesic and analgesic effect, not only in arthritis and arthrosis of various types, but also in polyneuritis, neuritis and neuralgia. Seduxen is an excellent muscle relaxant, which has been observed in 13 of its 16 organic patients to a marked degree and in three to a moderate degree; by reducing the dose sufficiently, a detrimental degree of muscle weakness can be avoided. Dose: 3x1/2 tablets daily is recommended as the initial dose, but in the vast majority of patients 3x1 tablets daily was adequate; in some cases 3x 14 tablets daily proved beneficial. Experience has shown that the side effects of Seduxen are mild, exceeding those of known tranquillant drugs only in cases of overdose or individual hypersensitivity. A certain degree of drowsiness is relatively common, but this, like muscle hypotension in paretic patients, can be avoided by reducing the dose appropriately. ]

Clinical Neuroscience

[Serum glutamic acid oxaloacetic acid transaminase activity in muscle diseases]

LIPCSEY Attila, SZABADI Elemér, FEKETE Istvánné

[The authors measured GOT enzyme activity in serum from patients with muscle atrophy of various origins (myogenic and neurogenic atrophy) and in serum from individuals with various neurological diseases. Their experience has shown that in myogenic diseases, if the presence of other diseases associated with parenchymal breakdown can be excluded, the measurement of GOT activation can be used to support the myogenic nature of the process.]

Clinical Neuroscience

[Further studies to detect human-brain corticosteroid fractions]

FAZEKAS I. Gyula, FAZEKAS Attila

[1. Lobar pneumonia, sudden cardiac death from paralysis, sudden cardiac death from paralysis in alcoholic state, self-harm, lightning strike, apoplexy cerebri, carcinosis peritonei, isonicide poisoning, cyanide poisoning, barbiturate poisoning, CO poisoning, Wofatox poisoning, alcohol poisoning+freezing deaths 26-92 years of age from 5 brain areas of 18 people (11 males and 7 females) were extracted 1 1/2-10 h after death, paper chromatographed in Bush 5 system, followed by chromatography in 2 n NaOH and 0.1% tetrasolium blue 9: 1. Evaluation was based on the tetrasolium blue reaction, NaOH fluorescence, Rf. values, standards and native blue fluorescence. 2 Brain extracts were run with different amounts of tetrahydrocortisol, tetrahydrocortisol, cortisol, cortisone, corticosterone and 11-dehydrocorticosterone as standards. The brain areas tested were : 1. bridge+brain, 2. cerebellum, 3. cerebellar nuclei, 4. cerebral cortex, 5. cerebral white matter. 3. 10 corticosteroid fractions were identified in total, 6 fractions were all identical to the standards, the other 4 unidentified steroids were labelled X1, X2, X3, X4. 4. These steroids were detected in different qualities and quantities in different brain areas depending on the deaths. 5. cortisol (=hydrocortisone) was detected in almost all brain areas tested in all 18 cases. Cortisol was found in most brain areas of those who died of heart failure, self-harm, lightning, apoplexy cerebri and various poisonings, but could not be detected in brain areas of those who died of heart failure in an alcoholic state and of cyanide poisoning. Other fractions were present in varying numbers and quantities in different brain areas. 6. Most fractures and the largest number were found in the brain areas of those who died of carcinosis peritonei and pneumonia. Fewest fractures and least amount were found in brain areas of those who died of cardiac arrest in alcoholic state and various intoxications in alcoholic state, and alcohol poisoning + frostbite. 7. Consistent with our previous animal studies and our studies on human subjects, we observed in the present study that alcohol induced significantly fewer corticosteroid fractions and quantities in all areas of the human brain compared to those in the non-alcoholic state. 8. In the cases studied, the total steroid content of each brain area does not show a consistent quantitative pattern that is characteristic of each death. 9. No lawful correlations between age, sex, adrenal weight, body weight, body height and the quantity and quality of corticosteroid content in the brain were found. 10. No decrease in brain corticosteroid content within 10 hours after death was observed with increasing time.]

Clinical Neuroscience

[Book review]

GOMBI Róza

[The author presents Bechtereva, N. P., Bondarchuk, A. N., Smirnov, B. M. and Trohachev, A. 1.: Physiology and pathophysiology of deep structures of the human brain.]

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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.

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.]