Clinical Neuroscience

[Wegener's granulomatosis involving the nervous system ]

HALMAY Zsuzsa1, VATHY István1

MARCH 01, 1969

Clinical Neuroscience - 1969;22(03)

[The authors describe a case of Wegener's granulomatosis in which, in addition to the tympanic pathological lesions, extensive vasculitis and granulomatous inflammation of the meninges and brain matter, as well as granulomatous perineuritis, were observed. The neurological manifestations of Wegener's granulomatosis involvement of the nervous system. ]

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  1. BOTE II. sz. Kórbonctani Intézet és Fül-Orr-Gége Klinika

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[Fluorescein angiography is very useful for differentiating between congestive papillitis and pseudopapillitis. In congestive papillitis the papilla is fluorescent, in pseudopapillitis this fluorescence is not detectable on the papilla.]

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[Effect of cervical lymphatic dysfunction on EEG after tonsillectomy]

OBÁL Ferenc, SZABON József, BÖRCSÖK Edit, FÖLDI Mihály

[Tonsillectomy shifts the EEG in the direction of slowing down, because this operation leads to a transient disturbance of cervical lymph flow and thus to a transient subclinical lymphostatic encephalopathy. ]

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[Reversible internuclearis of traumatic origin ophthalmoplegia]

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[An 18-year-old young man developed internuclear ophthalmoplegia with rapid regression after trauma, among other microsymptoms. After reviewing the hypothesized pathomechanism, the author points out that in seemingly trivial traumas that do not involve the skull or spine, certain predisposing factors may lead to brainstem lesions with asymptomatic or only suggestive clinical signs, which may be of importance in subsequent differential diagnosis or specialist opinion. ]

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[Analysis of violent sexual offences with special reference to psycho-cultural aspects]

SZABÓ Miklós, BURIS László

[The authors have processed data from the Institute of Forensic Medicine of the University of Debrecen Medical School on medical expert opinions on violent sexual offences for the years 1955-1965. The perpetrators of these offences are most frequently among the 21-30 year olds. 55.89% of offenders had some form of mental defect. Factors that may be a motive for committing sex offences are significantly present in the indicators without such a discrepancy. The vast majority of the victims of these crimes were juveniles, 37.29% of whom were mentally ill. In all cases of sexual offences, authors consider it important to conduct a detailed mental health assessment of both the offenders and the victims of the offence. ]

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[Comments on childhood ammentiform psychosis mechanisms of child psychosis]

ZSADÁNYI Ottó, KLEININGER Ottó, GŐDÉNY Sára

[An 11-year-old child with an aetiologically unclear clinical presentation classified as amentiform psychosis is analysed. Results of EEG, PEG, Psychological-testing series are compared with clinical findings over a follow-up of nearly 2 years. In their opinion, neither bacteriological-virological nor psychogenic stress effects can be demonstrated due to currently available technical conditions, so that perhaps pubertal hormone disruption resulted in an anatomical functional transient harmony disturbance that was expressed in clinical psychosis, anatomical-electrical in relation to bihemispheric asynchrony. It is hypothesized that interhemispherially transmitted informatio asynchrony, which also seems to be associated with hormonal disturbances during puberty, may result in a disturbance of realistic perception of the external world and may cause transient psychiatric disturbances. This seems to be confirmed by the return to equilibrium of anatomical, electrical (PEG, EEG.) activity and recovery without residual symptoms.]

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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.

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[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

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[A short chronicle of three decades ]

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[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.]

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[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]