Lege Artis Medicinae

[Significance of intracranial lipomas in connection with a rare case ]


AUGUST 31, 1993

Lege Artis Medicinae - 1993;3(08)

[Intracranial lipomas are rare lesions which are diagnosed in about 0,08% of autopsy cases. An intracranial lipoma in the left Sylvian area of a 93 year old woman was incidentally observed during autopsy. Histological findings supported the diagnosis based on the macroscopic characteristic features. Intracranial lipomas, which are predominantly localized in the median areas are presently considered as develop mental anomalies of the subarachnoid space and not as real tumors. The theory of their pathogenesis explains the other developmental brain anomalies that are often associated with the lesion, as well as the finding of intralipomal vessels and cranial nerves. Though such lipomas are usually asymptomatic, several cases were demonstrated to be associated with seizures. Other symptoms may include hydrocephalus, headaches, behavio ral disorders, focal neurological signs. Diagnosis is based on CT or MRI findings. Intracranial lipomas are usually treated symptomatically and surgical treatment is seldom indicated In most cases shunt operations are performed, since resection is difficult and complete relief of symptoms cannot be expected as a result. ]


  1. Bács-Kiskun Megyei Önkormányzat Kórháza, Patológia, Kecskemét



Further articles in this publication

Lege Artis Medicinae

[The relationship between genetic polymorphism of apolipoprotein E and atherosclerosis and its relevance with clinical practice]


[The lipoprotein metabolism, having crucial role in atherogenesis is regulated by apolipo proteins, lipoprotein receptors and lipidtrans ferase enzymes. The genetic polymorphism of these proteins has been reported to be associated with lipid disorders. Beneath the rare forms (familial hypercholesterolemia, familial defective apo B syndrome) the most important monogenetic dyslipoproteinemia seems to be related to the apolipoprotein E polymorphism. The mean serum cholesterol concentration is influenced by the different apo E phenoytpes (E4 with high, E2 with low cholesterol level). In Hungary, the allele-frequencies (22 0,06, 22 0,80, 34 0,12) and the effect of apo E alleles on cholesterol concentration are very similar to the results found in other populations. Apo E polymorphism shows association with 1. hyperlipoproteinemia type III (E 2/2); 2. dyslipoproteinemia in familial hypercholeste rolemia (E2); 3. premature coronary heart disease (E4); 4. hypercholesterolemia in some populaton (E4); 5. insulin dependent diabetes mellitus in the Hungarian population (E2); 6. the rate of intestinal cholesterol absorption in some population (E4 with higher capacity). In such conditions the determination of apo E phenotype or genotype is very important to reveal the risks of the atherosclerosis and to asses the optimal hypolipidemic therapy.]

Lege Artis Medicinae

[Transvaginal color doppler in early pregnancy]

SZABÓ István, CSABAY László, NÉMET János, PAPP Zoltán

[The authors performed serial examinations using a transvaginal transducer with color Doppler facilities in normal and pathologic early pregnancies in order to examine the circulatory changes in the female genital tract and developing embryo. This is a preliminary study demonstrating the application of TVCD and summarizing the main circulatory characteristics in early pregnancy as a part of a detailed program investigating circulation in the first trimester of pregnancy. Parallel with the implantation as a result of trophoblast induction the branches of the uterine arteries can be visualized by TVCD, and characteristic ilus velocity waveform can be identified in each portion of this network. No diastolic flow can be detected in the embryonic arteries until 12–14 weeks of gestation. The fetal heart rate shows a characteristic change between the 5th and the 14th week of gestation. Examination of the circulatory changes in pathologic early pregnancies helps to establish an exact clinical diagnosis and to choose the proper treatment. The recent advent of the transvaginal probe with color Doppler imaging has permitted accurate studies of the circulatory changes in the female reproductive organs to be performed and provided more information about physiologic and pathologic processes in early pregnancy than all the non-invasive systems developed previously. ]

Lege Artis Medicinae


GÁBOR Zsuzsa

[In the May issue of your newspaper, we published the musings of doctor Lajos Matos, who complained about the "pains of screening". It is feared that a supplement could be filled with not so much refuting the arguments put forward to justify his concerns, but rather adding to them. It is worth reflecting, however, at least at the level of the list, because the train of thought, which has forgotten important aspects (and facts), has led to a very depressing conclusion. ]

Lege Artis Medicinae

[Relative antithrombotic effects of aspirin and of F(ab')2 fragments of an antibody blocking glycoprotein IIB/IIIA receptor]

KISS Róbert Gábor, JEAN-MARIE Stassen, TANIA Roskams, DÉSIRÉ Collen

[The antithrombotic effect of heparin (control group, 100 U/kg bolus and 50 U/kg/hr infusion), of heparin and aspirin (ASA group, 10 mg/kg bolus) and of heparin and F(ab')2 fragments of the murine monoclonal antibody against the platelet glycoprotein lib/Illa (GPIb/Illa) receptor (7E3-F/ab'/2 group, 0.8 mg/kg bolus) were studied in 3 groups of dogs with a 3 cm long everted (inside-out) segment of the carotid artery inserted into the femoral artery and a superimposed constriction which reduced blood flow to 35% of baseline.ASA and 7E3-F(ab')2 caused inhibition of ex vivo platelet aggregation with a decrease from 63 + 8 to 16 + 10% (mean + SEM, p < 0.001) in the ASA group and from 57 £ 5 to 0% in the 7Ė3-F(ab”)2 group. The template bleeding time increased in the ASA group (from 1.4 + 0.2 to 2.9 + 0.4 min, p < 0.05) and in the 7E3-f(ab')2 group (from 1.4 + 0.2 to 51 + 12.6 min, p < 0.001). In the control group the everted segments occluded and remained closed in 6 dogs and showed cyclic flow reduction phenomena in the 5 other dogs. In the ASA group inserted arteries occluded and remained closed in 5 dogs and showed cyclic flow reduction in 4 dogs; one segment remained open (p = 0.69 compared to control). In the 7E3-F(ab')2 group all segments remained patent (p < 0.001 compared to the control and to the ASA group). Thus, the GPllb/Illa blocking monoclonal antibody is significantly more effective than aspirin in the prevention of platelet mediated arterial occlusion. ]

Lege Artis Medicinae

[Boston Area Anticoagulation Trial for Atrial Fibrillation ]


[With the exception of the first month, the prothrombin time was within the desired range for 83% of the study period. There were two "strokes" in the warfarin group (0.41%/year) and 13 in the control group (2.98%/year). The overall mortality rate was 2.25% in the warfarin group and 5.97% in the controls. Minor bleeding occurred in 38 patients on warfarin and 21 in the controls. Subsequent analysis of the control group according to whether and at what dose they were taking aspirin and the extent to which it protected against brain events showed that most brain events occurred among those taking 325 mg of aspirin per day (mean 3.9% per year). In the group taking neither aspirin nor warfarin, the incidence of "stroke" was 1.8% per year and in the warfarin-treated group it was 0.45%.]

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Clinical Neuroscience

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[Objectives - Authors examined the rehabilitation possi­bi­lities, necessities, and results of patients after operation with brain tumor, and report their experiences. Method - Retrospective, descriptive study at the Brain Injury Rehabilitation Unit, in National Institute for Medical Rehabilitation. Patients - Patients were admitted consecutively after rehabilitation consultation, from different hospitals, following surgical intervention of brain tumors, between 01 January 2001 and 31 December 2016. Patients participated in a postacute inpatient rehabilitation program, in multidisciplinary team-work, leaded by Physical and Rehabilitation Medicine specialist included the following activities: rehabilitation nursing, physical, occupational, speech, psychological and neuropsychological therapy. Results - At the rehabilitation unit, in the sixteen-year period 84 patients were treated after operation with brain tumor. Patients arrived at the unit after an average of 41 days to the time of the surgical intervention (range: 10-139 days), and the mean length of rehabilitation stay was 49 days (range: 2-193 days). The mean age of patients was 58 years (20-91), who were 34 men and 50 women. The main symptoms were hemiparesis (64), cognitive problems (26), dysphagia (23), aphasia (16), ataxia (15), tetraparesis (5), and paraparesis (1). The mean Barthel Index at the time of admission was 35 points, whereas this value was 75 points at discharge. After the inpatient rehabilitation, 73 patients improved functionally, the status of 9 patients did not show clinically relevant changes, and 2 patients deteriorated. During the rehabilitation 10 patients required urgent interhospital transfer to brain surgery units, 9 patients continued their oncological treatment, two patients continued rehabilitation treatment at another rehabilitation unit, and after rehabilitation 73 patients were discharged to their homes. Conclusions - Inpatient rehabilitation treatment could be necessary after operation of patients with brain tumor especially when functional disorders (disability) are present. Consultation is obligatory among the neurosurgeon, rehabilitation physician and the patient to set realistic rehabilitation goals and determine place and method of rehabilitation treatment, but even at malignancies cooperation with oncological specialist also needed. Authors’ experience shows benefits of multidisciplinary rehabilitation for patients after brain tumor surgery. ]

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Clinical Oncology

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Clinical Neuroscience



[Out of an average total of 1400 autopsies per year, neuropathological examinations were performed in 477 cases between 1997 and 1999 to investigate the incidence of dementias. The majority of the studied subjects were over 50 years old. Bielschowsky's and/or Gallyas's silver methods and, in some cases, protein tau (MAP) immuncytochemistry and amyloid staining were performed beside routine examination. Pathological changes were found in 212 of the 364 cases studied by the above methods but histological changes associated with dementia were only detected in 167 cases. The various forms of Alzheimer's dementia were also classified by age. The "incipient" form of Alzheimer's disease was verified in 23 cases. Old infarcts of various extensions were found in 42 percent of Alzheimer's dementias. Very mild or age-related degenerative changes were observed in 82 cases among subjects over 50 years old. Of these, eight patients died in their 90s. In some cases (n=38) the number of neuritic plaques dominated over the number of neurofibrillary tangles but a reverse finding also occurred (n=13). Neuronal degeneration was variable and was not always proportional to the number of neurofibrillary tangles. "Simple type of senile atrophy" was defined by the presence of minor or age-related Alzheimer changes and was considered a separate entity. The "incipient" form of Alzheimer's dementia was diagnosed in relatively young individuals where mild Alzheimer changes were found at the neuropathological examination. "Preclinical" Alzheimer's dementia could only be suspected by clinical data and could very rarely be supported by the neuropathological finding of "incipient" form. The ratio of pure Alzheimer’s to vascular dementias cases proved to be 54:41 in this study. The results suggest that dementias are considerably underdiagnosed both in the clinical and pathological practice and that the recently defined "preclinical" and "incipient" forms are very hard to recognize both clinically and pathologically. The neuropathological study of the degenerative, mainly Alzheimer's type, findings in the randomly selected autopsies revealed great variations which raises many questions concerning the normal and pathologic aging of the brain as well as the "incipient" and senile forms of Alzheimer's dementia.]

Lege Artis Medicinae



[INTRODUCTION - In Hungary, like in other countries, previously undiagnosed diseases are frequently discovered at autopsies despite the availability of modern diagnostic tools. The aim of this study was to determine the accuracy of clinical diagnosis in malignant tumour cases. METHODS - Between 1996 and 2006, 5005 autopsies were performed in our institute. Malignant tumour cases with differing clinical and pathological diagnoses were selected and revised with regard to the localization of the primary tumour and the type of diagnostic difference, i.e., false negative, false positive or difference in the tumour site. The proportion of tumours with clinically undetermined primary site that were subsequently recognized at autopsy was established. The causes of misdiagnoses and the appropriateness of therapy were also analysed with regard to whether diagnostic mistakes were made and whether these significantly affected disease outcome. RESULTS - Of 1495 autopsies 235 cases (16%) showed a difference between the clinical and the pathological tumour diagnosis and a further 74 cases (5%) had a clinically undetermined primary tumour. Of the misdiagnosed cases 57% were false negative, 23% were false positive and 20% differed in their localization. Autopsy clarified 75% of the clinically undetermined primary tumours. Overall, there was one misdiagnosis or undetermined primary localization for every 5 correct clinical diagnoses (309/1495, 21%). The most frequent misdiagnosed tumours were lung, liver and kidney cancers. Most (60%) misdiagnoses were due to factors independent from the clinician, so these in fact were not diagnostic errors. Out of the remaining 40%, the true diagnostic error had an adverse effect on disease outcome in 11%.. CONCLUSION - Despite of the use of modern diagnostic tools the rate of clinically misdiagnosed malignant tumours is high, therefore, autopsy will still play an outstanding role in the future in quality control of clinical activity and education.]