Lege Artis Medicinae

[Two Seconds]

dr. TAMÁS László

JANUARY 22, 2008

Lege Artis Medicinae - 2008;18(01)

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Clinical Neuroscience

Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.

Clinical Neuroscience

[Interdisciplinary approach of vestibular system impairment]

PONGRÁCZ Endre

[In the first part of this review the definition of vertigo/dizziness was discussed. The major difference between the two signs is the exsistence of the direction, which is specific for vertigo. Dizziness is a frequent complaint in the clinical practice. Its frequency is increasing with advance of age, to intimate the play of declining cognitive process in the pathogenesis of its. The popular health significance of vertigo is in the rowing number of the patients. The onset of the most cases with acute vertigo appears between secundums and minutes so the patients will be provided in circumstances of emergency department. First of all three form schould be take into account: neuronitis vestibularis, benign paroxysmal positional vertigo and Meniere syndrome. Without tipical periferal signs of vertigo, central cause should be searched, principally stroke (lysis possibility). The differential diagnose of the different dizzeness/vertigo forms according to the elapsed time of the onset or congenital and acquired nystagmus was created in tables. The recommendations of the therapy of acute and chronic dizziness/ vertigo syndroms are, lack of results of evidence based trials doubtful. The more often used drugs based on clinical trials are discussed as vinpocetine, betahistine and piracetam. The in vitro and in vivo data suggest that the last molecule is eligible to use both in periferal and central type of vertigo syndroms.]

Clinical Neuroscience

[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

GABRIELLA BALÁS, ISTVÁN KOMOLY, SÁMUEL DÓCZI, TAMÁS JANSZKY, JÓZSEF ASCHERMANN, ZSUZSANNA NAGY, FERENC BOSNYÁK, EDIT KOVÁCS

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

Hungarian Radiology

[Stroke prevention: Experience with endovascular therapy of carotid artery stenosis]

SZENTGYÖRGYI Réka, VÖRÖS Erika, PÓCSIK Anna, MAKAI Attila, BARZÓ Pál, SZTRIHA László, SZIKRA Péter, PALKÓ András

[INTRODUCTION - Carotid artery stenting as an alternative to carotid endarterectomy is still not accepted by many Hungarian vascular surgeons. The purpose of our study was to prove that carotid artery stenting is effective in the treatment of primary atherosclerotic lesions and it carries a low risk of complications. PATIENTS AND METHODS - 149 patients (86 men, 63 women, 33-82 years old, mean age 57.5 years) were evaluated angiographically. 146 primary atherosclerotic lesions, and 8 post-endarterectomy restenoses were considered for carotid artery stenting. All patients had significant, over 60% stenosis according to NASCET criteria. Atherosclerotic plaques were classified as smooth, irregular and ulcerated. Subtotal occlusions (stenoses over 95%) were noted. The necessity of pre- or postdilation and the types of stent used were registered. Procedural success and periprocedural complication rates were noted. Followup colour Doppler sonography was performed at 1, 6 and 12 months. RESULTS - Subtotal occlusions were detected in 28% of the lesions. Procedural success rate was 149/150 (99%). Stenting was carried out in 86% with Monorail Carotid Wallstent. Predilation or use of protecting device was avoided in 96%. Postdilation was avoided in 6 cases of ulcerated plaques to prevent distal embolisation. Residual stenosis was always less than 30%. Stroke occured in 2.6%, TIA in 0.7%. Two of our patients developed restenosis. CONCLUSION - Carotid artery stenting is a safe alternative to carotid endarterectomy for most patients with primary atherosclerotic stenosis, as it can be carried out with clinical complication rate as low as published in the ACAS.]

Ca&Bone

[Effect of cigarette smoking on bone density]

MÉSZÁROS SZILVIA, FERENCZ VIKTÓRIA, DELI Mónika, BORS Katalin, HORVÁTH CSABA

[INTRODUCTION - Smoking is associated with a decreased bone mass and increased risk of osteoporotic fractures.The aim of this study was to investigate the impact of current tobacco smoking to bone mineral density (BMD) in Hungarian females. PATIENTS AND METHODS - We measured BMD in 43 (25-72 yrs) smoker and 43 age- and BMI-matched non-smoker women by dual X-ray absorptiometry (Prodigy, GE Lunar) at the lumbar spine and proximal femur and by single photon absorptiometry at the radius midshaft of the non-dominant side (NK 364, Gamma). RESULTS - Osteoporosis (T-score at any measured site below - 2.5) was found to be more common among smokers compared to non smokers (63.6% vs 36.4%, χ2-test p=0.009). Among premenopausal women no difference was found in BMD between the two groups, whereas postmenopausal smoker women tended to have a lower BMD value compared to those who didn’t smoke. In postmenopausal women a decrease of borderline significance was found in lumbar BMD (0.977 vs 1.04; p=0.06). CONCLUSION - Our observation suggests that there is only a slight decrease in bone mass due to smoking, however, added to menopausal bone loss this effect can be a significant contributor to the increased fracture risk of involutional age.]