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Lege Artis Medicinae

MAY 01, 2000

[The cervical spine in rheumatoid arthritis]

KORDA Judit, VERES Róbert

[The neck is the third most common site of involvement after the hands and feet in rheumatoid arthritis (RA). Deformities of the cervical spine can appear in the early stage of the disease, but most often they are seen in patients with rheumatoid arthritis with more than ten years of duration. Progression of the deformity is unpredictable, but follow up for five to ten years has shown the worsening of the instability in 16-80% of the patients. Many patients with rheumatoid disease of the cervical spine remain asymptomatic for years, but they are at risk of a range of neurological complications and even sudden death from me dullary compression. Neurological abnormalities may be subtle and difficult to establish in the presence of deforming arthritis. Once myelopathy develops, it is usually rapidly progressive. The primary goal in the management of the cervical spine is to prevent the onset of irreversible neurological deficit. Patients should have regular physical examinations to avoid the masking of subtle changes of myelopathy by severe peripheral joint disease. Use of the different measurements, especially posterior atlantodental interval and subaxial canal diameter measured on plain lateral cervical radiograph is a reliable screening tool to identify high risk patients who require further evaluation. The primary technical objective of surgery is stabilization of the diseased spinal segments and relief of spinal cord compression via reduction of subluxation or decompression. Complications are not uncommon, but tend to occur less frequently, and neurological recovery is most favorable when severe cord compression is not present preoperatively. ]

Clinical Neuroscience

MAY 30, 2021

[A case of destructive cervical spondylarthropathy related to chronic dialysis]

BERTA Balázs, KOMÁROMY Hedvig, SCHWARCZ Attila, KAJTÁR Béla, BÜKI András, KUNCZ Ádám

[A case of a 61-year-old male patient suffered chronic renal failure and dialysed for 23 years with destructive cervical spondylarthropathy is presented. The patient presented with sudden onset of cervical pain radiating into his shoulders without neurological deficits. CT and MRI of the cervical and thoracic spine revealed severe destructive changes and compressive fractures of C6 and C7 vertebrae which caused the narrowing of the nerve root canals at these levels. A 360-degree fixation was performed to treat the unstable fracture and the patient’s pain (C6 and C7 corpectomy, autolog bone graft replacement of the two vertebral bodies, anterior plate fixation and posterior instrumentation with screws and rods). Postoperatively the patient had no significant pain, no neurological deficit and he was able to manage independent life himself. During the immediate follow-up CT of the neck showed the satisfactory position of the bone graft and the metal implantations. The 6 months follow-up CT revealed the anterior migration of the two screws from the Th1 vertebral body and 2 mm ventral elevation of the caudal end of the plate from the anterior surface of the Th1 vertebral body. The 1-year follow-up could not be performed because the patient died due to cardio-pulmonary insufficiency. This is the second Hungarian report of a chronic dialysis related severe spondylarthropathy which may cause pathologic fractures of the vertebral bodies. The typical radiological and histological findings are discussed. This disease affect patients’ quality of life and the conservative treatment alone seems to be ineffective in most cases. Based on the literature and personal experiences, the authors suggest 360-degree fixation of the spine to provide sufficient stability for the vertebrae of ”bad bone quality”, and early mobilisation of the patient can be achieved.]

Clinical Neuroscience

SEPTEMBER 30, 2019

Coexistence of cervical vertebral scalloping, pedicle deficiencies and dural ectasia in type I neurofibromatosis

YALDIZ Mahizer

Neurofibromatosis type 1 (NF-1; also known as Von Recklinghausen’s disease) is a common autosomal dominant disease that occurs in the general population at the rate of 1 in 3000. Many NF-1 patients present with spinal malformations. A 54-year-old female patient was admitted to the Outpatient Clinic of Dermatology with gradually increasing swelling and spots on the body that had been present for a long period of time. Cervical vertebral scalloping, pedicle deficiencies and dural ectasia (DE) were also detected. She was diagnosed with NF-1. NF-1 is routinely seen in dermatology practice. Coexistence of NF-1 with vertebral scalloping, pedicle deficiencies and DE rarely occurs. Our case is the second reported instance in the literature of NF-1 with a spinal anomaly in the cervical region, and the first reported instance of the coexistence of NF-1 with cervical vertebral scalloping, pedicle deficiencies and DE.

Clinical Neuroscience

MAY 30, 2021

Fatal outcome of cervical myelopathy caused by fibrocartilaginous embolism. Rare cause of spinal vascular damage

FOLYOVICH András, HAVAS László, VADÁSZ Gizella, FEHÉR Ágnes, VADASDI Károly, SZABÓ Zsolt, TÓTH Kornélia, BÉRES-MOLNÁR Anna Katlin, TOLDI Gergely

Fibrocartilaginous embolism is a rare cause of ischemic myelopathy. Authors report a case of a 39-year-old woman with progressive tetraparesis and severe autonomic dysfunction. Despite of the detailed examinations, the definite diagnosis was verified by autopsy. The patient was admitted because of progressive pain and numbness of the upper extremities and tetraparesis. Hypotonic muscles of the lower extremities with mild tetraparesis were observed. Magnetic resonance imaging showed an intramedullary lesion at the level of the cervical V-VII vertebral. Patient’s tetraparesis worsened gradually to plegia with urinary retention. Expansive, rapidly progressing multiple decubiti developed, which were resistant to therapy. In spite of the complex therapy, the patient died. No internal disease was found to explain the death by autopsy. Multiple subacute infarctions of the cervical myelon (involving the lateral columns as well) in the territory of the anterior spinal artery were verified by neuropathological examination. The occluded vessels were filled by a material containing cartilaginous cells, while signs of atherosclerosis or thrombosis were not present. Cartilaginous embolism of spinal arteries was diagnosed.

Clinical Oncology

APRIL 30, 2020

[Hormone replacement therapy in cancer survivors – Review of the literature]

DELI Tamás, OROSZ Mónika, JAKAB Attila

[Rapid advance in oncology leads to increasing survival of oncologic patients. More and more of them live long enough to reach either the natural age of menopause or, as a side effect of their oncotherapy, experience the cessation of gonadal function, leading to premature ovarian insuffi ciency, with disturbing vasomotor symtoms and long-term negative cardiovascular and skeletal effects. Thus, an ever increasing number of cancer survivors search endocrinologic help in the form of hormone replacement therapy (HRT). The misinterpretation of the WHI (Women’s Health Initiative) Study has lead to an irrational fear of female hormone replacement, both by the general population and medical professionals. It has seemed the logical and safe conclusion to many physicians to avoid HRT, supposing that this attitude defi nitely causes no harm, whereas the decision of prescribing estrogen alone or with progestins might bear oncologic and thromboembolic risks and may even lead to litigation in case of a potentially related complication. However, it was known even before the WHI results that premature menopause and hypogonadism decreases the life expectancy of women by years through its skeletal and cardiovascular effects, and this negative effect correlates with the length of the hypoestrogenaemic period. Yet, the oncologic risk of HRT is extremely diffi cult to assess. In this work we review the latest evidence from in vitro experiments to clinical studies. We group tumours regarding the oncologic risk of properly chosen female hormone replacement therapy in cancer survivors as follows: ’HRT is advanageous’ (e.g. endometrial cancer type I, cervical adenocarcinoma, haematologic malignancies, local cutaneous malignant melanoma, colorectal cancer, hepatocellular cancer); ’HRT is neutral’ (e.g. BRCA 1/2 mutation carriers without cancer, endometrial cancer type II, uterinal carcinosarcoma and adenosarcoma, certain types of ovarian cancer, cervical, vaginal and vulvar squamous cell carcinoma, prolactinoma, kidney cancer, pancreatic cancer, thyroid cancer); ’HRT is relatively contraindicated’ for various reasons (e.g. leiomyosarcoma, certain types of ovarian tumours, brain tumours, advanced metastatic malignant melanoma, lung cancer, gastric cancer, bladder cancer); ’HRT is diasadvantageous and thus contraindicated’ (e.g. breast cancer, endometrial stroma sarcoma, meningioma, glioma, hormone receptor positive gastric and bladder cancer).]

Clinical Neuroscience

DECEMBER 31, 1954

[Multinucleated sympathetic ganglion cell in humans]

HARSÁNYI László

[In view of the foregoing, it must therefore be concluded, contrary to previous observations, that the formula in the cervical sympathetic ganglia of healthy adult humans, also in the ggl. c. sup., can be regarded as an abnormal element and its formation is presumably due to a cell division disorder.]

Clinical Neuroscience

NOVEMBER 20, 1996

[Post-traumatic ischemic stroke in childhood]

VELKEY Imre, LOMBAY Béla

[A report is given about two children with post-traumatic ischemic stroke. In the first case a blunt head injury, in the second case a minor cervical trauma caused the ischemic cerebrovascular episodes. The diagnosis was made after repeated CT scans by the help by sonography. The possible traumatic origin of acute hemiparesis due to ischemic stroke in children is emphasized. ]

Clinical Neuroscience

JULY 30, 2020

[The complex intensive care and rehabilitation of a quadriplegic patient using a diaphragm pacemaker]

FODOR Gábor, GARTNER Béla, KECSKÉS Gabriella

[A 21 year female polytraumatized patient was admitted to our unit after a serious motorbike accident. We carried out CT imaging, which confirmed the fracture of the C-II vertebra and compression of spinal cord. Futhermore, the diagnostic investigations detected the compound and comminuted fracture of the left humerus and femur; the sacrum and the pubic bones were broken as well. After the stabilization of the cervical vertebra, a tracheotomy and the fixation of her limbs were performed. She spent 1.5 years in our unit. Meanwhile we tried to fix all the medical problems related to tetraplegia and respiratory insufficiency. As part of this process she underwent an electrophysiological examination in Uppsala (Sweden) and a diaphragm pacemaker was implanted. Our main goal was to reach the fully available quality of life. It is worth making this case familiar in a wider range of public as it could be an excellent example for the close collaboration of medical and non-medical fields.]

Clinical Neuroscience

MAY 30, 2020

[Early experiences in surgical treatment of thoracic disc herniation from posterior transdural approach at Neurosurgery Clinic Szeged University]

MÁRKOS-GERGELY Gellérd, WATFA Kerim, BALÁZSFI Márton, SZEGETI Andrea, BARZÓ Pál

[Background – Because of the rare occurrence of thoracic disc herniation and surgery needed treatment the used approaches and their efficiency are still subjects of discussions. In Hungarian practice, the most frequent explorations are costotransversectomy and laminectomy, but there are many other important methods available like thoracoscopic and posterior transdural approaches. This case report will present the benefits and the surgical procedure of posterior transdural sequesterectomy, carry out for the first time in Hungary at the Neurosurgical Department on Szeged University. Case presentation – A 50-year-old female patient with achondroplasic nanism has been operated several times since 2011. She suffered from a progressive, multi-segment affected degenerative discopathy and myelopathy. Finally in the background of the recurrent paraparesis was confirmed thoracic disc herniations at the levels of T8 and T9. The use of intraoperative electrophysiology was not feasable, because the earlier described cervical myelopathy. For this reason we used the posterior transdural approach, as the best and safest, visual control warranted technique. Conclusions – The posterior transdural approach offers an alternative option for experienced surgeons, furthermore in contrast with traditional, technically difficult to implement or special instrumentation demanding approaches this technique seems to be more efficient.]

Clinical Neuroscience

NOVEMBER 20, 2015

[A rare complication of a rare disease; stroke due to relapsing polychondritis]

KILIC COBAN Eda, XANMEMMEDOV Elimir, COLAK Melek, SOYSAL Aysun

[Relapsing polychondritis (RP) is an episodic and progressive inflammatory disease of cartilaginous structures. Its diagnosis is based primarily on clinical features such as laboratory parameters, biopsy. Neurological complications occur in 3% of the cases and are classified as an important cause of death. The cranial nerve disorders are most common but hemiplegia, ataxia, myelitis, polyneuritis, seizures, confusion, hallucination and headache can also happen. The aetiology of central nervous system involvement is still unknown. Moreover stroke has rarely reported in these patients. The diagnosis of stroke is challenging because of its rarity among these patients. Perhaps vasculitis is the common underlying mechanism. Also meningitis and encephalitis can occur during the course of RP. A 44 year-old woman was admitted with uncontemplated left hemiparesis, redness, swelling, and tenderness of the metacarpophalangeal and interphalangeal joints of the right hand and the cartilaginous portion. White blood cell count, C-reactive protein and the erythrocyte sedimentation rate were elevated. Vasculitis biomarkers were normal in our patient. Carotid and vertebral artery doppler ultrasonography, cranial and cervical MR Angiography were normal. Echocardiography showed a mild mitral valve prolapse and regurgitation. Our patient had the history of auricular polychondritis but she had not been diagnosed. Hemiparesis was her first neurological manifestation that led her to doctors for diagnosis. Our patient fulfilled the criteria of RP so no biopsy was needed. She was treated with oral prednisolone (80 mg/day) and aspirin (300 mg/day) and now she is on 10 mg prednisolone and 150 mg azathioprine. Two months later her physical and neurological symptoms returned to normal.]