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Clinical Neuroscience

MAY 03, 1954

[Histological lesions of the nervous system associated with senium]

HORÁNYI Béla

[1. The degree of senile atrophy of the brain is usually disproportionate to age and the degree of mental and other performance. 2. The senium does not create qualitatively new histological changes. 3. The so-called wear pigment is not a morphological expression of neuronal wear and aging. 4. Senile neuronal lesions can lead to the destruction of functioning elements (large cerebral cortex, subcortical ducts, olfactory tract, etc.) 5. In the senium, the corpus pineale may still contain many intact parenchymal cells; the corpus pineale also has a function in the semium. 6. One of the focal points of senium problems is the issue of vascular permeability. 7. Alzheimer's fibril lesion and senile paque are not necessarily accompanying the senium, but their presence is not an essential pathological function. 8. The compensatory functional capacity of each individual against senile nervous system tissue changes is different. 9. The extent of senile nervous system lesions does not show any sorting principle.]

Clinical Neuroscience

DECEMBER 19, 1951

[Parietal syndromes (Gerstmann's syndrome, attitudinal diseases) in the light of conditioned reflexology]

JUBA Adolf

[Anomia, parietal agraphia and alexia, and finally ujjagnosia were found in three circumscribed skull lesions of the left parietal landscape (the fossa in case 1 affecting the junction of the gyr. angularis, gyr. supramarginalis and the peduncular segment of the 1st temporal gyrus, in observations 2 and 3 the gyr. angularis and partly the occipital cortex). The anomia can be interpreted, following the Pavlovian doctrines, in terms of increased iraddition of the stimulus, reduced concentration, and ultimately degradation of differential inhibition: patients vocalise a series of similar words but do not always reach the adaequate word trace. A similar mechanism is at work in the development of agraphia and alexia, exacerbated by the limitation of dynamic stereotypy to capture the word composed of letters. Parietal foci thus limit speech in its entirety and the pathology of the lesion cannot be seen as a negative of the normal functioning of the site. Finger agnosia in case 1 presented as a simple finger anomaly; in cases 2 and 3, where the occipital cortex was also damaged, the disorder corresponded to Gerstmann's true finger agnosia. Here, a multilayered inhibition of the conditional connections is expected, in which the relaxation of the kinaesthesia-optic junction plays a major role. In a fourth brain lesion in j.o., the foci were located in the more superior lip of the posterior segment of the right interparietal sulcus. In the aura of the epileptic seizures, there was a rotating dizziness, with an onset of contralateral adversion, all of which could be evaluated as focal symptoms. Macropsia developed during the aura and can be understood as a distortion of the optic and oculomotor connections (Pavlov), which indicate the size of objects, and developed in response to the pathological stimulus.]

Clinical Neuroscience

MARCH 28, 1952

[Posttraumatic intracerebral pneumocele]

STEPIEN Lucjan

[The intracerebral pneumothorax (IP) was first described by Chiari in 1884 (1), and then detected by Luckett (2) in 1913 with rtg. as air trapped in the brain ventricle after a skull fracture. Since that time, numerous publications have discussed the aetiology, symptomatology and treatment of IP; in the Polish literature Chorobski and Tyczka (3), Zawadowski (4), Herman and Spiro (5). There are about 120 publications on the same subject in the literature.]

Lege Artis Medicinae

FEBRUARY 01, 2000

[Perinatal postasphyxial brain damage and its obstetric prevention]

PAPP Zoltán

[The author provides an overview of the definition and aethiopathogenesis of fetal hypoxia and asphyxia, including possible forms of post asphyxial damages of mature fetuses as well as the incidence and neurological consequences of cerebralpalsy. Among from the screening methods of fetal hypoxia the special importance of colour-Doppler and pulse-Doppler technique (flowmetry), cardiotocography (CTG), non-stress test, biophysical profile examinations, amnioscopy and fetal pulsoxymetry are emphasized. In the prevention of fetal asphyxia the significance of preconceptional and prenatal care, the importance of maternal diseases, pathological conditions of the fetus and the umbilical cord, as well as the influence of factors during labour and delivery are also emphasized. The practice of the authors is supported by the recommendation of British obstetricians, when making a fetal scalp pH examination in case of pathological CTG findings, or performing a prophylactic cesarean section if the pH examination is not available. Since the number of postasphyxial damage in mature newborn infants is still high in Hungary, it is concluded, that an increase is required in the rate of cesarean sections when fetal asphyxia is present. ]

Clinical Neuroscience

NOVEMBER 20, 1996

First experiences with MR-compatible implants in the management of Aneurysmal subarachnoid haemorrhage

DÓCZI Tamás, KÖVÉR Ferenc, HORVÁTH Zoltán, MÉSZÁROS István, VADON Gábor

Aneurysm clips made of titanium alloy were considered to be useful for clinical application due to the expected reduction in artifact formation on postoperative CT and MR. First, the behaviour of the new titanium clip (Aesculap) was investigated in phantom experiments in CT and MR scanners. After the in vitro tests had proved the applicability of the new implants, a series of operations was performed employing the new clip in 21 patients and the traditional phynox clip in 17 patients. All patients with a titanium implant had postoperative 11, T2 and proton-weighted MR scans. In 12 cases pre- and postoperative; in 9 cases only postoperative MR angiographies were carried out. In 4 patients both control MR- and catheter angiographies were performed. Clinical results as analysed at least 6 months following the operation were not different from those of 1992 and 1993 of the same team and were comparable to recently published data in the literature. The study has shown that ability to effectively diagnose clip-adjacent brain structures can be improved considerably by employing clips of titanium alloys. Concerning the value of postoperative MR angiography either with or without contrast material to control the effectiveness of aneurysm occlusion, the following conclusion was drawn: while the postoperative potency of the parent artery was clearly visualized in every case, it was impossible to define whether occlusion of the aneurysm had been complete.

Clinical Neuroscience

JULY 30, 2021

[Personalised epilepsy treatment]

ALTMANN Anna

[Epilepsy is one of the most common chronic neurological disease in childhood. Patients with epilepsy – even with so-called benign epilepsy – need medication for years. During this time, children go through a very big change, not only gaining weight and height, but also changing hormonal and metabolic processes. Maturation processes in different brain areas also take place at different rates depending on age. All of these should be considered when preparing a therapeutic plan. In everyday practice after the diagnosis of epilepsy, the applied drug is most often selected based on the shape and type of seizure. However, a number of other factors need to be considered when designing a therapeutic strategy: 1. efficacy (form of epilepsy, type of seizure), 2. age, gender, 3. pharmacological properties of the drug, 4. adverse drug reaction profile, 5. lifestyle (community), figure (skinny, corpulent, obese), 6. other comorbidities (nutrition, behavioral and learning problems, circulatory disorders, kidney or liver disease), 7. expected interactions with other drugs already used, 8. genetics, 9. other aspects (drug registration and prescription rules). The purpose of this article is to help to decide which antiepileptic drugs are expected to have the least side effects in a particular child with different comorbidities and which medications should be avoided if possible.]

Clinical Neuroscience

JULY 30, 2021

[Controversies in neurology: Diagnosis, follow up and therapy of multiple sclerosis with pathomechanismal approach]

VÉCSEI László

[The clinical boundaries between the relapsing and progressive course of multiple sclerosis are often indistinct. Despite the variable patterns of evolution, there are no biological reasons for discerning different multiple sclerosis phenotypes. Indeed, both primary progressive and secondary forms of the disease share similar pathological features in respect of the extent of inflammatory infiltrates, axonal damage, and cortical demyelination. The data indicating that primary progressive multiple sclerosis is preceded by an asymptomatic relapsing remitting phase. The proposed definition of secondary progressive multiple slcerosis, the attainment of at least EDSS of 4 is required to mark the transition to the progressive phase. Therefore, the clinical progress can be uncovered in the early phase of the disease. Furthermore, a continuous progression independent of relapsing activity is commonly observed during the relapsing remitting phase. A continuous smouldering process underpins the subtle clinical deterioration, which stands out as an important unmet treatment target. Concerning cognitive dysfunction of the patients pro-inflammatory cytokines have been associated with worse cognition in active multiple sclerosis, and this inflammatory milieu could also contribute to altered mentation during relapses. Therefore, long before people with multiple sclerosis become physically disabled, they have usually acquired hidden disabilities related to cognitive impairment. Silent progression appears during the relapsing remitting phase and it associates with brain atrophy. This suggests that the same process that underlies secondary progressive multiple sclerosis likely begins far earlier than is generally recognized. This supports a unitary view of multiple sclerosis biology. ]

Clinical Neuroscience

NOVEMBER 20, 1996

[Repeated stroke, psychotic episode - primary antiphospholipid syndrome?]

CSIBRI Éva, FARKAS Márta

[The antiphospholipid syndrome described some 10 years ago is characterized by a predisposition to arterial and venous thrombosis and the presence of antiphospholipid antibodies. It is often associated with systemic lupus erythematosus, but its primary forms are also well known. Its clinical features are well known in neurology as well as in psychiatry. In this paper we present a case report with therapeutic implications. We discuss the importance of reccurent stroke at a young age in association with the possibility of a rare manifestation of antiphospholipid syndrome: organic brain disease, appearing in the form of schizoaffective psychopathological symptoms.]

Clinical Neuroscience

NOVEMBER 20, 1996

[Left median thalamic infract and complex plasy]

VASTAGH Ildikó, FOLYOVICH András, ARÁNYI Zsuzsanna, BODROGI László, TÁRCZY Miklós

[The authors present the case history of a 68-years­ old female patient. The patient, who is known to have hypertension, developed on the day of her admission a short lasting loss of consciousness. Upon recovery the following neurological symptoms were observed: gaze paresis upward and to the right, skew deviation, partial gaze paresis downward, slight right sided hemipares is, ataxia of the right extremities and trunk, right sided hemihypesthesia. Short neuropsychological examination disclosed a speech disorder and the disturbance of abstract thinking. CT scan of the brain showed a congenital arachnoidal cyst in the region of midline cerebellar structures, ischemic infarcts in the right cerebellar hemisphere and in the medial part of the left thala­mus. MRI in addition revealed a 2-3 mm large infarct in the mesencephalon. MR angiography showed a tortuous basilar artery. Neuro-ophthalmological examination and acoustic evoked potentials indicated a functional disturbance at the right side of the brainstem at the level of the pons and midbrain. The authors present a case with a thalamic infarct accompanied by a complex eye movement disorder and cerebellar symptoms. They wish to indicate the role of thalamic infarcts in the development of a sud­den loss of consciousness with successive neuropsy­chological disturbance and gaze palsy.]

Clinical Neuroscience

SEPTEMBER 20, 1996

[Transoesophageal echocardiography after stroke]

NAGY Lajos, SÁMOCYI Marianna, TARJÁN Jenő, GARZULY Ferenc

[40 stroke patients were studied by both transoesophageal and transthoracic echocardiography. The diagnosis of stroke was based on medical history, physical examination and computerized tomographic brain scan. 39 patients underwent carotid duplex scan as well. Transoesphageal echocardiography was used to examine 40 patients of whom 19 had cardiac source of embolism. Out of these, 7 patients had definitive, whereas 12 had possible cardiac source of embolism. Transthoracic echocardiography was diagnostic only in 8 cases. Using carotid duplex scan, carotid stenosis was detected in 8 patients and sclerosis without significant stenosis in 8 others. From each of these two groups 4 patients had coexistent cardiac source of embolism as well. In the 8 patients with atrial fibrillation the left atrial thrombus and spontaneous echo contrast were more frequent than in patients with sinus rhythm. The transoesophageal echocardiography altered the management of antico agulation in 3 patients. The authors concluded that transoesophageal echocardiography is necessary in stroke patients.]