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Clinical Neuroscience

JULY 30, 2017

[Systemic thrombolysis after the administration of idarucizumab in acute ischemic stroke]


[Introduction - Expanding indications have resulted in an increasing number of patients taking novel oral anticoagulants, posing a major treatment dilemma in acute ischemic stroke. Case presentation - We present a successful intravenous thrombolysis in a dabigatran-treated patient with acute ischemic stroke after the administration of idarucizumab. Discussion - According to current guidelines, systemic thrombolysis is contraindicated under treatment with novel oral anticoagulants (taken within 48 hours). In this scenario, idarucizumab offers a solution by reversing the anticoagulant effect of dabigatran. Conclusion - Although there have only been case reports published so far, the dabigatran-antidote idarucizumab seems to give new therapeutic opportunities in the treatment of acute ischemic stroke.]

Clinical Neuroscience

MAY 30, 2017

[Non-contrast brain ct based systemic thrombolysis of two wake up ischemic stroke patients in rural settings]

POZSEGOVITS Krisztián, RENCZ László, CSÚSZ Lajos, SZABÓ Géza

[Background and presentation - Conventionally the acute ischemic stroke patients who wake up with symptomes (WUS - wake up stroke) cannot benefit from systemic thrombolysis due to the uncertainty of the exact onset time of the cerebrovascular event. Perfusion brain imaging could be used as patient selection tool but the method is not available in many settings. Simple non-contrast CT scan is easily accessible and reliable as it shows the different stages of the evolving ischemia with high accuracy. Early brain CT scan results of WUS patients have the same characteristics as the ones who are surely within therapeutic window. The intravenous thrombolysis with recombinant tissue plasminogen activator (rTPA) of WUS patients seems to be similarly successful as the ones with known onset time, the treatment does not come with excess complications, higher rate of symptomatic intracranial hemorrhage was not found in previous reports. Purpose - In this report we present two systemic thrombolysis cases of acute ischemic stroke patients who woke up with stroke symptoms. Methods - In 2014 and 2015 we performed systemic thrombolysis for one wake up stroke patients, respectively. Both patients had large vessel occlusion. Indication was based on favourable non-contrast brain CT scan results. Results - Treatment of these two patients with rTPA proved to be safe, no hemorrhage occurred after treatment. Conclusion - We presented two acute ischemic stroke patients with symptomes at early wake up who were treated intravenously with recombinant tissue plasminogen activator based on non-contrast CT alone without complications and some moderate improvement at 90 days in the settings of a rural town hospital in a middle income country.]

Hypertension and nephrology

APRIL 10, 2017

[Efficient, cardiovascular risk-dependent therapy of patients with hypertension according to the data from database of the Hungarian Hypertension Registry]

KISS István, PAKSY András, KÉKES Ede, KERKOVITS Lóránt

[Over 3.5 million people have hypertension in Hungary, although with only 40-45% of them have the target blood pressure of under 140/90 been reached thanks to the non-medication and medication therapies. The reason of this can be several folds as an improperly chosen blood pressure lowering therapy, not sufficient care, insufficient doctor-patient cooperation and the incompetent information of the patients. According to the Hungarian Hypertension Register’s database of 2015 it is confirmed that the reaching of target blood pressure significantly differs and in the case of the hypertension disease coincide with the morbidity and mortality differences of the regions. These regional differences can be explained with not only the social, cultural and economic dissimilarities, but with the diversity of the quality of the healthcare and the professional work. Analyzation of the biggest risk factors of hypertension as the diabetes, ischemic heart failure and chronic kidney disease showed that when all of them are extant, the reaching of the target blood pressure is only successful in the case of 26% of the male and 33% of the female’s patients. According to the Register it turned out that the leading cause of the unsuccessful reaching of the target blood pressure is the peripheral vascular disease in the case of female patients which is followed by in turn with the disorder of lipid metabolism, the disorder of uric acid metabolism and obesity. The leading cause in the case of male patients is lipid metabolism which is followed by in turn with smoking, alcohol abuse and peripheral vascular disease. According to the summed-up results, 88% of the patients received combined treatment with the medication suggested by the professional guidelines. The proportion responsible for the unsuccessful reaching of the target blood pressure can be explained by the insufficient patient concordance and adherence. Both patient information and the care involved in the doctor-patient relationship have to be corrected and improved. One possible solution is the transmission of some competence of the doctors to the well-trained assistants and nurses who have a decisive role in the risk assessment and the base medical examination. It is also important to draw the pharmacists in too to the care of patients with applying more telemedicinal methods. It can be concluded from the results that came from the processing of the Register’s database that the population-level knowledge is important and the continuation of the data entry into the Register is necessary.]

Clinical Neuroscience

MARCH 30, 2017

Pazopanib induced unilateral posterior reversible encephalopathy syndrome

ARSLAN Beyza Muhsine, BAJRAMI Arsida, DEMIR Elif, CABALAR Murat, YAYLA Vildan

Posterior reversible encephalopathy syndrome (PRES) is a reversible clinical and neuroradiological syndrome which may appear at any age and characterized by headache, altered consciousness, seizures, and cortical blindness. The exact incidence is still unknown. The most commonly identified causes include hypertensive encephalopathy, eclampsia, and some cytotoxic drugs. Vasogenic edema related subcortical white matter lesions, hyperintense on T2A and FLAIR sequences, in a relatively symmetrical pattern especially in the occipital and parietal lobes can be detected on cranial MR imaging. These findings tend to resolve partially or completely with early diagnosis and appropriate treatment. Here in, we present a rare case of unilateral PRES developed following the treatment with pazopanib, a testicular tumor vascular endothelial growth factor (VEGF) inhibitory agent.

Clinical Neuroscience

JANUARY 20, 2017

[Thrombolysis in case of ischemic stroke caused by aortic dissection]

LANTOS Judit, NAGY Albert, HEGEDŰS Zoltán, BIHARI Katalin

[Seldom, an acute aortic dissection can be the etiology of an acute ischemic stroke. The aortic dissection typically presents with severe chest pain, but in pain-free dissection, which ranges between 5-15% of the case, the neurological symptoms can obscure the sypmtos of the dissection. By the statistical data, there are 15-20 similar cases in Hungary in a year. In this study we present the case history of an acute ischemic stroke caused by aortic dissection, which is the first hungarian publication in this topic. A 59-year-old man was addmitted with right-gaze-deviation, acute left-sided weakness, left central facial palsy and dysarthric speech. An acute right side ischemic stroke was diagnosed by physical examination without syptoms of acute aortic dissection. Because, according to the protocol it was not contraindicated, a systemic intravenous thrombolysis was performed. The neurological sypmtoms disappeared and there were no complication or hypodensity on the brain computed tomography (CT). 36 hours after the thrombolysis, the patient become restlessness and hypoxic with back pain, without neurological abnormality. A chest CT was performed because of the suspition of the aortic dissection, and a Stanford-A type dissection was verified. After the acute aortic arch reconstruction the patient died, but there was no bleeding complication at the dissection site caused by the thrombolysis. This case report draws attention to the fact that aortic dissection can cause acute ischemic stroke. Although it is difficult to prove it retrospectively, we think the aortic dissection, without causing any symptoms or complain, had already been present before the stroke. In our opinion both the history of our patient and literature reviews confirms that in acute stroke the thrombolysis had no complication effect on the aortic dissection but ceased the neurological symptoms. If the dissection had been diagnosed before the thrombolysis, the aortic arch reconstruction would have been the first step of the treatment, without thrombolysis. ]

Lege Artis Medicinae

SEPTEMBER 20, 2015

[Causes and pathological appearances of ischemic heart diseases]


[The myocardial ischemia is caused by insufficient offer of oxygen, it can be caused by damage of coronary arteries which is called coronary heart disease, and might be non coronary in origin, this is the relative coronary insufficiency. The reason of coronary heart diesease is the stenosis or occlusion of the lumen of subepicardial main coronary branches as well as intramyocardial small vessels. The type of alterations either of the main or the small vessels are mentioned. The myocardial bridge play an important part in genesis of intimal plaques. The discrepancy occuring between the actual oxygen demand and oxygen offer causes the relative coronary insufficiency, such as myocardial hypertrophy, anemia, shock, fever etc. The myocardial damages, those of caused ischemia can be devided pathologically irreversibile lesions (infarction, coagulative and colliquation myocytolysis) and ischemic heart disease (ischemic cardiomypathy) and clinically angina pectoris and sudden death. The irreversible lesions are detailed in morphological point of view, and differenece between the regional and subendocardial infarction is accentuated.]

Clinical Neuroscience

SEPTEMBER 30, 2015

[Transient pseudobulbar syndrome in unilateral frontal opercular infarcts]

RÓZSA Anikó, TORÁK Gyöngyi, NAGY Éva, KOVÁCS Krisztina, GÁCS Gyula

[The classic anterior (frontal) opercular syndrome (Foix- Chavany-Marie sy.) is a cortical pseudobulbar palsy mainly due to bilateral lesions of anterior brain operculum. In 2000 the authors had a 70-year old female patient with acute onset of swallowing and speaking difficulty. Neurological examination established a left facial central palsy, the palsy of the tongue and the soft palate, dysarthry, difficulty in chewing with left side hemiparesis. The CT scan showed a right side (one-sided) frontal opercular ischemic lesion. This event switched their attention especially to this group of cases and subsequently the authors collected 12 patients with these symptoms. Authors discuss the patomechanism of transient pseudobulbar palsy that occurs due to unilateral opercular lesion that the diaschisis effect might explain.]

Clinical Neuroscience

SEPTEMBER 30, 2015

Extreme delta brush EEG pattern in a case with anti-NMDA receptor encephalitis


Anti-N-methyl-D-aspartate receptor NMDA-R encephalitis is caused by antibodies against the NMDA-R and characterized by a severe encephalopathy with psychosis, epileptic seizures and autonomic disturbances. This disorder is often accompanied with malignancies, especially ovarian teratoma. Some patients’ EEGs show a different pattern similar to the waveforms of premature infants and this pattern is specifically named as extreme delta brush (EDB). We report a 24-year-old female having anti-NMDA receptor encephalitis and EDB patern.

Journal of Nursing Theory and Practice

FEBRUARY 28, 2015

[The significance of post-reanimation treatment using therapeutic hypothermia in the intensive care ward]


[Aim of the research: To assess the significance of applying therapeutic hypothermia (TH) in order to prevent cerebral neurologic damage following cardiopulmonary resuscitation (CPR). Research and sampling methods: Retrospective and quantitative research, applying stratified, not random sampling. The research was conducted by analysing medical and clinical nurse documentation, using direct data collection. The total number of patients (n) referred to the intensive care ward of county hospital due to prolonged life support (PLS) during the two different years was 68. In 2005, the number of patients (n) not receiving TH was 28 whereas in 2010 the number of patients who did receive TH was 29 and the number of those who did not receive TH in the same year was 11. Results: Comparing the research results of the two patient groups, it can be concluded that the patients who received TH in 2010 left the intensive care ward with better neurological function, no significant difference. PLS carried out with full body cooling proved to be more effective by decreasing hypoxic damage in the brain tissue, in consequence of which better neurological results are expectable. Conclusion: the application of TH is necessary following CPRs when the patient remains unconscious even after regaining spontaneous circulation. In everyday practice of intensive care wards, TH should be applied as per standard protocol. All clinical nurse staff should be aware of the cooling techniques and of the use the necessary medical equipment. Practical application and the earliest possible start of TH can be done more effectively by improving the nurses’ relevant knowledge, providing higher financial support and expanding the circle of medical equipment. ]