Clinical Neuroscience

JANUARY 30, 2021

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study


Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

Lege Artis Medicinae

APRIL 23, 2021

[Tobacco use habits and cessation support tasks in Hungary. PART 1.]

CSELKÓ Zsuzsa, FÉNYES Márta, CSÁNYI Péter, BOGOS Krisztina, KISS Judit, DEMJÉN Tibor

[Today, non-communicable diseases and their underlying main risk factors, namely tobacco use, physical inactivity, excessive alcohol intake and unhealthy diet are responsible for almost 70% of the mortality worldwide. The Global Ac­tion Plan issued for the preven­tion and control of non-communicable diseases aims among others to reduce smoking rates by 30% as compared to the 2010 prevalence. The aim of the World Health Or­ga­ni­zation (WHO) in ac­cor­dance with the United Nations Sus­tai­nable Development Goals (UN SDG 2030) proposes to achieve a 23% target rate in Hun­gary by 2025. Based on the current smo­king prevalance (29%) and preliminary estimates this goal will not be accomplished. It is highly concerning that while the con­sumption of traditional tobacco products does not decrease at the expected rate in Hungary, novel nicotine and tobacco products are spreading worldwide and in Hungary as well. Thus in order to curb tobacco use, more ro­bust actions are needed in Hungary. More emphasis should be laid on the provisions of the WHO Fra­mework Con­vention on Tobacco Control (FCTC). This document re­com­mends to in­crease the tax rate of to­bacco products, declares to halt the spread of novel nicotine and tobacco products, and urges health care requirements to support smokers in quit­ting. The present summary describes the smoking cessation support related tasks of the health care in­dust­ry, taking into ac­count current national smoking habits. ]

Clinical Neuroscience

MARCH 30, 2021

[Single-hole, ruptured parenchymal arteriovenous fistula of the mesencephalon: not known vascular malformation of the brain or a posthemorrhagic entity? ]

KULCSÁR Zsolt, MACHI Paolo, VARGAS Isabel Maria, SCHALLER Karl, LOVBLAD Olof Karl

[The subtypes of brain arteriovenous malformations, with direct, single-hole fistulas without co-existing nidus are not described as existing entities inside the brain parenchyma but on the pial surface. True parenchymal arteriovenous malformations present with nidal structure, even if they are small, whereas surface lesions may present a direct fistulous configuration. In this case of midbrain haemorrhage a direct arteriovenous fistula was detected at the level of the red nucleus between a paramedian midbrain perforator artery and a paramedian parenchymal vein, with pseudo-aneurysm formation at the fistulous connection, without signs of adjacent nidus structure. The hypothesis whether a pre-existing arteriovenous fistula ruptured or a spontaneous haemorrhage has caused the fistulous connection is discussed. ]

Clinical Neuroscience

MARCH 30, 2021

[Treatment options for enormous carotid thrombus as a complication of SARS-CoV-2 infection]

KONCZ Júlia, OROSZ Viktor, SULYOK Zoltán, ANDRÁS Emőke, KÁDÁR Balázs, OLÁH Csaba

[In SARS-CoV-2 positive patients with corresponding neurological symptoms the presence of carotid bifurcation macrothrombus should always be considered. Hypercoagulopathy caused by viral endotheliitis, systemic inflammation and cytokine storm play an important role in its development. Here we present two patients treated with different treatment strategies because of carotid bifurcation macrothrombus as a complication of SARS-CoV-2 infection. In both cases, the soft macrothrombus was eliminated and the patients’ neurological condition were improved. Intravenous thrombolysis, acute carotid stenting with embolic filter protection device and mechanical thrombectomy with aspiration are effective treatments.]

Lege Artis Medicinae

FEBRUARY 20, 2021

[Chronic obstructive pulmonary disease and recommendations for treatment]


[Chronic obstructive pulmonary disease (COPD) is prognosticated to become the 3rd most prevalent cause of early lethality. It’s main etiology is long-term smoking which induces chronic inflammation and obstruction of the airways as well as elastolysis of the pulmonary interstitium which lead to emphysema. Increased resistance of the intrathoracic airways and emphysema induce hyperinflation of the lung and chest which increases the work-load of the respi­ratory muscles. COPD patients are typically hypoxaemic and normocapnic. Finally, fatigue of the respiratory muscles cause the development of global respiratory failure (hypercapnia and severe hypoxaemia). Most effective intervention is smoking cessation. Maintanance treatment includes inhalational long-acting bronchodilators with or without inhalational corticosteroids. Acute exacerbation is treated with O2 supplementation, inhalational bronchodilators, systemic steroids and/or antiobiotics. Frequency and severity of acute exacerbations prognosticate shorter survival. In chronic respiratory failure long-term home O2 therapy can be provided.]