Neurology

Lege Artis Medicinae

MARCH 26, 2024

[Significance and diagnosis of diabetic neuropathy in clinical practice]

SZTANEK Ferenc, HERNYÁK Marcell, KEMPLER Péter

[Diabetic neuropathy is an early detectable microvascular complication of diabetes. Most often, we can recognize it by its symp­toms of distal-type symmetric poly­neu­­ropathy, further the damage to the au­to­nomic nervous system is increasing the cardiovascular mortality. Screening for diabetic neuropathy is essential in clinical prac­tice, since the signs of nerve damage related to diabetes can be detected at an early stage and open the way to therapeutic interventions. Proper diagnosis and continuous monitoring of diabetic neuropathy is also important during the patient care. This summary concerns the importance and diagnostic options of diabetic neuro­pa­thy for clinical practice.]

HUN 2024;34(3)

Lege Artis Medicinae

MARCH 26, 2024

[Women and migrain ]

ÁFRA Judit

[Migraine is a headache disorder affecting 14% of general population, being even more prevalent (20%) among women in the 20–64 age group, who are actively working and are mainly at reproductive age. 18–25% of migrainous women have an attack related to menstrual cycle, 7% of them having an attack only at this period. Fluctuation of estrogen level may be responsible for these attacks, we can use NSAIDs, slowly acting triptans or progestin-only treatment as short-term prophylaxis. Hormonal contraception is not contraindicated in migraine. Combined (estrogen+progestin) treatment is proposed only in migraine without aura, but in case of more frequent and/or severe attacks or the appearence of an aura treatment should be stopped. In migraineurs with elevated risk of stroke combined hormonal contraception should be used with caution. In migraine with aura patients progestin-only contraception is possible. During pregnancy in 55–91% of migraineus women attacks disappear or are less severe. In most cases migraine with aura attacks occur during this period. Non-pharmacological treatments should be considered as first in the treatment off attacks, with consideration of risk/benefit ratio paracetamol, metamizol or triptans may be used. With the meno­pause in 2/3 of patients migraine gets better but because of the fluctuation of hormon levels it can be worse than before. Hor­mo­nal replacement therapy is not contraindicated in migrainous women but it can result in worsening of migraine. ]

HUN 2024;34(3)

Lege Artis Medicinae

MARCH 26, 2024

[Blooming again – women’s life paths after brain injury ]

MASÁT Orsolya, BÁLINT Brigitta, BOLLA Brigitta, GORJANÁCZ Ilona, SIPOS Hédi, BÚZÁS Lili, DÉNES Zoltán

[After a serious brain injury or trauma, there is damaged the functional capacity of the affected persons and their self-image too. Traditional rehabilitation pays little attention to the female patients’ lost femininity. The aim of this study was to present the way of supporting women to realize again their femininity psychologically and physically alike after a brain injury.

In the Brain Injury Rehabilitation Unit of the National Institute for Medical Rehabilitation, the authors completed the female patients’ rehabilitation with special group sessions once a week. The topics were tailored to the needs of participants. There were targeted two specific objectives: achieving to perceive femininity in an autonomous way and regaining the feeling of femininity in the changed life circumstances due to the injury.

Occupational therapist, physiotherapists and nurses provided service to develop functional abilities. A psychologist helped the participants in trauma processing. Since the beginning in January 2022, two therapy cycles have been completed so far, each of which with 10-12 sessions. A total of 31 female patients and 8 supporting team members participated in these two groups so far.

Personalised rehabilitation was adjusted to the involved persons’ life circumstances, individuality, personality, family and social relations. Our experimental female group helped the participants to experience their femininity physically, mentally and psychologically too, according to their feedback.]

HUN 2024;34(3)

Lege Artis Medicinae

MARCH 26, 2024

[Introduction of artificial intelligence based national decision support system to improve stroke care in Hungary ]

SZIKORA István, MAGYAR Bence, TÉGLÁS Sándor, SZUDI Gábor, SZALMÁS Orsolya, CZENCZ Máté, KONDOR Máté, POZSÁR Kinga, NARDAI Sándor, ERÔSS Lóránd, ÓVÁRY Csaba, HORVÁTH Krisztina, MOLNÁR Ferenc József, PÁPAI György, JANCSÓ Ádám, SZABÓ Zoltán, BENES Edvárd, CHADAIDE Zoltán

[Indication for recanalization therapy of acute ischemic stroke is based on imaging procedures. In order to minimize the time loss passing by recog­nizing the condition and the transfer of images to other facility, we established a stroke imaging network (eStroke network) supported by Artificial Intelligence (AI) in Hungary. Our study aims to present this system. 

Organized by the National Institute of Mental Health, Neurology, and Neurosurgery (NIMNN), we included a total of 28 stroke centers, among them 4 thrombectomy centers. An earlier network of the University of Pécs and the widened network parallel with the NIMNN project cover 10 centers thus the service is now available in 38 stroke centers of this country. Stroke CT scans are automatically transmitted via the central teleradiology server to a central image processing server which analyzes the size of the ischemic area (ASPECT score), detects large vessel occlusion and it’s localization, analyzes the quality of collateral circula­tion and standard CT perfusion parameters using an AI based software (eStroke, Brainomix Ltd.). Results and processed images are sent automatically back to the PACS system of the sending institution and that of the concerning thrombectomy center and become available in anonymous form via cloud by desktop computers or mobile application. 

During the first year of opera­tion, the system has processed 38,060 scans of 16,276 patients. In NIMNN experience by samples of 65 and 152 cases, for drip and ship patients the time from the first alerting of the ambulance service, until arrival at the thrombectomy center was reduced by 38 minutes from 4:18 to 3:40 minutes. 

Building an AI based central stroke imaging network for improving of stroke care’s results is technically feasible. Operation of the eStroke system is capable of reducing patient transportation times, however, further optimization is needed. ]

HUN 2024;34(3)

Clinical Neuroscience

JANUARY 30, 2024

[Association of upper extremity anthropometry and subcutaneus adipose tissue with carpal tunnel syndrome]

DAROL Sarica Elif, ÇİÇEKLİ Esen , SAYAN Saadet , KOTAN Dilcan , ALEMDAR Murat

[Body mass index (BMI) is positively correlated with the frequency of carpal tunnel syndrome (CTS). However, there are different types of obesity, and the localization of adipose tissue differs between the genders. In this study, we purposed to investigate whether there was an association between the amount of local adipose tissue thickness and anthropometry in upper extremity with the presence and/or electrophysiological severity of CTS on both genders. ]

HUN 2024;77(1-2)

Clinical Neuroscience

JANUARY 30, 2024

Comparison of pre-mortem 2D-3D ultrasound examination to post-mortem micro-CT of carotid arteries – first experiences

SZEGEDI István , SZABÓ András Dániel , EMRI Miklós , BÉRESOVA Mónika , NAGY Mariann , MOLNÁR Sarolta , NAGY Attila , BERÉNYI Ervin , OLÁH László , CSIBA László

A prerequisite for the treatment of carotid atherosclerosis is the accurate measurement of the stenosis, that is most commonly evaluated by duplex ultrasonography. In this study, we aimed to verify the reliability of 2D and 3D ultrasonography, comparing the data to results of post-mortem micro-CT examination. Neurological patients with any life-threatening, presumably fatal neurological disease were enrolled.

ENG 2024;77(1-2)