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Péter Barsi

Publications and source records attributed to Péter Barsi.

16 recordsLinked to original sources
PubMed2006

[Executive dysfunction in frontal lesions and frontal epilepsy].

BACKGROUND: To explore the functions of the frontal lobe that are associated with high order cognitive and behavioral aspects such as the organization and execution of thoughts and behavior by neuropsychological methods is difficult. These so called executive functions are in close connection with the prefrontal thalamocortical circuits, damage of which can cause deficits in cognitive functions and even changes in personality. METHODS: The aim of this study is to present a neuropsychological battery for testing frontal lobe functions. 31 patients (with frontal epilepsy and/or frontal lesion) and 38 healthy control subjects participated in the study. The control subjects were matched to the patient group in age, gender and education. RESULTS: Comparing to the controls the patient group showed significant deficits in most of the measured executive functions, except two tests which show that the short time selective attention is preserved. We divided the patient group into three subgroups (frontal epilepsy only FLE, frontal lesion only FL, frontal lesion and epilepsy FLE+FL) and we found that except working memory deficits and problems in inhibition, there were no difference between the FLE patients and the control group. We found most frequently perseveration and errors in a strategy making task among the FL (mainly medial) patients. We didn't find any difference in these tests according to the lateralization of the lesion. CONCLUSION: In conclusion we found that working memory deficits and problems in inhibition differentiated the frontal patient group from the controls in all cases. We emphasize that in frontal epilepsy (with no reported MR lesion) there are the same type, however more limited neuropsychological alterations as in lesional frontal dysfunction.

Adult↗
PubMed2006

[Aids-related toxoplasma-encephalitis presenting with acute psychotic episode].

The most frequent neurological manifestations of the Acquired Immunodeficiency Syndrome-(AIDS) are Cerebral Toxoplasmosis, Primary Central Nervous System Lymphoma (PCNSL), Progressive Multifocal Leukoencephalopathy (PML) and AIDS-encephalitis (AIDS-dementia complex, multinucleated giant cell encephalitis, HIV-encephalopathy). Neurological complications usually occur in the advanced stages of the disease, and they are uncommon in the beginning as presenting illness, but may result in life-threatening condition or in death. Rarely the disease presents as a neuropsychiatric illness in an undiagnosed AIDS patient, delaying a proper diagnosis. We present the case of a 34 years old patient treated for AIDS-related Toxoplasma-encephalitis in our department. His illness started as an acute psychosis followed by rapid mental and somatic decline, leading to death in three months. His HIV-seropositivity was not known at his admission, and the extraneural manifestations were slight. The diagnosis was established by serology, imaging methods and histopathological investigation. After presenting the medical history and results of autopsy studies of the patient we discuss the problems of the differential diagnosis, especially regarding the findings of the imaging methods.

AIDS-Related Opportunistic Infections↗
PubMed2006

Thalamic lesion and epilepsy with generalized seizures, ESES and spike-wave paroxysms--report of three cases.

We report three patients, who have thalamic lesion and secondary generalized epilepsy with generalized spike wave pattern. The first two patients have unilateral perinatal lesion, one with generalized tonic-clonic seizures on awakening the other with Landau-Kleffner-like syndrome. During the course of the disease both children developed electrical status epilepticus in slow wave sleep (ESES). The third patient has a dominantly unilateral thalamic tumor and epilepsy that mimics juvenile myoclonic epilepsy. All the patients have a lesion located in the inferior-medial-posterior part of the thalamus. The role of some thalamic and subthalamic nuclei in the generalized spike-wave electrical pattern patophysiology is discussed, with emphasis on the possible role of the inhibitory system from the zona incerta.

Adult↗
PubMed2005

Long-term outcome after temporal lobe surgery--prediction of late worsening of seizure control.

We analyzed possible predictors of late worsening of seizure control in 94 adult patients who had anterior temporal lobectomy (ATL) from the Epilepsy Center of the National Institute of Psychiatry and Neurology, Budapest between 1985 and 2001. We evaluated data regarding epilepsy, presurgical evaluation, pre- and postoperative EEG, structural imaging, histology and operative complications. The mean follow-up was 6.1 years (range: 2-17 years). The outcome was measured as Engel class, the time to the first seizure and the longest seizure free period. Multiple regression analysis was used to assess predictors. Seizure free outcome was achieved in 72% of the patients 1-year after surgery. Eighty-seven percent of them remained seizure free at the second year of follow-up, 74% at the fifth, and 67% at the tenth year of follow-up. After 2 years of follow-up improvement was present in 3%, worsening in 18% of the patients. Factors associated with long-term worsening were: postoperative ipsilateral EEG spikes over the resected side, preoperative bilateral interictal discharges, cortical dysplasia of Taylor's type, and ictal contralateral propagation. In these patients, even in seizure free state, therapy reduction might be inappropriate.

Adolescent↗
PubMed2005

[Supplementary sensory-motor seizures--symptomatology, etiology, and surgical management with illustrative case reports].

In the past decade, owing to the advance of epilepsy surgery, growing knowledge has accumulated on the role of the supplementary motor area, described by Penfield and coworkers in the early fifties, in movement regulation and on the characteristics of seizures involving this area. In the Hungarian neurological literature this topic--despite its neurophysiological and practical clinical importance--has been hardly touched. The authors, based on their own experience obtained from surgeries performed within the framework of the "Co-operative Epilepsy Surgery Program", describe the electrophysiological features of this area, its role in movement regulation and the symptoms of epileptic seizures stemmed from or spread onto this area. Using cases as illustrations, they demonstrate the reasoning and various algorithms of the multidisciplinary examination necessary to explore the seizure onset zone and the pathways of seizure spread. Details of the surgical solution are also described.

Adolescent↗
PubMed2005

Rapid re-enlargement of a macroprolactinoma after initial shrinkage in a young woman treated with bromocriptine.

We report the case of a macroprolactinoma in a 32-year-old woman, who presented with secondary amenorrhea, galactorrhea, increased plasma prolactin level (3259 ng/ml), headache and bi-temporal visual field defect. Magnetic resonance imaging showed a large pituitary tumor. The patient responded well to bromocriptine (7.5 mg/day) with improvement of clinical symptoms and normalization of plasma prolactin within a few weeks. After 4 months of treatment, tumor size was also reduced markedly. During continued treatment at the same dose of bromocriptine the plasma prolactin level remained normal, but after 8 months of treatment the patient suddenly complained of worsening of her visual fields, and magnetic resonance imaging indicated re-enlargement of the tumor. Bromocriptine was discontinued and transsphenoidal pituitary surgery was performed. After surgery the visual field defect improved, but postoperative plasma prolactin level (1104 ng/ml) and magnetic resonance imaging indicated a residual tumor. Postoperative treatment with quinagolide (0.15 mg/day) resulted in disappearance of all clinical symptoms, normalization of prolactin level and a reduction in size of the residual tumor. This case demonstrates that a dissociation of the inhibitory effect of bromocriptine on tumor size and prolactin level may rarely develop during the course of drug treatment in a patient with macroprolactinoma.

Adult↗
PubMed2004

Neuropathology of white matter disease in Leber's hereditary optic neuropathy.

Leber's hereditary optic neuropathy (LHON) is associated with point mutations in the mitochondrial DNA (mtDNA), coding for a mitochondrial respiratory chain complex I subunit. It is characterized by bilateral, usually sequential, optic neuropathy and may co-occur with multiple sclerosis-like white matter lesions. Despite repeated clinical reports including MRI and histopathological examination of the visual system, neuropathological descriptions of LHON associated with multiple sclerosis-like syndrome are lacking. We present here the case of a female patient with a point mutation at nucleotide position T14484C, who suffered from relapsing episodes of visual loss of both eyes and consecutively developed Hashimoto thyroiditis as well as widespread demyelinating CNS lesions outside the visual system. She died of bronchopneumonia at the age of 44 years, after a disease duration of 19 years, with progressive deterioration, epileptic seizures and immobility. Immunohistochemical analysis on formalin-fixed and paraffin-embedded tissue reveals a spectrum of neuropathological changes, including actively and inactively demyelinating plaques in the white matter and optic nerve, vacuolation and cystic necrosis with CD8-positive T cells in the frontal lobe, axonal damage, and vacuolation of white matter. Tissue destruction is associated with upregulation of mitochondrial manganese superoxide dismutase within the lesions and an increase in the expression of inducible nitric oxide synthase within macrophages and microglia. This variable phenotype of extraoptic LHON disease suggests that mtDNA mutations may affect the nervous system on a common metabolic basis and occasionally may aggravate or initiate autoimmune pathology.

Adult↗
PubMed2004

[Effectiveness and safety of intraventricular fibrinolysis in secondary intraventricular hemorrhages (a prospective, randomized study)].

BACKGROUND AND PURPOSE: Intraventricular clot secondary to brain hemorrhage has still one of the worst prognosis among all stroke subtypes, regardless of conservative therapy or surgical interventions. The rapid clot resolution with thrombolytic agents could improve the outcome by restoring the impaired cerebrospinal fluid circulation, for this reason, the authors examined the safety and efficacy of Urokinase therapy in a randomized, controlled study. METHODS: They enrolled 27 patients with severe intraventricular hemorrhage between 1998 and 2002. All patients had supratentorial intracerebral hemorrhage caused by hypertension, with IVH, moreover clinically worsening course due to the obstructive hydrocephalus confirmed by CT. Eleven persons were treated with ventriculostomy alone and 16 received adjunctive intraventricular urokinase. The authors examined the early, 30-day and 1-year mortality, furthermore the neurological (Scandinavian Stroke Scale) and functional outcome (Barthel Scale). The mean age was 60 +/- 9.5. The initial Scandinavian Stroke Scale was 7.51 +/- 8.64, Glasgow Coma Scale was 6.85 +/- 2.52, intracerebral hemorrhage volume was 22.44 +/- 18.14 ml. RESULTS: The 1 year survival rate was significant higher in the urokinase treated group (p = 0.014), This tendency in the mortality (31.3% vs. 54.5%) and in the neurological/functional condition (SSS, p = 0.078/Barthel, p = 0.119) at 30th day have been also documented. No hemorrhagic complications due to urokinase were observed. Two meningitis (7.4%) and two intraparenchymal hemorrhages (7.4%) related to drain insertion were detected (p = 0.009). The probability of pulmonary infection was roughly two times higher in the group without clot lysis (RR = 1.870; 95% CI: 1.004-3.482). CONCLUSIONS: In the authors experience, urokinase treatment reveals to be safe in the intraventricular clot lysis. This therapy allows earlier mobilization and rehabilitation, and decreases the number of infections, which are favorable to the long-term survival rate.

Adult↗
PubMed2004

Epilepsy caused by retrosplenial tumor.

We present a patient in whom retrosplenial tumour was associated with epileptic symptoms characterized by complex partial seizures and widespread interictal and ictal epileptiform EEG abnormalities. The patient had verbal memory deficit symptoms as well. After surgical removal of the tumour (oligoastrocytome) the clinical symptoms and EEG signs disappeared. The characteristics of our patient demonstrate the possible role of the retrosplenial area in widespread epileptic symptoms and in the regulation of secondary bilateral synchrony, in addition to its recently described importance in the memory functions.

Adult↗
PubMed2003

Comparative evaluation of concomitant structural and functional neuroimages in Rasmussen's encephalitis.

BACKGROUND AND PURPOSE: Rasmussen's encephalitis (RE) is a rare condition of unknown cause characterized by intractable seizures, progressive hemiparesis, mental impairment, and inflammatory histological findings in the cortex. The primary diagnosis is based on biopsy to confirm the typical clinical, electroencephalography, and brain imaging findings. The main objective of this study was to compare simultaneous structural and functional neuroimages in RE. METHODS: Concomitant magnetic resonance imaging and 2-deoxy-2-[18F]-fluoro-D-glucose positron emission tomography data from the authors' series of 5 children and 8 patients described in the literature were analyzed and compared. RESULTS: Typical early findings of RE include metabolic abnormalities (hypermetabolism and hypometabolism) starting in the frontal or temporal regions or, occasionally, involving the whole hemisphere. Focal abnormalities of cerebral glucose metabolism indicate lesions sooner and depict their extent better than concomitant magnetic resonance images. The major structural abnormality remains unilateral; however, contralateral frontal lobe hypometabolism or crossed cerebellar diaschisis can be a finding of this disease. Basal ganglia involvement and whole hemispheric metabolic abnormality appear typically only after several months of disease onset. CONCLUSION: Concomitant structural and functional neuroimaging provide possibly complementary information in the early noninvasive workup of RE and may facilitate the early diagnosis of this rare disorder.

Adolescent↗
PubMed2002

[MR investigation of spinal cord herniation in the thoracic spine].

Transdural herniation of the spinal cord is thought to be previously extremely rare and very often misdiagnosed. Possible reasons may be iatrogenic and traumatic or in about one third of cases it may be unknown, where the probable origin might be a congenital dural defect. The pathology may show characteristic and misleading MR patterns of the thoracic spine, emphasising the importance of these patterns. This anomaly can lead to progressive Brown-Sequard syndrome. Surgical intervention, consisting the repair of the dural defect may result in improvement or even complete regression of the neurologic deficits.

Adult↗
PubMed2002

[MR investigations in stroke].

In the article digital imaging methods are presented with special emphasis on the use on diagnostics of cerebral circulation studies. Recently, fundamental changes have happened in this field, concerning especially the MR investigations. These changes have influenced the therapeutic strategies of ischaemic stroke. Authors give the theoretical background on the diffusion and perfusion MR imaging, emphasising the importance of their "mismatch" and its impact in the estimation of the outcome of ischaemic events. More recently, new, controversial facts arose, regarding the reasons of the introduction of the theory of so called "negative" and "positive" mismatches. As a consequence, a level of uncertainty took place in the judgement of prognostics. The leading institutions are searching the way to solve the problem which seems to be the quantitative evaluation of the diffusion, perfusion and mismatch data. The advent of the multislice spiral CT with very fast imaging and the importance of CT investigations increased. With this new kind of equipment, even perfusion studies can be performed using iodinated contrast medium.

Contrast Media↗
PubMed2002

Sleep-dependent hippocampal slow activity correlates with waking memory performance in humans.

The positive effect of postlearning sleep on memory consolidation as well as the relationship between sleep-related memory processes and the hippocampal formation are increasingly clarified topics in neurobiology. However, the possibility of a stable relationship between waking mnemonic performance and sleep-dependent hippocampal electric activity is unexplored. Here we report a correlative analysis between sleep-dependent parahippocampal-hippocampal (pHip-Hip) electric activity recorded by foramen ovale (FO) electrodes and different types of memory performances in epileptic patients. Psychological testing was performed days or weeks before electrophysiological recordings. The relative spectral power of the slow activity (below 1.25 Hz) during deep non-REM (NREM) sleep at the right pHip-Hip region correlated positively with the visual memory performance according to Rey-Osterrieth Complex Figure Test (ROCFT). Along the posterior-anterior direction of the hippocampal formation a linear increasing of correlations was observed. The relative power of the activity below 1.25 Hz at the left pHip-Hip during phasic REM sleep correlated positively with verbal learning performance and mnemonic retention values according to ROCFT. It is concluded that the pHip-Hip structures' capacity of producing high amplitude and synchronized slow (< 1 Hz) oscillation during deep NREM sleep is related to the functional power of these structures. We hypothesize that the asymmetric (side-specific) propagation of ponto-geniculo-occipital (PGO) activity to the pHip-Hip region is related to the memory correlates of phasic REM sleep.

Adult↗
PubMed2002

Lateralization as a factor in the prognosis of middle cerebral artery territorial infarct.

The consequences of cerebral infarcts involving the left hemisphere differ from those of the right homologue areas. Data of 337 consecutive, unselected patients with acute ischaemic stroke in the territory of the right or left middle cerebral artery were analysed. Furthermore, lesion locations of 77 stroke patients with early death were compared with those of 315 patients followed for more than 28 days. Without any differences in stroke severity and in the volume of the lesions, the outcome of strokes of the right hemisphere was less favourable, and the case fatality rate was higher than in controls during a 10-year follow-up period. The rate of early death due to cardiogenic cause was relatively higher in the right hemispherical group. The asymmetry of the sympathetic nervous system, and the distinct psychosyndromes following the injury of the two hemispheres may underlie this difference in prognosis.

Aged↗