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Andorka C, Barta H, Sesztak T, Nyilas N, Kovacs K, Dunai L, Rudas G, Jermendy A, Szabo M, Szakmar E. The predictive value of MRI scores for neurodevelopmental outcome in infants with neonatal encephalopathy. Pediatr Res 2024:10.1038/s41390-024-03189-1. [PMID: 38637693 DOI: 10.1038/s41390-024-03189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND MRI scoring systems are utilized to quantify brain injury and predict outcome in infants with neonatal encephalopathy (NE). Our aim was to evaluate the predictive accuracy of total scores, white matter (WM) and grey matter (GM) subscores of Barkovich and Weeke scoring systems for neurodevelopmental outcome at 2 years of age in infants receiving therapeutic hypothermia for NE. METHODS Data of 162 infants were analyzed in this retrospective cohort study. DeLong tests were used to compare areas under the curve of corresponding items of the two scoring systems. LASSO logistic regression was carried out to evaluate the association between MRI scores and adverse composite (death or severe disabilities), motor and cognitive outcomes (Bayley developmental index <70). RESULTS Weeke scores predicted each outcome measure with greater accuracy than the corresponding items of Barkovich system (DeLong tests p < 0.03). Total scores, GM and cerebellum involvement were associated with increased odds for adverse outcomes, in contrast to WM injury, after adjustment to 5' Apgar score, first postnatal lactate and aEEG normalization within 48 h. CONCLUSION A more detailed scoring system had better predictive value for adverse outcome. GM injury graded on both scoring systems was an independent predictor of each outcome measure. IMPACT STATEMENTS A more detailed MRI scoring system had a better predictive value for motor, cognitive and composite outcomes. While hypoxic-ischemic brain injuries in the deep grey matter and cerebellum were predictive of adverse outcome, white matter injury including cortical involvement was not associated with any of the outcome measures at 2 years of age. Structured MRI evaluation based on validated scores may aid future clinical research, as well as inform parents and caregivers to optimize care beyond the neonatal period.
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Affiliation(s)
- Csilla Andorka
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Hajnalka Barta
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Timea Sesztak
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
- Department of Neuroradiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Nora Nyilas
- Department of Neuroradiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Kata Kovacs
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Ludovika Dunai
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Gabor Rudas
- Department of Neuroradiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Agnes Jermendy
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Miklos Szabo
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Eniko Szakmar
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary.
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Derfalvi B, Boros KK, Szabo D, Bozsaki G, Cseh A, Rudas G, Muller KE, Veres G. Joint involvement, disease activity and quality of life in pediatric Crohn's disease - a cross-sectional study. Pediatr Rheumatol Online J 2022; 20:6. [PMID: 35093127 PMCID: PMC8801094 DOI: 10.1186/s12969-022-00664-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/06/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Few published data describe how joint involvement, the most prevalent extraintestinal manifestation, affects quality of life (QoL) of children with Crohn's disease (CD). Arthritis and arthralgia rates in pediatric CD patients are reportedly 3-24% and 17-22%, respectively, but studies on pre-emptive and systematic screening of joint involvement with detailed musculoskeletal rheumatological exam are lacking. More detailed data collection on joint involvement improves our understanding of how arthropathy relates to disease activity and QoL measured by the Pediatric CD Activity Index (PCDAI) and IMPACT-III questionnaire. Our study aims were to assess joint involvement in pediatric CD and correlate it with the PCDAI and IMPACT-III. METHODS In this cross-sectional, observational study, a pediatric gastroenterologist assessed consecutively-seen pediatric CD patients at a tertiary care center. Patients were screened for prevalence of current and previous arthropathy, including arthritis, enthesitis and arthralgia. A single experienced pediatric rheumatologist evaluated detailed musculoskeletal history, joint status, and modified Juvenile Arthritis Multidimensional Assessment Reports (JAMAR). PCDAI, IMPACT-III, sacroiliac MRI, and HLA-B27 genetic testing were also completed. RESULTS A total of 82 (male:female, 1.2:1; age, 13.7 ± 3.2 years) patients were involved in this study. Mean disease duration at time of study was 21.6 ± 21 months; eight of the patients were newly-diagnosed. Of the 82 patients, 29 (35%) had evidence of arthritis; for 24 of those, this was revealed by physical exam during cross-sectional screening, and by prior documentation for the remaining five patients. Joint examination confirmed active arthritis in 8/24 (33%), active enthesitis in 1/24 (4%), and evidence of previous arthritis in 15/24 (62.5%) patients. Hip (41%) and knee (38%) joints were most commonly affected. Cumulative incidence of arthralgia was 48% (39/82), and 46% (18/39) of those patients had only arthralgia without arthritis, usually affecting the knee. Axial involvement was present in 10/82 (12%) patients. Joint involvement correlated with more severe CD disease activity, specifically higher PCDAI and lower IMPACT-III scores, and increased requirement for infliximab treatment. Sacroiliitis and HLA-B27 positivity were insignificant factors in this cohort. CONCLUSIONS When a rheumatologist performed the assessment, joint involvement in pediatric CD was more prevalent than previously reported, in this cross-sectional study. Arthritis was associated with more severe CD disease activity and lower QoL.
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Affiliation(s)
- Beata Derfalvi
- Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Kriszta Katinka Boros
- grid.11804.3c0000 0001 0942 98211st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Doloresz Szabo
- grid.11804.3c0000 0001 0942 98211st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Gabor Bozsaki
- grid.11804.3c0000 0001 0942 98211st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Aron Cseh
- grid.11804.3c0000 0001 0942 98211st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Gabor Rudas
- grid.11804.3c0000 0001 0942 9821MR Science Centre, Semmelweis University, Budapest, Hungary
| | - Katalin Eszter Muller
- grid.9679.10000 0001 0663 9479Institute for Translational Medicine, University of Pécs, Pécs, Hungary ,grid.413987.00000 0004 0573 5145Heim Pal National Pediatric Institute, Budapest, Hungary
| | - Gabor Veres
- grid.7122.60000 0001 1088 8582Paediatric Institute, University of Debrecen, Debrecen, Hungary
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Barta H, Jermendy A, Kovacs L, Schiever N, Rudas G, Szabo M. Predictive performance and metabolite dynamics of proton MR spectroscopy in neonatal hypoxic-ischemic encephalopathy. Pediatr Res 2022; 91:581-589. [PMID: 34489532 PMCID: PMC8904256 DOI: 10.1038/s41390-021-01626-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/26/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Prognostic value of proton MR spectroscopy (H-MRS) in hypoxic-ischemic encephalopathy (HIE) is acknowledged; however, effects of gestational age (GA) and postnatal age (PA) on prediction and metabolite levels are unknown. METHODS One hundred and sixty-nine newborns with moderate-to-severe HIE were studied, having ≥1 H-MRS scan during postnatal days 0-14 and known neurodevelopmental outcome (Bayley-II score/cerebral palsy/death). Initial scans were categorized by PA (day 1-3/4-6/≥7), and metabolite ratios were compared by predictive value. Metabolite dynamics were assessed in a total of 214 scans performed in the study population, using regression modeling, with predictors GA, PA, and outcome. RESULTS N-acetyl-aspartate (NAA)/creatine (Cr) and myo-inositol (mI)/NAA height ratios were consistently associated with outcome throughout the first 14 days, with the highest predictive value in the late (≥7 days) period (AUC = 0.963 and 0.816, respectively). Neither GA nor PA had an overall effect on these metabolite ratios, which showed strongest association with outcome (p < 0.001). Assessed separately in patients with good outcome, GA became a significant covariate for metabolite ratios (p = 0.0058 and 0.0002, respectively). However, this association disappeared in the poor outcome group. CONCLUSIONS In HIE, NAA/Cr and mI/NAA give most accurate outcome prediction throughout postnatal days 0-14. GA only affected metabolite levels in the good outcome group. IMPACT Proton MR spectroscopy metabolite ratios N-acetyl-aspartate/creatine and myo-inositol/N-acetyl-aspartate have persistently high predictive value throughout postnatal days 0-14 in newborns with hypoxic-ischemic encephalopathy, with the highest predictive power between postnatal days 7 and 14. Overall, neither metabolite ratio was affected by gestational age nor by postnatal age, while they showed the strongest association with neurological outcome. However, in newborns facing good outcome, metabolite ratios were associated with gestational age, whereas in cases facing poor outcome, this association disappeared. Proton MR spectroscopy provides valuable prognostic information in neonatal hypoxic-ischemic encephalopathy throughout the first 2 weeks of life, irrespective of the timing of MR scan.
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Affiliation(s)
- Hajnalka Barta
- Division of Neonatology, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary.
| | - Agnes Jermendy
- grid.11804.3c0000 0001 0942 9821Division of Neonatology, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Livia Kovacs
- grid.11804.3c0000 0001 0942 9821Division of Neonatology, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Noemie Schiever
- grid.11804.3c0000 0001 0942 9821Division of Neonatology, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Gabor Rudas
- grid.11804.3c0000 0001 0942 9821Medical Imaging Centre, Department of Neuroradiology, Semmelweis University, Budapest, Hungary
| | - Miklos Szabo
- grid.11804.3c0000 0001 0942 9821Division of Neonatology, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
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Horváthy-Szőcs A, Liptai Z, Dobner S, Rudas G, Barsi P. A Closer Investigation of the Synchronous Bilateral Pattern of MRI Lesions in Acute Necrotizing Encephalopathy Type 1. AJNR Am J Neuroradiol 2021; 42:2251-2253. [PMID: 34593382 DOI: 10.3174/ajnr.a7305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/03/2021] [Indexed: 11/07/2022]
Abstract
We observed a lesion pattern in a series of 4 cases of RANBP2-mutation-linked acute necrotizing encephalopathy, which appears to be specific for this condition. The setting of synchronous bilateral mammillary, amygdaloid, and lateral geniculate lesions, along with claustro-parahippocampal lesions, can serve as a diagnostic tool in this condition. We add several further details to the MR imaging features of the typical brain lesions encountered in this disease.
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Affiliation(s)
- A Horváthy-Szőcs
- From the Department of Neuroradiology (A.H.-S., G.R., P.B.), Medical Imaging Centre
| | - Z Liptai
- Second Department of Pediatrics (Z.L., S.D.), Semmelweis University, Budapest, Hungary
- Department of Pediatric Infectology (Z.L., S.D.), St. Laszlo Hospital, Budapest, Hungary
| | - S Dobner
- Second Department of Pediatrics (Z.L., S.D.), Semmelweis University, Budapest, Hungary
- Department of Pediatric Infectology (Z.L., S.D.), St. Laszlo Hospital, Budapest, Hungary
| | - G Rudas
- From the Department of Neuroradiology (A.H.-S., G.R., P.B.), Medical Imaging Centre
| | - P Barsi
- From the Department of Neuroradiology (A.H.-S., G.R., P.B.), Medical Imaging Centre
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Vojcek E, Jermendy A, Laszlo AM, Graf R, Rudas G, Berenyi M, Seri I. The role of brain territorial involvement and infection/inflammation in the long-term outcome of neonates with arterial ischemic stroke: A population-based cohort study. Early Hum Dev 2021; 158:105393. [PMID: 34034089 DOI: 10.1016/j.earlhumdev.2021.105393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neonatal arterial ischemic stroke (NAIS) carries the risk of significant long-term neurodevelopmental burden on survivors. AIMS To assess the long-term neurodevelopmental outcome of term neonates diagnosed with NAIS and investigate the associations among brain territorial involvement on MRI, clinical risk factors and neurodevelopmental outcomes. STUDY DESIGN Population-based cohort study. SUBJECTS Seventy-nine term neonates with NAIS confirmed by MRI born between 2007 and 2017. OUTCOME MEASURES Long-term neurodevelopmental outcome assessed using the Bayley Scales of Infant Development-II, the Brunet-Lézine test and the Binet Intelligence scales-V. RESULTS Follow-up was available in 70 (89%) of the subjects enrolled, at a median age of 60 months [IQR: 35-84]. Normal neurodevelopmental outcome was found in 43% of the patients. In a multivariable model, infants with main MCA stroke had an increased risk for overall adverse outcome (OR: 9.1, 95% CI: 1.7-48.0) and a particularly high risk for cerebral palsy (OR: 55.9, 95% CI: 7.8-399.2). The involvement of the corticospinal tract without extensive stroke also increased the risk for cerebral palsy/fine motor impairment (OR: 13.5, 95% CI: 2.4-76.3). Multiple strokes were associated with epilepsy (OR: 9.5, 95% CI: 1.0-88.9) and behavioral problems (OR: 4.4, 95% CI: 1.1-17.5) and inflammation/infection was associated with cerebral palsy (OR: 9.8, 95% CI: 1.4-66.9), cognitive impairment (OR: 9.2, 95% CI: 1.8-47.8) and epilepsy (OR: 10.3, 95% CI: 1.6-67.9). CONCLUSIONS Main MCA stroke, involvement of the corticospinal tract, multiple strokes and inflammation/infection were independent predictors of adverse outcome, suggesting that the interplay of stroke territorial involvement and clinical risk factors influence the outcome of NAIS.
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Affiliation(s)
- Eszter Vojcek
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics, Saint John Hospital and North-Buda Unified Hospitals, Budapest, Hungary.
| | - Agnes Jermendy
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Anna M Laszlo
- Institute of Mathematics and Base Sciences, Szent István University, Budapest, Hungary
| | - Rozsa Graf
- Department of Rehabilitation, Szent János Hospital and North Buda United Hospitals, Budapest, Hungary
| | - Gabor Rudas
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Marianne Berenyi
- Department of Developmental Neurology, Saint Margaret Hospital, Budapest, Hungary
| | - Istvan Seri
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, United States
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Toth-Bencsik R, Balicza P, Varga ET, Lengyel A, Rudas G, Gal A, Molnar MJ. New Insights of Phospholipase A2 Associated Neurodegeneration Phenotype Based on the Long-Term Follow-Up of a Large Hungarian Family. Front Genet 2021; 12:628904. [PMID: 34168672 PMCID: PMC8217829 DOI: 10.3389/fgene.2021.628904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Phospholipase A2-associated Neurodegeneration (PLAN) is a group of neurodegenerative diseases associated with the alterations of PLA2G6. Some phenotype-genotype association are well known but there is no clear explanation why some cases can be classified into distinct subgroups, while others follow a continuous clinical spectrum. Methods Long-term neurological, and psychiatric follow-up, neuropathological, radiological, and genetic examinations, were performed in three affected girls and their family. Results Two 24-years old twins and their 22-years old sister harbored the p.P622S, and p.R600W mutation in PLA2G6. The age of onset and the most prominent presenting symptoms (gaze palsy, ataxia, dystonia, psychomotor regression indicated atypical neuroaxonal dystrophy (ANAD), however, optic atrophy, severe tetraparesis would fit into infantile neuroaxonal dystrophy (INAD). All siblings had hyperintensity in the globi pallidi and substantiae nigrae which is reported in ANAD, whereas it is considered a later neuroradiological marker in INAD. The slow progression, rigidity, bradykinesis, and the prominent psychiatric symptoms indicate PLA2G6-related dystonia-parkinsonism. Abnormal mitochondria, lipid accumulation and axonal spheroids were observed in the muscle and nerve tissue. Brain deposition appeared 6 years following the initial cerebellar atrophy. Mild MRI alterations were detected in the asymptomatic carrier parents. Conclusion The colorful clinical symptoms, the slightly discordant phenotype, and the neuroimaging data in the family supports the view that despite the distinct definition of age-related phenotypes in PLAN, these are not strict disease categories, but rather a continuous phenotypic spectrum. The mild MRI alterations of the parents and the family history suggest that even heterozygous pathogenic variants might be associated with clinical symptoms, although systematic study is needed to prove this.
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Affiliation(s)
- Renata Toth-Bencsik
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Peter Balicza
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Edina Timea Varga
- Department of Neurology, Albert Szent-Györgyi Medical and Pharmaceutical Center, University of Szeged, Szeged, Hungary
| | - Andras Lengyel
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Gabor Rudas
- MR Research Center, Semmelweis University, Budapest, Hungary
| | - Aniko Gal
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Maria Judit Molnar
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
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Balicza P, Bencsik R, Lengyel A, Gal A, Grosz Z, Csaban D, Rudas G, Danics K, Kovacs GG, Molnar MJ. Novel dominant MPAN family with a complex genetic architecture as a basis for phenotypic variability. Neurol Genet 2020; 6:e515. [PMID: 33134513 PMCID: PMC7577556 DOI: 10.1212/nxg.0000000000000515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/27/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Our aim was to study a Hungarian family with autosomal dominantly inherited neurodegeneration with brain iron accumulation (NBIA) with markedly different intrafamilial expressivity. METHODS Targeted sequencing and multiplex ligation-dependent probe amplification (MLPA) of known NBIA-associated genes were performed in many affected and unaffected members of the family. In addition, a trio whole-genome sequencing was performed to find a potential explanation of phenotypic variability. Neuropathologic analysis was performed in a single affected family member. RESULTS The clinical phenotype was characterized by 3 different syndromes-1 with rapidly progressive dystonia-parkinsonism with cognitive deterioration, 1 with mild parkinsonism associated with dementia, and 1 with predominantly psychiatric symptoms along with movement disorder. A heterozygous stop-gain variation in the C19Orf12 gene segregated with the phenotype. Targeted sequencing of all known NBIA genes, and MLPA of PLA2G6 and PANK2 genes, as well as whole-genome sequencing in a trio from the family, revealed a unique constellation of oligogenic burden in 3 NBIA-associated genes (C19Orf12 p.Trp112Ter, CP p.Val105PhefsTer5, and PLA2G6 dup(ex14)). Neuropathologic analysis of a single case (39-year-old man) showed a complex pattern of alpha-synucleinopathy and tauopathy, both involving subcortical and cortical areas and the hippocampus. CONCLUSIONS Our study expands the number of cases reported with autosomal dominant mitochondrial membrane protein-associated neurodegeneration and emphasizes the complexity of the genetic architecture, which might contribute to intrafamilial phenotypic variability.
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Affiliation(s)
- Peter Balicza
- Institute of Genomic Medicine and Rare Diseases (P.B., R.B., A.L., A.G., Z.G., D.C., M.J.M.), Semmelweis University, Budapest, Hungary; Neurology Outpatient Clinic (A.L.), General Medical Clinic, Motala Hospital, Sweden; Department of Neuroradiology (G.R.), and Department of Forensic and Insurance Medicine (K.D.), Semmelweis University, Budapest, Hungary; Tanz Centre for Research in Neurodegenerative Disease (G.G.K.), and Department of Laboratory Medicine and Pathobiology (G.G.K.), University of Toronto; and Laboratory Medicine Program (G.G.K.), University Health Network, Toronto, Canada
| | - Renata Bencsik
- Institute of Genomic Medicine and Rare Diseases (P.B., R.B., A.L., A.G., Z.G., D.C., M.J.M.), Semmelweis University, Budapest, Hungary; Neurology Outpatient Clinic (A.L.), General Medical Clinic, Motala Hospital, Sweden; Department of Neuroradiology (G.R.), and Department of Forensic and Insurance Medicine (K.D.), Semmelweis University, Budapest, Hungary; Tanz Centre for Research in Neurodegenerative Disease (G.G.K.), and Department of Laboratory Medicine and Pathobiology (G.G.K.), University of Toronto; and Laboratory Medicine Program (G.G.K.), University Health Network, Toronto, Canada
| | - Andras Lengyel
- Institute of Genomic Medicine and Rare Diseases (P.B., R.B., A.L., A.G., Z.G., D.C., M.J.M.), Semmelweis University, Budapest, Hungary; Neurology Outpatient Clinic (A.L.), General Medical Clinic, Motala Hospital, Sweden; Department of Neuroradiology (G.R.), and Department of Forensic and Insurance Medicine (K.D.), Semmelweis University, Budapest, Hungary; Tanz Centre for Research in Neurodegenerative Disease (G.G.K.), and Department of Laboratory Medicine and Pathobiology (G.G.K.), University of Toronto; and Laboratory Medicine Program (G.G.K.), University Health Network, Toronto, Canada
| | - Aniko Gal
- Institute of Genomic Medicine and Rare Diseases (P.B., R.B., A.L., A.G., Z.G., D.C., M.J.M.), Semmelweis University, Budapest, Hungary; Neurology Outpatient Clinic (A.L.), General Medical Clinic, Motala Hospital, Sweden; Department of Neuroradiology (G.R.), and Department of Forensic and Insurance Medicine (K.D.), Semmelweis University, Budapest, Hungary; Tanz Centre for Research in Neurodegenerative Disease (G.G.K.), and Department of Laboratory Medicine and Pathobiology (G.G.K.), University of Toronto; and Laboratory Medicine Program (G.G.K.), University Health Network, Toronto, Canada
| | - Zoltan Grosz
- Institute of Genomic Medicine and Rare Diseases (P.B., R.B., A.L., A.G., Z.G., D.C., M.J.M.), Semmelweis University, Budapest, Hungary; Neurology Outpatient Clinic (A.L.), General Medical Clinic, Motala Hospital, Sweden; Department of Neuroradiology (G.R.), and Department of Forensic and Insurance Medicine (K.D.), Semmelweis University, Budapest, Hungary; Tanz Centre for Research in Neurodegenerative Disease (G.G.K.), and Department of Laboratory Medicine and Pathobiology (G.G.K.), University of Toronto; and Laboratory Medicine Program (G.G.K.), University Health Network, Toronto, Canada
| | - Dora Csaban
- Institute of Genomic Medicine and Rare Diseases (P.B., R.B., A.L., A.G., Z.G., D.C., M.J.M.), Semmelweis University, Budapest, Hungary; Neurology Outpatient Clinic (A.L.), General Medical Clinic, Motala Hospital, Sweden; Department of Neuroradiology (G.R.), and Department of Forensic and Insurance Medicine (K.D.), Semmelweis University, Budapest, Hungary; Tanz Centre for Research in Neurodegenerative Disease (G.G.K.), and Department of Laboratory Medicine and Pathobiology (G.G.K.), University of Toronto; and Laboratory Medicine Program (G.G.K.), University Health Network, Toronto, Canada
| | - Gabor Rudas
- Institute of Genomic Medicine and Rare Diseases (P.B., R.B., A.L., A.G., Z.G., D.C., M.J.M.), Semmelweis University, Budapest, Hungary; Neurology Outpatient Clinic (A.L.), General Medical Clinic, Motala Hospital, Sweden; Department of Neuroradiology (G.R.), and Department of Forensic and Insurance Medicine (K.D.), Semmelweis University, Budapest, Hungary; Tanz Centre for Research in Neurodegenerative Disease (G.G.K.), and Department of Laboratory Medicine and Pathobiology (G.G.K.), University of Toronto; and Laboratory Medicine Program (G.G.K.), University Health Network, Toronto, Canada
| | - Krisztina Danics
- Institute of Genomic Medicine and Rare Diseases (P.B., R.B., A.L., A.G., Z.G., D.C., M.J.M.), Semmelweis University, Budapest, Hungary; Neurology Outpatient Clinic (A.L.), General Medical Clinic, Motala Hospital, Sweden; Department of Neuroradiology (G.R.), and Department of Forensic and Insurance Medicine (K.D.), Semmelweis University, Budapest, Hungary; Tanz Centre for Research in Neurodegenerative Disease (G.G.K.), and Department of Laboratory Medicine and Pathobiology (G.G.K.), University of Toronto; and Laboratory Medicine Program (G.G.K.), University Health Network, Toronto, Canada
| | - Gabor G Kovacs
- Institute of Genomic Medicine and Rare Diseases (P.B., R.B., A.L., A.G., Z.G., D.C., M.J.M.), Semmelweis University, Budapest, Hungary; Neurology Outpatient Clinic (A.L.), General Medical Clinic, Motala Hospital, Sweden; Department of Neuroradiology (G.R.), and Department of Forensic and Insurance Medicine (K.D.), Semmelweis University, Budapest, Hungary; Tanz Centre for Research in Neurodegenerative Disease (G.G.K.), and Department of Laboratory Medicine and Pathobiology (G.G.K.), University of Toronto; and Laboratory Medicine Program (G.G.K.), University Health Network, Toronto, Canada
| | - Maria Judit Molnar
- Institute of Genomic Medicine and Rare Diseases (P.B., R.B., A.L., A.G., Z.G., D.C., M.J.M.), Semmelweis University, Budapest, Hungary; Neurology Outpatient Clinic (A.L.), General Medical Clinic, Motala Hospital, Sweden; Department of Neuroradiology (G.R.), and Department of Forensic and Insurance Medicine (K.D.), Semmelweis University, Budapest, Hungary; Tanz Centre for Research in Neurodegenerative Disease (G.G.K.), and Department of Laboratory Medicine and Pathobiology (G.G.K.), University of Toronto; and Laboratory Medicine Program (G.G.K.), University Health Network, Toronto, Canada
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Jimoh IJ, Sebe B, Balicza P, Fedor M, Pataky I, Rudas G, Gal A, Inczedy-Farkas G, Nemeth G, Molnar MJ. Wernicke-Korsakoff syndrome associated with mtDNA disease. Ther Adv Neurol Disord 2020; 13:1756286420938972. [PMID: 32821290 PMCID: PMC7412926 DOI: 10.1177/1756286420938972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 05/27/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Wernicke encephalopathy (WE) and Wernicke-Korsakoff syndrome (WKS) are well-known disorders caused by thiamine deficiency. In addition to the classical concept of these diseases, some literature data suggest a connection between mitochondrial dysfunction and WE/WKS. Psychotic disorders and WKS seem to run in families, as the deficiency of the oxidative phosphorylation can be a trigger factor in psychotic events and WE/WKS as well. We present a patient harbouring the m.A3243G mtDNA mutation with the clinical and magnetic resonance imaging (MRI) findings of WKS who developed schizophrenia with predominantly negative symptoms some years later. Case presentation A 27-year-old woman was referred to our clinic with severe weight loss after severe vomiting episodes, memory dysfunction and gait ataxia. Family history, as well as clinical, imaging and laboratory findings suggested a mitochondrial aetiology of her symptoms. Brain MRI detected bilateral mild thalamic lesions and loss of corpus mammillae, indicating Wernicke encephalopathy. Genetic testing detected an m.A3243G mtDNA mutation, which has been frequently associated with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes. High-dose vitamin B1 supplementation with supportive antioxidant therapy improved the patient's memory and learning disturbance; however, some months later she developed psychosis with predominantly negative symptoms and her cognitive functions deteriorated again. Both cognitive and negative symptoms responded well to cariprazine monotherapy. Discussion Mitochondrial disease due to mtDNA alteration can be a rare cause of WE. In addition to vitamin B1 supplementation, cariprazine with significant dopamine D3 receptor binding can be useful to treat the predominantly negative symptoms and cognitive dysfunction in patients with mitochondrial dysfunction. Conclusion We assume that patients with a mitochondrial disorder might be prone to develop WE/WKS and therefore need tailored supportive therapy during metabolic crisis as well as symptom-based personalized antipsychotic treatment.
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Affiliation(s)
| | | | - Peter Balicza
- Semmelweis University of Medicine, Budapest, Hungary
| | - Mariann Fedor
- Semmelweis University of Medicine, Budapest, Hungary
| | - Ilona Pataky
- Peter Pazmany Catholic University, Budapest, Hungary
| | - Gabor Rudas
- Semmelweis University of Medicine, Budapest, Hungary
| | - Aniko Gal
- Semmelweis University of Medicine, Budapest, Hungary
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9
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Fekete B, Pentelényi K, Rudas G, Gál A, Grosz Z, Illés A, Idris J, Csukly G, Domonkos A, Molnar MJ. Broadening the phenotype of the TWNK gene associated Perrault syndrome. BMC Med Genet 2019; 20:198. [PMID: 31852434 PMCID: PMC6921552 DOI: 10.1186/s12881-019-0934-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Abstract
Background Perrault syndrome is a genetically heterogenous, very rare disease, characterized clinically by sensorineural hearing loss, ovarian dysfunction and neurological symptoms. We present the case of a 33 years old female patient with TWNK-associated Perrault syndrome. The TWNK gene is coding the mitochondrial protein Twinkle and currently there are only two reports characterizing the phenotype of TWNK-associated Perrault syndrome. None of these publications reported about special brain MRI alterations and neuropathological changes in the muscle and peripheral nerves. Case presentation Our patients with TWNK-dependent Perrault syndrome had severe bilateral hypoacusis, severe ataxia, polyneuropathy, lower limb spastic paraparesis with pyramidal signs, and gonadal dysgenesis. Psychiatric symptoms such as depression and paranoia were present as well. Brain MRI observed progressive cerebellar hyperintensive signs associated with cerebellar, medulla oblongata and cervical spinal cord atrophy. Light microscopy of the muscle biopsy detected severe neurogenic lesions. COX staining was centrally reduced in many muscle fibers. Both muscle and sural nerve electron microscopy detected slightly enlarged mitochondria with abnormal cristae surrounded by lipid vacuoles. In the sural nerve, dystrophic axons had focally uncompacted myelin lamellae present. Genetic investigation revealed multiple mtDNA deletion and compound heterozygous mutations of the TWNK gene (c.1196 A > G, c.1358 G > A). Conclusion This study demonstrates that TWNK associated Perrault syndrome has a much broader phenotype as originally published. The coexistence of severe hypoacusis, spastic limb weakness, ataxia, polyneuropathy, gonadal dysgensia, hyperintense signals in the cerebellum and the presence of the mtDNA multiple deletion could indicate the impairment of the TWNK gene. This is the first report about pyramidal tract involvement and cerebellar MRI alteration associated with TWNK-related Perrault syndrome.
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Affiliation(s)
- Bálint Fekete
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, 26 Üllői Rd, Budapest, 1085, Hungary.
| | - Klára Pentelényi
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, 26 Üllői Rd, Budapest, 1085, Hungary
| | - Gabor Rudas
- MR Research Centre, Semmelweis University, Budapest, Hungary
| | - Anikó Gál
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, 26 Üllői Rd, Budapest, 1085, Hungary
| | - Zoltán Grosz
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, 26 Üllői Rd, Budapest, 1085, Hungary
| | - Anett Illés
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, 26 Üllői Rd, Budapest, 1085, Hungary
| | - Jimoh Idris
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, 26 Üllői Rd, Budapest, 1085, Hungary
| | - Gabor Csukly
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Andor Domonkos
- Institute of Experimental Medicine of the Hungarian Academy of Sciences, Budapest, Hungary
| | - Maria Judit Molnar
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, 26 Üllői Rd, Budapest, 1085, Hungary
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Ilias A, Lovasz BD, Gonczi L, Kurti Z, Vegh Z, Sumegi LD, Golovics PA, Rudas G, Lakatos PL. Optimizing Patient Management in Crohn's Disease in a Tertiary Referral Center: the Impact of Fast-Track MRI on Patient Management and Outcomes. J Gastrointestin Liver Dis 2019; 27:391-397. [PMID: 30574621 DOI: 10.15403/jgld.2014.1121.274.ocm] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Rapid optimization of treatment algorithms and disease outcomes requires an objective measurement of disease activity in patients with Crohn's disease (CD). Our aim was to evaluate the impact of rapid-access to magnetic resonance imaging (MRI) on treatment optimization, clinical decision-making and outcomes for CD patients in a specialized tertiary care for inflammatory bowel disease (IBD) patients. METHODS A cohort of 75 referral CD patients (median age: 34, IQR: 25-43 years) who had underwent 90 fast-track MR enterography (MRE) scans between January 2014 and June 2016 were retrospectively enrolled. The MRI results were compared to clinical activity scores and biomarkers (C-reactive protein). The immediate impact of fast-track MRI on clinical decision-making, including changes in medical therapy, the need of hospitalization and surgery were evaluated. RESULTS The location of CD was ileo-colonic in 61% of the patients with perianal fistulas in 56% and previous surgeries in 55%. The indication for fast-track MRI scans was active disease (clinical or biomarker activity) in 55.6%. The radiological activity (including mild radiological signs to severe lesions) was detected in 94% of cases. Significant/severe MRI activity was depicted in 68% of these patients. Correlation between MRI radiological activity and clinical disease activity or colonoscopy was moderate (kappa: 0.609 and 0.652). A change in therapeutic strategy was made in 94.1% of cases with severe MRI radiological activity vs. 50% of patients without severe MRI radiological activity (p=0.001). Significant/severe MRI activity was followed by higher surgery rates among patients with clinical disease activity (50% vs. 12.5%; p=0.013). MRI performed on patients with clinical and biomarker remission identified disease activity in a significantly smaller proportion. CONCLUSIONS Fast-track MRI had a great impact on patient management in CD patients with clinical or biomarker activity, leading to better patient stratification and faster optimization of the therapy (medical or surgical), while MRI revealed previously undiagnosed disease activity only in a small proportion of patients in clinical remission.
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Affiliation(s)
- Akos Ilias
- Semmelweis University, First Department of Medicine, Budapest, Hungary
| | - Barbara D Lovasz
- Semmelweis University, First Department of Medicine;Institute of Applied Health Sciences, Semmelweis University, Budapest, Hungary
| | - Lorant Gonczi
- Semmelweis University, First Department of Medicine, Budapest, Hungary
| | - Zsuzsanna Kurti
- Semmelweis University, First Department of Medicine, Budapest, Hungary
| | - Zsuzsanna Vegh
- Semmelweis University, First Department of Medicine, Budapest, Hungary
| | - Liza D Sumegi
- Semmelweis University, First Department of Medicine, Budapest, Hungary
| | | | - Gabor Rudas
- Semmelweis University, Magnetic Resonance Imaging Research Center, Budapest, Hungary
| | - Peter L Lakatos
- Semmelweis University, First Department of Medicine, Budapest, Hungary;Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada. ;
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Barta H, Jermendy A, Kolossvary M, Kozak LR, Lakatos A, Meder U, Szabo M, Rudas G. Prognostic value of early, conventional proton magnetic resonance spectroscopy in cooled asphyxiated infants. BMC Pediatr 2018; 18:302. [PMID: 30219051 PMCID: PMC6139158 DOI: 10.1186/s12887-018-1269-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/28/2018] [Indexed: 11/20/2022] Open
Abstract
Background Neonatal hypoxic-ischemic encephalopathy (HIE) commonly leads to neurodevelopmental impairment, raising the need for prognostic tools which may guide future therapies in time. Prognostic value of proton MR spectroscopy (H-MRS) between 1 and 46 days of age has been extensively studied; however, the reproducibility and generalizability of these methods are controversial in a general clinical setting. Therefore, we investigated the prognostic performance of conventional H-MRS during first 96 postnatal hours in hypothermia-treated asphyxiated neonates. Methods Fifty-one consecutive hypothermia-treated HIE neonates were examined by H-MRS at three echo-times (TE = 35, 144, 288 ms) between 6 and 96 h of age, depending on clinical stability. Patients were divided into favorable (n = 35) and unfavorable (n = 16) outcome groups based on psychomotor and mental developmental index (PDI and MDI, Bayley Scales of Infant Development II) scores (≥ 70 versus < 70 or death, respectively), assessed at 18–26 months of age. Associations between 36 routinely measured metabolite ratios and outcome were studied. Age-dependency of metabolite ratios in whole patient population was assessed. Prognostic performance of metabolite ratios was evaluated by Receiver Operating Characteristics (ROC) analysis. Results Three metabolite ratios showed significant difference between outcome groups after correction for multiple testing (p < 0.0014): myo-inositol (mIns)/N-acetyl-aspartate (NAA) height, mIns/creatine (Cr) height, both at TE = 35 ms, and NAA/Cr height at TE = 144 ms. Assessment of age-dependency showed that all 3 metabolite ratios (mIns/NAA, NAA/Cr and mIns/Cr) stayed constant during first 96 postnatal hours, rendering them optimal for prediction. ROC analysis revealed that mIns/NAA gives better prediction for outcome than NAA/Cr and mIns/Cr with cut-off values 0.6798 0.6274 and 0.7798, respectively, (AUC 0.9084, 0.8396 and 0.8462, respectively, p < 0.00001); mIns/NAA had the highest specificity (95.24%) and sensitivity (84.62%) for predicting outcome of neonates with HIE any time during the first 96 postnatal hours. Conclusions Our findings suggest that during first 96 h of age even conventional H-MRS could be a useful prognostic tool in predicting the outcome of asphyxiated neonates; mIns/NAA was found to be the best and age-independent predictor. Electronic supplementary material The online version of this article (10.1186/s12887-018-1269-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hajnalka Barta
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary.
| | - Agnes Jermendy
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Marton Kolossvary
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Lajos R Kozak
- MR Research Center, Semmelweis University, Budapest, Hungary
| | - Andrea Lakatos
- MR Research Center, Semmelweis University, Budapest, Hungary
| | - Unoke Meder
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Miklos Szabo
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Gabor Rudas
- MR Research Center, Semmelweis University, Budapest, Hungary
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Bansagi B, Lewis-Smith D, Pal E, Duff J, Griffin H, Pyle A, Müller JS, Rudas G, Aranyi Z, Lochmüller H, Chinnery PF, Horvath R. Phenotypic convergence of Menkes and Wilson disease. Neurol Genet 2016; 2:e119. [PMID: 27878136 PMCID: PMC5114694 DOI: 10.1212/nxg.0000000000000119] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 10/05/2016] [Indexed: 11/25/2022]
Abstract
Menkes disease is an X-linked multisystem disorder with epilepsy, kinky hair, and neurodegeneration caused by mutations in the copper transporter ATP7A. Other ATP7A mutations have been linked to juvenile occipital horn syndrome and adult-onset hereditary motor neuropathy.1,2 About 5%-10% of the patients present with "atypical Menkes disease" characterized by longer survival, cerebellar ataxia, and developmental delay.2 The intracellular copper transport is regulated by 2 P type ATPase copper transporters ATP7A and ATP7B. These proteins are expressed in the trans-Golgi network that guides copper to intracellular compartments, and in copper excess, it relocates copper to the plasma membrane to pump it out from the cells.3ATP7B mutations cause Wilson disease with dystonia, ataxia, tremor, and abnormal copper accumulation in the brain, liver, and other organs.4.
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Affiliation(s)
- Boglarka Bansagi
- John Walton Muscular Dystrophy Research Centre (B.B., D.L.-S., J.D., H.G., A.P., J.S.M., H.L., R.H.), and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine Institute of Genetic Medicine, Newcastle University, UK; Department of Neurology (E.P.), University of Pecs, Hungary; MRI Research Centre (G.R.), and MTA-SE NAP B Peripheral Nervous System Research Group (Z.A.), Department of Neurology, Semmelweis University, Budapest, Hungary; MRC-Mitochondrial Biology Unit (P.F.C.), and Department of Clinical Neurosciences (P.F.C.), Cambridge Biomedical Campus, University of Cambridge, UK
| | - David Lewis-Smith
- John Walton Muscular Dystrophy Research Centre (B.B., D.L.-S., J.D., H.G., A.P., J.S.M., H.L., R.H.), and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine Institute of Genetic Medicine, Newcastle University, UK; Department of Neurology (E.P.), University of Pecs, Hungary; MRI Research Centre (G.R.), and MTA-SE NAP B Peripheral Nervous System Research Group (Z.A.), Department of Neurology, Semmelweis University, Budapest, Hungary; MRC-Mitochondrial Biology Unit (P.F.C.), and Department of Clinical Neurosciences (P.F.C.), Cambridge Biomedical Campus, University of Cambridge, UK
| | - Endre Pal
- John Walton Muscular Dystrophy Research Centre (B.B., D.L.-S., J.D., H.G., A.P., J.S.M., H.L., R.H.), and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine Institute of Genetic Medicine, Newcastle University, UK; Department of Neurology (E.P.), University of Pecs, Hungary; MRI Research Centre (G.R.), and MTA-SE NAP B Peripheral Nervous System Research Group (Z.A.), Department of Neurology, Semmelweis University, Budapest, Hungary; MRC-Mitochondrial Biology Unit (P.F.C.), and Department of Clinical Neurosciences (P.F.C.), Cambridge Biomedical Campus, University of Cambridge, UK
| | - Jennifer Duff
- John Walton Muscular Dystrophy Research Centre (B.B., D.L.-S., J.D., H.G., A.P., J.S.M., H.L., R.H.), and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine Institute of Genetic Medicine, Newcastle University, UK; Department of Neurology (E.P.), University of Pecs, Hungary; MRI Research Centre (G.R.), and MTA-SE NAP B Peripheral Nervous System Research Group (Z.A.), Department of Neurology, Semmelweis University, Budapest, Hungary; MRC-Mitochondrial Biology Unit (P.F.C.), and Department of Clinical Neurosciences (P.F.C.), Cambridge Biomedical Campus, University of Cambridge, UK
| | - Helen Griffin
- John Walton Muscular Dystrophy Research Centre (B.B., D.L.-S., J.D., H.G., A.P., J.S.M., H.L., R.H.), and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine Institute of Genetic Medicine, Newcastle University, UK; Department of Neurology (E.P.), University of Pecs, Hungary; MRI Research Centre (G.R.), and MTA-SE NAP B Peripheral Nervous System Research Group (Z.A.), Department of Neurology, Semmelweis University, Budapest, Hungary; MRC-Mitochondrial Biology Unit (P.F.C.), and Department of Clinical Neurosciences (P.F.C.), Cambridge Biomedical Campus, University of Cambridge, UK
| | - Angela Pyle
- John Walton Muscular Dystrophy Research Centre (B.B., D.L.-S., J.D., H.G., A.P., J.S.M., H.L., R.H.), and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine Institute of Genetic Medicine, Newcastle University, UK; Department of Neurology (E.P.), University of Pecs, Hungary; MRI Research Centre (G.R.), and MTA-SE NAP B Peripheral Nervous System Research Group (Z.A.), Department of Neurology, Semmelweis University, Budapest, Hungary; MRC-Mitochondrial Biology Unit (P.F.C.), and Department of Clinical Neurosciences (P.F.C.), Cambridge Biomedical Campus, University of Cambridge, UK
| | - Juliane S Müller
- John Walton Muscular Dystrophy Research Centre (B.B., D.L.-S., J.D., H.G., A.P., J.S.M., H.L., R.H.), and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine Institute of Genetic Medicine, Newcastle University, UK; Department of Neurology (E.P.), University of Pecs, Hungary; MRI Research Centre (G.R.), and MTA-SE NAP B Peripheral Nervous System Research Group (Z.A.), Department of Neurology, Semmelweis University, Budapest, Hungary; MRC-Mitochondrial Biology Unit (P.F.C.), and Department of Clinical Neurosciences (P.F.C.), Cambridge Biomedical Campus, University of Cambridge, UK
| | - Gabor Rudas
- John Walton Muscular Dystrophy Research Centre (B.B., D.L.-S., J.D., H.G., A.P., J.S.M., H.L., R.H.), and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine Institute of Genetic Medicine, Newcastle University, UK; Department of Neurology (E.P.), University of Pecs, Hungary; MRI Research Centre (G.R.), and MTA-SE NAP B Peripheral Nervous System Research Group (Z.A.), Department of Neurology, Semmelweis University, Budapest, Hungary; MRC-Mitochondrial Biology Unit (P.F.C.), and Department of Clinical Neurosciences (P.F.C.), Cambridge Biomedical Campus, University of Cambridge, UK
| | - Zsuzsanna Aranyi
- John Walton Muscular Dystrophy Research Centre (B.B., D.L.-S., J.D., H.G., A.P., J.S.M., H.L., R.H.), and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine Institute of Genetic Medicine, Newcastle University, UK; Department of Neurology (E.P.), University of Pecs, Hungary; MRI Research Centre (G.R.), and MTA-SE NAP B Peripheral Nervous System Research Group (Z.A.), Department of Neurology, Semmelweis University, Budapest, Hungary; MRC-Mitochondrial Biology Unit (P.F.C.), and Department of Clinical Neurosciences (P.F.C.), Cambridge Biomedical Campus, University of Cambridge, UK
| | - Hanns Lochmüller
- John Walton Muscular Dystrophy Research Centre (B.B., D.L.-S., J.D., H.G., A.P., J.S.M., H.L., R.H.), and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine Institute of Genetic Medicine, Newcastle University, UK; Department of Neurology (E.P.), University of Pecs, Hungary; MRI Research Centre (G.R.), and MTA-SE NAP B Peripheral Nervous System Research Group (Z.A.), Department of Neurology, Semmelweis University, Budapest, Hungary; MRC-Mitochondrial Biology Unit (P.F.C.), and Department of Clinical Neurosciences (P.F.C.), Cambridge Biomedical Campus, University of Cambridge, UK
| | - Patrick F Chinnery
- John Walton Muscular Dystrophy Research Centre (B.B., D.L.-S., J.D., H.G., A.P., J.S.M., H.L., R.H.), and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine Institute of Genetic Medicine, Newcastle University, UK; Department of Neurology (E.P.), University of Pecs, Hungary; MRI Research Centre (G.R.), and MTA-SE NAP B Peripheral Nervous System Research Group (Z.A.), Department of Neurology, Semmelweis University, Budapest, Hungary; MRC-Mitochondrial Biology Unit (P.F.C.), and Department of Clinical Neurosciences (P.F.C.), Cambridge Biomedical Campus, University of Cambridge, UK
| | - Rita Horvath
- John Walton Muscular Dystrophy Research Centre (B.B., D.L.-S., J.D., H.G., A.P., J.S.M., H.L., R.H.), and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine Institute of Genetic Medicine, Newcastle University, UK; Department of Neurology (E.P.), University of Pecs, Hungary; MRI Research Centre (G.R.), and MTA-SE NAP B Peripheral Nervous System Research Group (Z.A.), Department of Neurology, Semmelweis University, Budapest, Hungary; MRC-Mitochondrial Biology Unit (P.F.C.), and Department of Clinical Neurosciences (P.F.C.), Cambridge Biomedical Campus, University of Cambridge, UK
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Tamás G, Kelemen A, Albert D, Rózsa I, Csibri E, Entz L, Fabó D, Halász L, Rudas G, Barsi P, Golopencza P, Eröss L. EP 8. Motor outcome of the bilateral subthalamic stimulation in Parkinson’s disease, one-year follow-up results from the Neuromodulation Centre in Budapest. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Vastagh I, Palásti Á, Aradi G, Tóth A, Várallyay G, Rudas G, Demeter J, Csomor J, Aberle S, Budka H, Bereczki D, Kovács G. Six-year survival of progressive multifocal leukoencephalopathy associated with follicular lymphoma. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.2137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hornyák C, Rudas G, Csillik A, Bereczki D, Kovács T. Reversible splenial lesion in a Caucasian adult. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Rab T, Vastagh I, Váradi V, Szőke K, Bozsik G, Várallyay G, Rudas G, Bereczki D. Internuclear ophthalmoplegia caused by an isolated ischemic lesion affecting the medial longitudinal fascicle. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Körtvélyes J, Bankó EM, Andics A, Rudas G, Németh J, Hermann P, Vidnyánszky Z. Visual cortical responses to the input from the amblyopic eye are suppressed during binocular viewing. Acta Biol Hung 2012; 63 Suppl 1:65-79. [PMID: 22453742 DOI: 10.1556/abiol.63.2012.suppl.1.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Amblyopia is a visual disorder caused by an anomalous early visual experience. It has been suggested that suppression of the visual input from the weaker eye might be a primary underlying mechanism of the amblyopic syndrome. However, it is still an unresolved question to what extent neural responses to the visual information coming from the amblyopic eye are suppressed during binocular viewing. To address this question we measured event-related potentials (ERP) to foveal face stimuli in amblyopic patients, both in monocular and binocular viewing conditions. The results revealed no difference in the amplitude and latency of early components of the ERP responses between the binocular and fellow eye stimulation. On the other hand, early ERP components were reduced and delayed in the case of monocular stimulation of the amblyopic eye as compared to the fellow eye stimulation or to binocular viewing. The magnitude of the amblyopic effect measured on the ERP amplitudes was comparable to that found on the fMRI responses in the fusiform face area using the same face stimuli and task conditions. Our findings showing that the amblyopic effects present on the early ERP components in the case of monocular stimulation are not manifested in the ERP responses during binocular viewing suggest that input from the amblyopic eye is completely suppressed already at the earliest stages of visual cortical processing when stimuli are viewed by both eyes.
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Affiliation(s)
- Judit Körtvélyes
- Faculty of Information Technology, Pázmány Péter Catholic University, Budapest, Hungary
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Abstract
Aim: Hypothermia is often induced to reduce brain injury in newborns, following perinatal hypoxic–ischaemic events, and in adults following traumatic brain injury, stroke or cardiac arrest. We aimed to devise a method, based on diffusion-weighted MRI, to measure non-invasively the temperature of the cerebrospinal fluid in the lateral ventricles. Methods: The well-known temperature dependence of the water diffusion constant was used for the estimation of temperature. We carried out diffusion MRI measurements on a 3T Philips Achieva Scanner involving phantoms (filled with water or artificial cerebrospinal fluid while slowly cooling from 41 to 32°C) and healthy adult volunteers. Results: The estimated temperature of water phantoms followed that measured using a mercury thermometer, but the estimates for artificial cerebrospinal fluid were 1.04°C lower. After correcting for this systematic difference, the estimated temperature within the lateral ventricles of volunteers was 39.9°C. Using diffusion directions less sensitive to cerebrospinal fluid flow, it was 37.7°C, which was in agreement with the literature. Conclusion: Although further improvements are needed, measuring the temperature within the lateral ventricles using diffusion MRI is a viable method that may be useful for clinical applications. We introduced the method, identified sources of error and offered remedies for each.
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Affiliation(s)
- L R Kozak
- MR Research Center, Szentagothai J. Knowledge Center, Semmelweis University, Budapest, Hungary.
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Rudas G, Varga E, Méder U, Pataki M, Taylor GA. Changes in echogenicity of spinal subarachnoid space associated with intracranial hemorrhage: new observations. Pediatr Radiol 2000; 30:739-42. [PMID: 11100488 DOI: 10.1007/s002470000336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE The role of subarachnoid blood and secondary, sterile inflammation in the pathogenesis of posthemorrhagic hydrocephalus (PHH) is not well understood. The aims of this study were to study the frequency and rate of spread of blood into the spinal subarachnoid space (SSS) and to evaluate the relationship of this finding and PHH. MATERIALS AND METHODS Nine premature babies with major intracerebral hemorrhage (ICH, grade 3 or higher), and ten premature infants with minor ICH (grade 1) or no evidence of ICH (control group) were identified and underwent serial cranial and spinal sonography at the time of initial diagnosis, 12-24 h after the ICH and weekly thereafter for at least 9 weeks. Sagittal and axial scans of the thoracolumbar spine were obtained and evaluated for the presence of echogenic debris in the dorsal SSS. Six additional patients who had cranial and spinal sonography died within the 1st week of life and underwent post-mortem examinations. RESULTS The SSS was echo-free (normal) in all cases at the time of initial sonographic diagnosis of ICH. Within 24 h, all babies with major ICH had developed increased echogenicity of the cervical and thoracic SSS. Echogenicity of the SSS decreased gradually over several weeks. Although transient ventricular dilatation was present in every patient, only one patient had rapidly progressive PHH requiring shunt placement. Transient cysts of the cervicothoracic subarachnoid space were identified in two patients 6-7 weeks after ICH. The subarachnoid space remained echo-free in all control infants At autopsy, all four infants with echogenic spinal debris had blood or blood products in the spinal subarachnoid space, whereas two infants with echo-free spinal images did not. CONCLUSIONS Spread of blood from the ventricular system into the spinal subarachnoid space after ICH is common and can be seen within 24 h of initial ICH. Subarachnoid blood is associated with post-hemorrhagic ventricular dilatation and transient spinal subarachnoid cyst formation.
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Affiliation(s)
- G Rudas
- Department of Pediatrics II, Semelweis University School of Medicine, Budapest, Hungary
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Rudas G, Almássy Z, Papp B, Varga E, Méder U, Taylor GA. Echodense spinal subarachnoid space in neonates with progressive ventricular dilatation: a marker of noncommunicating hydrocephalus. AJR Am J Roentgenol 1998; 171:1119-21. [PMID: 9763007 DOI: 10.2214/ajr.171.4.9763007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our purpose was to evaluate the frequency and clinical significance of echogenic debris in the spinal subarachnoid space of neonates at risk for progressive ventricular dilatation. SUBJECTS AND METHODS Spinal sonography was performed on 15 neonates with severe intracranial hemorrhage (n = 10) or bacterial meningitis (n = 5). Spinal sonography also was performed on 16 control neonates. Images were analyzed for the presence and location of echogeric debris within the thoracolumbar subarachnoid space. Lumbar punctures were performed on all 31 neonates, and CSF was analyzed for cell count and protein content. Ten of 15 neonates required ventricular drainage procedures. RESULTS Progressive ventricular dilatation occurred in 11 of 15 neonates with intracranial hemorrhage or meningitis. Echogenic debris was present in the thoracolumbar subarachnoid space on spinal sonography in every neonate with progressive ventricular dilatation compared with none of the 16 control neonates (p < .0001 by chi-square analysis). In addition, the 11 neonates with echogenic subarachnoid space had significantly higher protein and RBC contents in the lumbar CSF (p < .04). CONCLUSION Echogenic subarachnoid space revealed by sonography is associated with progressive ventricular dilatation after severe intracranial hemorrhage or bacterial meningitis and is caused by high protein and RBC contents in the subarachnoid space. This finding may be helpful in identifying neonates who will not benefit from serial lumbar punctures for treatment of hydrocephalus.
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Affiliation(s)
- G Rudas
- Second Department of Pediatrics, Semmelweis University of Medicine, Budapest, Hungary
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Gyulay K, Niederland T, Rudas G, Kontor E, Zalatnai A, Kopper L, Homoki J, Borsi J, Sólyom J. [Androgen-producing adrenocortical adenoma in childhood. Pitfalls of differential diagnosis]. Orv Hetil 1997; 138:2357-62. [PMID: 9340584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A two-year-old girl presented with clitoromegaly and an abdominal mass. Diagnostic procedures including sonography, computerized tomography, scintigraphy and measurement of catecholamines in urine excluded neuroblastoma, but suspected Wilms-tumor. Before completing the steroid measurements therapy was initiated according to Wilms-tumor (preoperative cytostatic therapy followed by surgical removal of the tumor). Morphology of the tumor, the serum and urinary steroid profile proved a benign adrenocortical adenoma producing mainly delta 5-steroids including the weak androgen, dehydroepiandrosterone.
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Affiliation(s)
- K Gyulay
- II. sz. Gyermekgyógyászati Klinika, Semmelweis Orvostudományi Egyetem, Budapest
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Abstract
We describe two cases of hydrocephalus in which spinal sonography revealed underlying causes responsible for the failure of therapeutic lumbar punctures.
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Affiliation(s)
- G Rudas
- Department of Pediatrics II, Semelweis University School of Medicine, Budapest, Hungary
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Liptai Z, Kálmánchey R, Rudas G, Farkas A. [Septo-optic dysplasia (de Morsier syndrome)]. Orv Hetil 1996; 137:1705-9. [PMID: 8992420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Authors report a rare central nervous system malformation on giving account of three of their cases. The possibility of septo-optic dysplasia should be raised in children with unilateral or bilateral hypoplasia of the optic nerve. The use of neuroimaging technics is necessary for establishing the diagnosis. Knowing the disease is important because of the hypopituitarism which can accompany it, and which can necessitate an early hormone replacement therapy.
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Affiliation(s)
- Z Liptai
- II.Gyermekgyógyászati Klinika, Semmelweis Orvostudományi Egyetem, Budapest
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Seri I, Rudas G, Bors Z, Kanyicska B, Tulassay T. Effects of low-dose dopamine infusion on cardiovascular and renal functions, cerebral blood flow, and plasma catecholamine levels in sick preterm neonates. Pediatr Res 1993; 34:742-9. [PMID: 8108186 DOI: 10.1203/00006450-199312000-00009] [Citation(s) in RCA: 113] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Effects of 2 and 4 micrograms/kg/min dopamine infusion on cardiovascular and renal functions, cerebral blood flow (CBF) and plasma catecholamine levels were studied in sick preterm neonates during the first four days of life. Preterm infants were found to have an enhanced responsiveness to the pressor effects of dopamine during this period. Comparison of the renal effects of 2 and 4 micrograms/kg/min dopamine in 61 preterm infants indicate that 2 micrograms/kg/min dopamine induces maximum diuresis and natriuresis during the first day of life provided that systemic blood pressure is within the predicted normal range. Although administration of 4 micrograms/kg/min dopamine induces further increases in blood pressure and glomerular filtration rate, urine output and sodium excretion remain similar to that on 2 micrograms/kg/min of the drug. These findings demonstrate that the direct tubular effects of dopamine play an important role in the diuretic and natriuretic action of the drug in the one-day old preterm infant. In five preterm neonates, changes in CBF transiently paralleled the dopamine-induced alterations in systemic blood pressure indicating that autoregulation of CBF is impaired but not completely ineffective in the one-day old preterm infant. In eight term neonates, increases in blood pressure had no effect on CBF. Measurements of plasma dopamine and norepinephrine levels in 14 preterm neonates and five children suggest that decreased metabolism of dopamine may contribute to the enhanced pressor responsiveness to dopamine in sick preterm infants.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- I Seri
- Joint Program in Neonatology, Children's Hospital and Harvard Medical School, Boston, Massachusetts 02115
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Kálmánchey R, Sallai A, Rudas G. [Childhood dancing eye syndrome in occult neuroblastoma]. Orv Hetil 1992; 133:2233-4, 2237. [PMID: 1326737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The case of a two year-old boy is described with dancing eyes syndrome (DES) together with ganglioneuroblastoma. Surgical removal of the tumour and ACTH therapy resulted in rapid improvement, and an almost symptome-free condition. The literature is reviewed. Need of vigorous search for an occult neuroblastoma in DES is pointed out, since the early diagnosis and tumour's surgery can significantly improve the outcome.
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Affiliation(s)
- R Kálmánchey
- II. Gyermekklinika, Semmelweis Orvostudományi Egyetem, Budapest
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Rudas G, Kádár K. [Neonatal bronchogenic cyst diagnosed by ultrasound]. Orv Hetil 1989; 130:133-5. [PMID: 2643787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This is the description of a patient who presented in the neonatal period with respiratory difficulties, caused by a bronchogenic cyst. In this context attention is drawn to the significance of ultrasonography in the diagnosis of mediastinal tumors, lobar emphysema, atelectasis and therapy-resistant pneumonias.
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Rudas G, Kádár K. Bronchogenic cyst diagnosed by ultrasonography in a neonate. Radiol Med 1988; 76:488-9. [PMID: 3060906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- G Rudas
- Department of Pediatrics II, Semmelweis University Medical School, Budapest, Hungary
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Abstract
A neonate developed aortic thrombosis following catheterization of the umbilical artery. The thrombus was identified and followed up by ultrasonography. Fibrinolytic therapy led to the almost complete disappearance of the aortic thrombus but the child died of cerebral haemorrhage. Physicians should be alerted to the possibility of aortic thrombosis in neonates following umbilical arterial catheterization. Ultrasonography is an appropriate method for diagnosis and follow-up in these cases.
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Affiliation(s)
- G Rudas
- 2nd Department of Pediatrics, Semmelweis University Medical School, Budapest, Hungary
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Horváth K, Simon K, Horn G, Rudas G, Bodánszky H. [Degranulation of mast cells of the small intestine after a single gliadin loading in celiac disease]. Orv Hetil 1986; 127:515-6, 519. [PMID: 3960532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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