Papers by Dániel Bereczki
Orvosi Hetilap, Aug 1, 2020
Bevezetés: A korai nemzetközi adatok szerint a COVID-19-pandémia alatt az akut ischaemiás stroke ... more Bevezetés: A korai nemzetközi adatok szerint a COVID-19-pandémia alatt az akut ischaemiás stroke miatti intézményi felvételek száma csökkent, és a kezelésig eltelt idő megnőtt. Célkitűzés: Azt vizsgáltuk, hogy a COVID-19-pandémia a magyarországi akut ischaemiás stroke ellátásra is hatással volt-e. Módszer: A járvány által érintett, 2020. 03. 01. és 2020. 04. 30. közötti időszakban egy egyetemi stroke-centrumban akut ischaemiás stroke miatt felvettek adatait hasonlítottuk 2019 azonos periódusához. A demográfiai és klinikai jellemzők mellett elemeztük az intravénás és az endovascularis kezelések arányát és az ellátás időbeli mutatóit. Eredmények: A COVID-időszakban 86, a kontrollidőszakban 97 akut ischaemiás stroke beteget láttunk el. A két időszak a demográfiai és a klinikai jellemzők szempontjából kiegyensúlyozott volt. A járvány alatt az endovascularis kezelések aránya nem változott (8%), az intravénás thrombolysisek aránya 26%-ról 16%-ra csökkent. A COVID-időszakban a stroke kezdetétől az intravénás kezelés megkezdéséig eltelt idő átlagosan 20 perccel nőtt, míg a kórházba érkezéstől a kezelésig eltelt idő átlagosan csak 5 perccel növekedett. A járvány alatt a 24 órán túl érkezettek aránya 13%-kal növekedett (p = 0,046). A beérkezési időkategóriák közötti átrendeződésben a többváltozós (vizsgálat éve, NIHSS, életkor) logisztikus regresszió alapján leginkább a vizsgálat évének (p = 0,096) lehet szerepe. Következtetések: A COVID-időszakban akut ischaemiás stroke miatt felvettek száma 11%-kal csökkent, a reperfúziós kezeléssel biztosan nem kezelhető, 24 órán túl érkező esetek aránya szignifikánsan növekedett. Míg az endovascularis beavatkozások aránya nem változott, az intravénás thrombolysisek abszolút aránya 10%-kal csökkent, és az intravénás kezelésig eltelt idő tendenciaszerűen megnőtt. Ezekben a változásokban magának a COVID-19-járványnak és a hozzá kapcsolódó kórházi ellátáson kívüli faktoroknak lehet a legnagyobb szerepük.
Neuroimaging - Clinical Applications, 2012
Cerebral small vessel disease (cSVD) is a spectrum of clinical and imaging abnormalities linked t... more Cerebral small vessel disease (cSVD) is a spectrum of clinical and imaging abnormalities linked to the pathology of small penetrating arteries and arterioles in the brain irrigating subcortical structures 1 . Accumulating data suggest that cSVD is the most prevalent neurological disorder in the ageing society of the developed world . The prevalence of its seemingly asymptomatic manifestations -silent brain infarcts-increases with age from approximately 6-7% at 60 years to 28% at 80 years of age according to a recent review . In another study lacunar infarcts were found in 23% of all subjects over 65 years, and in 43% of subjects over 80 years of age 5 . Its acute, symptomatic manifestations -lacunar strokesaccount for approximately 20% of all ischemic strokes [8] . Thus improved management of cSVD based on better understanding of the disease is of great importance. cSVD is characterised by the arteriolosclerosis and/or microatheromatosis of small calibre (50-500 μm) cerebral arterial vessels caused by various pathologies 1 . Its most common, sporadic form is related to age and vascular risk factors including hypertension and diabetes in particular. Inherited forms are increasingly recognised with CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) being the most prevalent genetic cSVD caused by the mutation of NOTCH 3 gene encoding a transmembrane receptor of vascular smooth muscle cells . CADASIL -affecting young to middle aged, otherwise healthy individuals-provides a pure model for cSVD and therefore has been extensively studied 11 . Inflammatory, infective and immunologically mediated forms are usually part of systemic diseases of diverse origin characterised by central nervous system vasculitis 12 . Cerebral amyloid angiopathy (CAA) -a pathological hallmark of Alzheimer's disease-affects small vessels both cortically and subcortically and may also lead to ischemic changes, although it is particularly associated with recurrent lobar haemorrhages . In this chapter we will only focus on the most common and well studied age and vascular risk factor related form of cSVD and CADASIL. cSVD predominantly affects perforating end-arteries branching usually perpendicularly from a large parent artery. These penetrating arteries irrigate the so called perforator areas including the basal ganglia and internal capsule (lenticulostriate arteries from the anterior cerebral artery (ACA) A1 segment and middle cerebral artery (MCA) M1 segment), the www.intechopen.com Neuroimaging -Clinical Applications 278 thalamus (thalamoperforators from the posterior cerebral artery (PCA) and posterior communicating artery (PCoA)), the pons (pontine perforators from the basilar artery (BA)) and the hemispheric deep white matter -centrum semiovale (perforators from the cortical, leptomeningeal arteries) . The pathological changes in cSVD lead to luminal narrowing, decreased autoregulation and vasoreactivity, and vessel wall damage in the cerebral microvessels resulting in their i. gradual stenosis, ii. sudden occlusion or iii. rupture. As a consequence the subcortical brain tissue suffers from i.: diffuse chronic hypoperfusion and ischemia leading to the progressive disintegration of cerebral white matter 17 ; ii.: acute localised ischemia resulting in lacunar infarcts 18 ; ad iii.: acute major haemorrhages or microbleeds . In an advanced state of the disease cerebral atrophy invariably occurs as a remote and/or diffuse consequence of vascular lesion burden 20 . The pathogenesis of cSVD manifestations is summarized in Figure . The gradual ischemic tissue damage clinically manifests in progressive vascular cognitive impairment (mainly executive dysfunction) and physical disability (gait disturbances, pseudobulbar palsies, urinary incontinence etc.), whereas acute focal ischemia presents with the so-called lacunar syndromes. Cerebral microbleeds are usually asymptomatic and their clinical significance is yet to be determined. In this chapter we will summarize recent knowledge about the MRI characteristics of cSVD. Since the cerebral microvasculature cannot be currently visualized in vivo, the consequent parenchymal lesions (lacunar infarcts, white matter lesions, microbleeds and atrophy) have been adopted as markers of cSVD 12 . We will not discuss the issue of major haemorrhages. According to the "lacunar hypothesis" first proposed by Fisher small subcortical infarcts of a diameter less than 15 mm -called lacunar infarcts (LI)-result from the sudden occlusion of penetrating arteries due to cSVD in typical locations -the perforator areas (see above) . Infarcts of this type have been linked to particular clinical syndromes with a relatively good prognosis called the lacunar syndromes, most frequent of which are the classical ones: pure motor stroke, pure sensory stroke, ataxic hemiparesis, dysarthria-clumsy hand syndrome and sensorimotor stroke. The concept of lacunar stroke that entered stroke classifications was based on postmortem and CT based studies both with considerable limitations. The pathological studies were limited by the low mortality of lacunar strokes and by the anatomical changes occurring in the chronic stage and/or during fixation. CT has a low sensitivity to detect small infarcts in certain locations (posterior fossa, cortex) and in the acute stage and cannot differentiate between fresh and old lesions. The advent of MRI and especially its newer techniques such as diffusion weighted imaging (DWI), perfusion weighted imaging (PWI) and diffusion tensor imaging (DTI) has slightly modified our understanding of LIs 21 . Because of their small size visualizing LIs is much more problematic than that of larger territorial infarcts. Compared to CT conventional MRI sequences such as T1 weighted, T2
The Journal of Neuropsychiatry and Clinical Neurosciences, 2016
To the Editor: The classic clinical syndrome of superficial siderosis (SS) is characterized by pr... more To the Editor: The classic clinical syndrome of superficial siderosis (SS) is characterized by progressive hearing loss, ataxia, and pyramidal signs, but other manifestations such as dementia may occur. Here we report a unique case of SS in a patient with progressive symptoms of corticobasal syndrome (CBS) 2 caused by a cavernoma in the thalamus under the wall of the third ventricle.
Acta Physiologica Hungarica, 2011
Women with gestational diabetes mellitus (GDM) are at high risk of subsequently developing type 2... more Women with gestational diabetes mellitus (GDM) are at high risk of subsequently developing type 2 diabetes mellitus which is an important cardiovascular risk factor. We have evaluated whether preclinical morphological and functional arterial changes are present in GDM. Diameter, intima-media thickness (IMT), intima-media crosssection area (IMCSA) and elasticity features (compliance, distensibility coefficient, circumferential strain, stiffness index (SI) a and b, incremental elastic modulus) of the common carotid arteries (CCA) were studied in the 3 rd trimester in 25 women with GDM, and 17 normal pregnant women matched for age and body mass index using an ultrasonographic vessel wall-movement tracking system and applanation tonometry. Mean IMT, IMCSA and SI α tended to be larger, whereas compliance was smaller in women with GDM but none of these differences were significant. Serum glucose (4.99±0.51 vs. 4.79±0.61 mmol/L, p=0.37) and HbA1c (5.33±0.27 vs. 5.36±0.47 mmol/L, p=0.85) proved normoglycemia in both groups. In conclusion, by the combination of methods we applied in this case control study, neither morphological nor functional characteristics of large elastic arteries differ significantly between well-treated normoglycemic women with GDM and non-diabetic pregnant women in the 3 rd trimester.
Background: recent advances in the therapeutic options may prevent deterioration related to Hunti... more Background: recent advances in the therapeutic options may prevent deterioration related to Huntington’s disease (HD) even at the presymptomatic stage. However, a well-characterized patient population is essential for screening and outcome monitoring as well. Accordingly, the aim of this study was to describe the characteristics of a Hungarian subpopulation of HD patients and mutation carriers diagnosed at the University of Szeged.Methods: we conducted a search for International Classification of Diseases (ICD) code G10H0 in the local medical database for the period between 1 January 1998 and 31 December 2018.Results: we identified 90 HD cases (male: 45, female: 45) and 34 asymptomatic carriers (male: 15, female: 19). The median age of onset was 45 years (range: 16-79). There were 3 cases of juvenile (3.3%), and 7 of late disease onset (7.8%). The median repeat length was 43 (range: 36-70) for the pathological and 19 for the non-pathological alleles (range: 9-35). 17.5% of the patho...
Ideggyogyaszati Szemle-clinical Neuroscience, 2010
Ideggyogyaszati Szemle-clinical Neuroscience, 2011
Orvosi Hetilap, 2016
Thromboangiits obliterans (Buerger’s disease) is a non-atherosclerotic, segmental inflammatory an... more Thromboangiits obliterans (Buerger’s disease) is a non-atherosclerotic, segmental inflammatory and obliterative disease affecting small and medium sized arteries and veins. The etiology is still unknown, but it is in close relationship with tobacco use. Symptoms begin under the age of 45 years and the undulating course is typical. Patients usually present with acute and chronic ischemic or infectious acral lesions. Diagnosis is usually based on clinical and angiographic criteria and it is important to exclude autoimmune disease, thrombophilia, diabetes, and proximal embolic sources. Even though Buerger’s disease most commonly involves the arteries of the extremities, the pathologic findings sometimes affect the cerebral, coronary and internal thoracic, renal and mesenteric arteries as well. The authors present the history of a patient with known Buerger’s disease and acute ischemic stroke. Brain imaging detected acute and chronic ischemic lesions caused by middle cerebral non-athero...
Ideggyógyászati szemle, 2016
OBJECTIVES Stroke is the third leading cause of death in the European region. In spite of a decre... more OBJECTIVES Stroke is the third leading cause of death in the European region. In spite of a decreasing trend, stroke related mortality remains higher in Hungary and Romania when compared to the EU average. This might be due to higher incidence, increased severity or even less effective care. METHODS In this study we used two large, hospital based databases from Targu Mures (Romania) and Debrecen (Hungary) to compare not only the demographic characteristics of stroke patients from these countries but also the risk factors, as well as stroke severity and short term outcome. RESULTS The gender related distribution of patients was similar to those found in the European Survey, whereas the mean age of patients at stroke onset was similar in the two countries but lower by four years. Although the length of hospital stay was significantly different in the two countries it was still much shorter (about half) than in most reports from western European countries. The overall fatality rate in both databases, regardless of gender was comparable to averages from Europe and other countries. In both countries we found a high number of risk factors, frequently overlapping. The prevalence of risk factors (hypertension, smoking, hyperlipidaemia) was higher than those reported in other countries, which can explain the high ratio of recurring stroke.
Turkish Neurosurgery, 2015
400 consecutive patients with SAH in a single neurosurgical center in Eastern Hungary. █ MATERIAL... more 400 consecutive patients with SAH in a single neurosurgical center in Eastern Hungary. █ MATERIAL and METHODS Patient Population Debrecen is the second largest city in Hungary. It is located in the Eastern part of the country. Data of primary SAH patients admitted or referred to the Department of Neurosurgery at the University of Debrecen between the 1 st of January 1987 and the 31 st of December 2004 were collected prospectively and entered in an anonymized database. Because University of Debrecen is a referring center of the region, patients are registered not only from Debrecen City, but also from several counties of the region with a catchment area of approximately 700 000 inhabitants. SAH was determined by clinical symptoms and neuroimaging findings (CT, angiography). Lumbar AIM: We set forth to identify predictors of symptomatic vasospasm in patients with subarachnoid hemorrhage (SAH). MATERIAL and METHODS: We used multivariate logistic regression analysis of the prospective, hospital based, single center register of the
Orvosi hetilap, Jan 26, 1998
Previously numerous investigators reported about impairment of cerebrovascular reserve capacity i... more Previously numerous investigators reported about impairment of cerebrovascular reserve capacity in Type I, diabetes mellitus. However, no similar data are available about patients suffering from Type II diabetes. The goal of the study was to assess cerebrovascular reserve in Type II diabetic patients. 14 NIDDM patients and 20 healthy controls were studied. Middle cerebral artery mean blood flow velocity was measured at rest and during 20 minutes after i.v. administration of 1 g. acetazolamide. Velocities measured after acetazolamide were compared to resting values and were expressed as the percent increase of the mean velocity. Data obtained in diabetics and healthy persons were compared using Student's t-test. The correlation between age of the patients, diabetes duration, actual blood glucose-, insulin-, glycosylated hemoglobin-, urine microalbumin concentrations and resting blood flow velocity and cerebrovascular reserve capacity was assessed using linear regression analysis....
Ideggyógyászati szemle, Jan 30, 2012
Stroke is a major public health issue in Hungary with considerable regional differences in mortal... more Stroke is a major public health issue in Hungary with considerable regional differences in mortality. We have limited information to explain such regional differences. To assess these differences, we would need comparative followup studies optimally carried out by personal contact with the patient or the carer. According to several epidemiological studies, follow-up can be carried out with significantly lower cost and similar efficiency by telephone contact or regular mail. In this pilot study we intend to assess: 1. the efficacy of telephone follow-up one year after stroke in this geographical region 2. whether the efficacy of follow-up can be further increased with questionnaires sent out by regular mail 3. whether telephone and mail-based assessment is sufficient to perform a larger population based study. We included 135 patients hospitalized consecutively for acute cerebrovascular disease (stroke or TIA) by the Department of Neurology, Semmelweis University in January and Febru...
Ideggyógyászati szemle, Jan 30, 2011
Fabry-disease (FD) is a rare X-linked lysosomal storage disease. Deficiency of alpha-galactosidas... more Fabry-disease (FD) is a rare X-linked lysosomal storage disease. Deficiency of alpha-galactosidase A activity leads to the accumulation of neutral glycosphingolipids, primarily globotriaosylceramide (GL-3) in various tissues, particularly blood vessels, kidneys, myocardium and in ganglions of the peripheral and autonomic nervous system and causes diverse symptoms. The classical phenotype is seen in most males and rarely in females. In women, symptoms start later and the severity is milder. Both peripheral and central nervous system can be both affected. Fabry-patiens and gene-carriers in the central region of Hungary are treated in the 2nd Pediatric Department, Semmelweis University. These patients are consulted by an interdisciplinary team. At present, four hemizygous male, four heterozygous female Fabry-patients and three asymptomatic heterozygous gene carriers are followed. After reviewing the neurological complications of FD, we present clinical and neuroimaging data of our pati...
Ideggyógyászati szemle, Jan 20, 2005
The Multiple Sclerosis Functional Composite (MSFC) has been recommended by the National Multiple ... more The Multiple Sclerosis Functional Composite (MSFC) has been recommended by the National Multiple Sclerosis Society as a new clinical outcome measure. It is based on measurements in three clinical dimensions: leg function/ambulation (timed 25-foot walk), arm function (9-hole peg test), and cognitive function (paced auditory serial addition test). Scores on component measures are converted to standard scores (Z-scores) that reflect patient performance. This method has not yet been introduced into routine clinical practice. MSFC calculation was applied to 17 patients with relapsing-remitting multiple sclerosis (age mean: 37.4+/-10.8 years; duration of the disease: 5.5+/-4.9 years, EDSS: 2.7+/-1.4) seen at the neuroimmunological outpatient clinic to evaluate its usefulness and its correlation with the traditionally applied Expanded Disability Status Scale (EDSS) and with patient-reported quality of life. Fifteen patients received immunomodulatory treatment (interferon beta and glatirame...
Ideggyógyászati szemle, Jan 30, 2011
We analyzed the statistical characteristics of subarachnoid hemorrhage (SAH) in Hungary in 2009. ... more We analyzed the statistical characteristics of subarachnoid hemorrhage (SAH) in Hungary in 2009. Using data supplied by the hospitals about their inpatient services to the National Health Insurance Fund with ICD-10 code 160. 1403 SAH hospital cases were recorded in 1028 patients. That is much more than we expected from previous data. 63.6% were women, hospital case fatality was 12.2%. The average hospital stay was 6.47 days. 763 CT examinations were done (74.2% of the patients). Hypertension was recorded in 61.3% of the patients. The incidence was increasing with age till the age group of 51-60 years, and decreased beyond that. In 531 patients the source of bleeding could be verified. Aneurysm of the anterior communicating artery was more frequent in men, aneurysm of the middle cerebral artery (MCA) and internal carotid artery in women. In total MCA aneurysm was the most frequent. Arteriovenous malformation was present in 7.6% of the patients. SAH was most frequent in January and Fe...
We report the association of ipsilateral trigemino-autonomic headache to a case of right-sided nu... more We report the association of ipsilateral trigemino-autonomic headache to a case of right-sided nuclear facial and abducens palsy (Gasperini syndrome), ipsilateral hypacusis and right hemiataxia, caused by the occlusion of the right anterior inferior cerebellar artery. Short-lasting attacks of mild to moderate ipsilateral fronto-periorbital head pain, accompanied by lacrimation and mild conjunctival injection during more severe attacks, were present from the onset of symptoms, with a gradual worsening over the next few months and remitting during naproxen therapy. Magnetic resonance imaging showed an infarct in the right cerebellar peduncle, extending toward the pontine tegmentum, also involving the ipsilateral spinal trigeminal nucleus and tract and the trigeminal entry zone. Gasperini syndrome may be accompanied by ipsilateral trigeminoautonomic head pain.
Orvosi Hetilap, 2014
Cerebrovascular diseases are associated with a high incidence of psychiatric disorders. Depressiv... more Cerebrovascular diseases are associated with a high incidence of psychiatric disorders. Depressive illness after stroke has been extensively investigated during the last three decades. Post-stroke depression is estimated to occur in 30–35% of the patients during the first year after stroke. Numerous studies have given information on its prevalence, pathogenesis, clinical course, treatment and prevention. Despite the high level of comorbidity, depressive symptoms appear to remain frequently unrecognized and untreated. This has a negative effect on the rehabilitation, quality of live, cognitive function and mortality of stroke patients. Orv. Hetil., 2014, 155(34), 1335–1343.
Ideggyógyászati szemle, Jan 30, 2010
Aspergillus infection of the central nervous system is a rare disease, occasionally seen among im... more Aspergillus infection of the central nervous system is a rare disease, occasionally seen among immunocompromised patients. The most frequent pathway is hematogenic dissemination. Less known is the direct propagation from the paranasal sinuses, which is usually observed in immunocompetent patients. We report a patient who developed cavernous sinus syndrome due to an invasive intracranial aspergilloma after longlasting chemo- and steroid therapy for chronic lymphoid leukemia and immunhemolytic anemia. The characteristic features seen on radiological images--brain CT and MRI--suggested the possibility of invasive aspergilloma. Postoperative histology defined the diagnosis. Our case review highlights the importance of considering the possibility of an invasive opportunistic infection of the CNS in an immunocompromised patient presenting a new neurological sign.
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Papers by Dániel Bereczki