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Article: Pulvinar.

Szirmai, Imre

Neuropsychopharmacologia Hungarica : a Magyar Pszichofarmakologiai Egyesulet lapja = official journal of the Hungarian Association of Psychopharmacology

2013 Volume 15, Issue 1, Page(s) 19–26

Abstract: The pulvinar is the largest nucleus of the thalamus. Its lateral and inferior areas have rich connections with the visual- and dorsolateral parietal cortices. Several cells in the medial and upper area connect the anterior cingulum and the premotor and ... ...

Title translation	Pulvinar.
Abstract	The pulvinar is the largest nucleus of the thalamus. Its lateral and inferior areas have rich connections with the visual- and dorsolateral parietal cortices. Several cells in the medial and upper area connect the anterior cingulum and the premotor and prefrontal association areas. This neuronal network was considered to organize the saccades and visual attention. Other cells in the medial nucleus have axonal connections with paralimbic-, insular and higher order association-cortices. The medial structure integrates complex sensory information with limbic reactivity settings, transmitting these to the temporal and parieto-occipital centres. The pulvinar is supplied by the posterior chorioideal artery. Visual salience is considered to be an important function of the pulvinar. Visual selection enables subjects to choose the actually adequate behavioral act. To serve the visual salience the pulvinar may also inhibit inappropriate eye movements. The pulvinar appears to be a key structure of the EEG's alpha rhythm generator, acting together with the parietooccipital and temporal cortices. Dynamic fluctuation of BOLD signals on fMRI correlates well with the change of alpha power even in resting state. We presume that the pulvinar is part of a closed cortico-subcortical circuit, analogous with the striatum, but the output of the pulvinar initiates complex behavioral reactions, including perception, selective attention and emotions. Damage of the pulvinar may elicit contralateral visual neglect, because of the dissociation of the neuronal network integrated by the superior temporal area. Increased activity of the pulvinar was found during abrupt reaction to fearful visual signals; and also in the etiopathology of endogenous depressions through the alteration of serotonin transporters. Increased bilateral signal intensity of the pulvinar on MRI was detected in cases of the new variants of Creutzfeldt-Jakob- and Fabry diseases.
MeSH term(s)	Alpha Rhythm ; Attention ; Cerebral Cortex/anatomy & histology ; Cerebral Cortex/physiology ; Humans ; Intention ; Neural Pathways/anatomy & histology ; Neural Pathways/physiology ; Perceptual Disorders/physiopathology ; Pulvinar/anatomy & histology ; Pulvinar/cytology ; Pulvinar/pathology ; Pulvinar/physiology ; Pulvinar/physiopathology ; Space Perception ; Thalamus/blood supply ; Vision, Ocular
Language	Hungarian
Publishing date	2013-03
Publishing country	Hungary
Document type	English Abstract ; Journal Article ; Review
ISSN	1419-8711
ISSN	1419-8711
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Article: Neurofóbia.

Szirmai, Imre

Ideggyogyaszati szemle

2012 Volume 65, Issue 7-8, Page(s) 221–228

Abstract: Neurophobia is the fear of neurological diseases. Its main symptom is that medical students and young doctors are not able to utilize their basic neurological knowledge at the bedside. According to statistics, every second student suffers from ... ...

Title translation	Neurophobia.
Abstract	Neurophobia is the fear of neurological diseases. Its main symptom is that medical students and young doctors are not able to utilize their basic neurological knowledge at the bedside. According to statistics, every second student suffers from neurophobia. This attitude could explain why in the last two decades less and less young doctors wanted to become neurologist. Medical students complain that they receive no instructions, and are afraid of loosing their interest and of facing the failure of their clinical competence. The hardship of neurology was explained by the insufficient knowledge of anatomy and the infrequent encounter with patients. Even general practitioners have anxiety about neurological patients. The loss of interest in the neurosciences seems to be associated with insensitivity to human-centered culture and with the corruption of empathic thinking. The professional burnout of medical doctors and students can be explained by stress, loss of respect, permanent competition, independence that interferes with responsibility, stiff hierarchy of the medical establishment, fear of diagnostic failures and of economical difficulties. The scores of depression were higher in female students than in males. The idea of the "good neurologist" has been changed. Business-oriented care, shortage of time, and financial restrictions corroded conventional practice and ceased vocational idealism. At present, personal teaching is being transformed into impersonal multimedia instruction and learning. Because of the drastic change of values, the age of inner-oriented professionals has ended also in medicine. Medical doctors follow even less the traditional path of professional behavior, but according to social demands, they choose their specialization for financial reasons. The highly esteemed social status of neurologists and psychiatrists is going to sink in Europe. To reduce neurophobia it would be desirable 1. to introduce neurology training in the early years of medical school; 2. to teach neurology in all semesters, 3. to assure the effective teaching of neuroanatomy and neurophysiology, 4. to organize more one-to-one teacher-student communication. In the United States, residents participate in teaching during their residency training. To master neurology dedicated teachers are needed whom neurology residents would have to meet personally with optimal frequency. However, these requirements seem to fail because of the chiefly technical character of the actual reforms.
MeSH term(s)	Anxiety/etiology ; Burnout, Professional/psychology ; Career Choice ; Computer-Assisted Instruction ; Depression/epidemiology ; Depression/etiology ; Diagnostic Errors/psychology ; Education, Medical/methods ; Education, Medical/organization & administration ; Education, Medical/standards ; Education, Medical/trends ; Europe ; Fear ; Female ; Humans ; Hungary/epidemiology ; Internal-External Control ; Internship and Residency/methods ; Internship and Residency/trends ; Male ; Mentors ; Morale ; Neurology/education ; Neurology/manpower ; Neurology/trends ; Neurosciences/education ; Neurosciences/manpower ; Phobic Disorders/etiology ; Physicians/economics ; Physicians/psychology ; Physicians/trends ; Professional Role ; Socioeconomic Factors ; Stress, Psychological/complications ; Stress, Psychological/etiology ; Students, Medical/psychology ; Students, Medical/statistics & numerical data ; Suicidal Ideation ; United States
Language	Hungarian
Publishing date	2012-07-30
Publishing country	Hungary
Document type	English Abstract ; Journal Article ; Review
ZDB-ID	2240317-6
ISSN	0019-1442
ISSN	0019-1442
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Article: Vascularis vagy "lower body Parkinsonizmus". Egy diagnózis tündöklése és Bukása.

Szirmai, Imre

Ideggyogyaszati szemle

2011 Volume 64, Issue 11-12, Page(s) 385–393

Abstract: Unlabelled: The "arteriosclerotic parkinsonism", which is called vascular parkinsonism (VP), was first described by Critchley'. The broad based slow gait, reduced stride lenght, start hesitation, freezing and paratonia was mentioned as "lower body ... ...

Title translation	Vascular or "lower body Parkinsonism": rise and fall of a diagnosis.
Abstract	Unlabelled: The "arteriosclerotic parkinsonism", which is called vascular parkinsonism (VP), was first described by Critchley'. The broad based slow gait, reduced stride lenght, start hesitation, freezing and paratonia was mentioned as "lower body parkinsonism" (LBP) which can be associated by slow speech, dysexecutive syndrome, and hand tremor of predominantly postural character. In VP the DAT-scan proved normal dopamine content of the striatum in contrast with Parkinson's disease (PD). Additionally, Lewy bodies of brainstem type were not found in VR Probability of VP increases if central type pathologic gait is prominent; the hands are slightly involved, the MRI indicates transparent periventricular white substance and/or brain atrophy. In some cases differentiation of gait apraxia and parkinsonism could be challenging. There is no rigor of the lower limbs at rest in neither of them, the disturbance of movement is evoked by the gait itself. Three subtypes of "gait ignition failure" has been recently described: (1) ignition apraxia, (2) equilibrium apraxia and (3) mixed gait apraxia. The primary progressive freesing gait was considered as a Parkinson-plus syndrome. Freesing occurs more frequently in diseases with pakinsonism than in PD. The grade of ventricle dilatation and the frontal leukoaraiosis was similar in LBP and gait apraxia. In cases of normal pressure hydrocephalus the impaired gait may mimic PD. Pathologic gait in VP can be explained by the lesions of the senso-motor association pathways in dorsal paramedian white substance within the vulnerable borderzone region. These may be colocalized with the representation of the lower extremities in the posterior third of the supplementer motor area. Rektor2 proposed to change the name of LBP to "cerebrovascular gait disorder". Notwithstandig central type gait disorder develops also in many degenerative diseases other than cerebro-vascular origin. The neuronal net controling the regulation of movement is widespread, therefore several cortical and subcortical lesions could elicit large variations of pathologic gait, ie.: ataxia, apraxia, ignition failure, akinesis etc. In conclusion: most of the central gait disorders regarding the pathology and their appearance can not be called "parkinsonism"; these are much closer related to the localization of lesions rather than to the diagnostic categories.
MeSH term(s)	Brain/physiopathology ; Dementia/complications ; Dementia/physiopathology ; Diagnosis, Differential ; Dopamine/deficiency ; Gait ; Gait Apraxia/etiology ; Gait Apraxia/physiopathology ; Gait Ataxia/etiology ; Gait Ataxia/physiopathology ; Gait Disorders, Neurologic/etiology ; Gait Disorders, Neurologic/pathology ; Gait Disorders, Neurologic/physiopathology ; Humans ; Lower Extremity/physiopathology ; Parkinson Disease/diagnosis ; Parkinson Disease/physiopathology ; Parkinson Disease, Secondary/blood ; Parkinson Disease, Secondary/complications ; Parkinson Disease, Secondary/diagnosis ; Parkinson Disease, Secondary/pathology ; Parkinson Disease, Secondary/physiopathology
Chemical Substances	Dopamine (VTD58H1Z2X)
Language	Hungarian
Publishing date	2011-11-30
Publishing country	Hungary
Document type	English Abstract ; Journal Article ; Review
ZDB-ID	2240317-6
ISSN	0019-1442
ISSN	0019-1442
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Article: Mi köze van az aphasiának a memória- és viselkedészavarokhoz?

Szirmai, Imre

Ideggyogyaszati szemle

2010 Volume 63, Issue 9-10, Page(s) 335–339

Title translation	What does aphasia have to do with memory and behavior disorders?.
MeSH term(s)	Aphasia/classification ; Aphasia/complications ; Aphasia/diagnosis ; Aphasia/pathology ; Aphasia/physiopathology ; Aphasia/psychology ; Brain/physiopathology ; Dementia/physiopathology ; Dementia/psychology ; Humans ; Memory Disorders/etiology ; Memory Disorders/pathology ; Memory Disorders/physiopathology ; Memory Disorders/psychology ; Mental Disorders/etiology ; Mental Disorders/pathology ; Mental Disorders/physiopathology ; Mental Disorders/psychology ; Psychomotor Performance ; Semantics ; Speech
Language	Hungarian
Publishing date	2010-09-30
Publishing country	Hungary
Document type	Journal Article
ZDB-ID	2240317-6
ISSN	0019-1442
ISSN	0019-1442
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Article: How does the brain create rhythms?

Szirmai, Imre

Ideggyogyaszati szemle

2010 Volume 63, Issue 1-2, Page(s) 13–23

Abstract: Connection was found between rhythmic cortical activity and motor control. The 10 Hz micro-rhythm and the 20-30 Hz bursts represent two functional states of the somatomotor system. A correspondence of the central micro-rhythm of the motor cortex and the ... ...

Abstract	Connection was found between rhythmic cortical activity and motor control. The 10 Hz micro-rhythm and the 20-30 Hz bursts represent two functional states of the somatomotor system. A correspondence of the central micro-rhythm of the motor cortex and the physiological hand tremor (8-12 Hz) is presumed. The precise tuning of the motor system can be estimated by the frequency of repetitive finger movements. In complex tapping exercise, the index finger is the most skillful, the 3rd, 4th and 5th fingers keep rhythm with less precision. It was found that the organization of mirror movements depends on the cortical representation of fingers. Mirror finger movements are more regular if the subject begins the motor action with the 5th (small) finger. Concerning cortical regulation of finger movements, it was suggested that there are two time-keeping systems in the brain; one with a sensitivity above and another with a sensitivity below the critical frequency of 3 Hz. The preferred meter which helps to maintain synchronous finger movements is the cadence of 4/4 and 8/8. We observed that the unlearned inward-outward sequential finger movement was equally impaired in nonmusician controls and patients with Parkinson-disease. In movement disorders, the ability of movement and the "clock-mechanism" are equally involved. The polyrhythmic finger movement is not our inborn ability, it has to be learned. The "timer" function, which regulates the rhythmic movement, is presumably localised in the basal ganglia or in the cerebellum. The meter of the music is built on the reciprocal values of 2 raised to the second to fifth power (1/1(2), 1/2(2), 1/2(3), 1/2(4), 1/2(5)). The EEG frequencies that we consider important in the regulation of conscious motor actions are approximately in the same domain (4, 8, 16, 32, 64 Hz). During music performance, an important neural process is the coupling of distant brain areas. Concerning melody, the musical taste of Europeans is octave-based. Musical ornaments also follow the rule of the gothic construction, that is: pursuit of harmony towards the single one rising from the unification of 8-4-2 classes. Leibnitz concerned music as the unconscious mathematics of the soul. Movement-initiating effect of music is used in rehabilitation of patients with movement disorders. The meter and rhythm have superiority over the melody. It is possible that rhythmic movements can be generated also in the absence of sensory input and the central oscillators can produce "fictive motor patterns".
MeSH term(s)	Basal Ganglia/physiology ; Brain/physiology ; Cerebellum/physiology ; Electroencephalography ; Fingers/physiology ; Hand/physiology ; Humans ; Motor Skills/physiology ; Movement/physiology ; Movement Disorders/physiopathology ; Music ; Parkinson Disease/physiopathology ; Psychomotor Performance/physiology ; Task Performance and Analysis
Language	English
Publishing date	2010-01-30
Publishing country	Hungary
Document type	Journal Article ; Review
ZDB-ID	2240317-6
ISSN	0019-1442
ISSN	0019-1442
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Article: Neurológia! Adieau? 2. Rész.

Szirmai, Imre

Ideggyogyaszati szemle

2010 Volume 63, Issue 5-6, Page(s) 156–163

Abstract: The education of neurologists is debilitated worldwide. University professors are engaged in teaching, research and patient-care. This triple challenge is very demanding, and results in permanent insecurity of University employees. To compensate for the ... ...

Title translation	Neurology! Adieau? (Part 2).
Abstract	The education of neurologists is debilitated worldwide. University professors are engaged in teaching, research and patient-care. This triple challenge is very demanding, and results in permanent insecurity of University employees. To compensate for the insufficient clinical training, some institutes in the USA employ academic staff members exclusively for teaching. The formation of new subspecialties hinders the education and training of general neurologists. At present, four generations of medical doctors are working together in hospitals. The two older generations educate the younger neurologists who have been brought up in the world of limitless network of sterile information. Therefore their manual skills at the bedside and their knowledge of emergency treatment are deficient. Demographics of medical doctors changed drastically. Twice as many women are working in neurology and psychiatry than men. Integrity of neurology is threatened by: (1) Separation of the cerebrovascular diseases from general neurology. Development of "stroke units" was facilitated by the better reimbursement for treatment and by the interest of the pharmaceutical companies. Healthcare politics promoted the split of neurology into two parts. The independent status of "stroke departments" will reduce the rest of clinical neurology to outpatient service. (2) The main argumentation to segregate the rare neurological diseases was that their research will provide benefit for the diseases with high prevalence. This argumentation serves territorial ambitions. The separation of rare diseases interferes with the teaching of differential diagnostics in neurological training. The traditional pragmatic neurology can not be retrieved. The faculty of neurology could retain its integrity by the improvement of diagnostic methods and the ever more effective drugs. Nevertheless, even the progression of neurological sciences induces dissociation of clinical neurology. Neurology shall suffer fragmentation if the professional authorities fail to control the separation of subspecialties, if teaching of future neurologists, including practical knowledge and skills of diagnostic decision making, is not supported.
MeSH term(s)	Biomedical Research/trends ; Education, Medical, Graduate/trends ; Faculty, Medical ; Female ; Humans ; Male ; Nervous System Diseases ; Neurology/education ; Neurology/trends ; Rare Diseases ; Schools, Medical/organization & administration ; Schools, Medical/trends ; Stroke ; United States
Language	Hungarian
Publishing date	2010-05-30
Publishing country	Hungary
Document type	English Abstract ; Journal Article ; Review
ZDB-ID	2240317-6
ISSN	0019-1442
ISSN	0019-1442
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Article: Neurológia! Adieau? 1. Rész.

Szirmai, Imre

Ideggyogyaszati szemle

2010 Volume 63, Issue 5-6, Page(s) 148–155

Abstract: The neurological practice suffered considerable changes during the last twenty years. The recent therapeutic methods and the acceptance of the ideology of evidence based medicine, which is based on confidence in statistics, changed the reasoning of the ... ...

Title translation	Neurology! Adieau? (Part 1).
Abstract	The neurological practice suffered considerable changes during the last twenty years. The recent therapeutic methods and the acceptance of the ideology of evidence based medicine, which is based on confidence in statistics, changed the reasoning of the neurologists. Therapy protocols intrude into the field of individual medicine, and doctors accept treatment schemes to alleviate responsibility of their decisions. In contrast with this, recent achievements in pharmacogenetics emphasize the importance of individual drug therapies. The protocol of intravenous cerebral thrombolysis does not require defining the origin of cerebral ischaemia in the acute stage, therefore, this procedure can be regarded as human experiment. According to the strict protocol thrombolysis might be indicated only in 1-8% of patients with cerebral ischaemia. According to the Cohrane database more trials are needed to clarify which patients are most likely to benefit from treatment. Because of the change in therapeutic principles transient ischaemic attack has been newly defined as "acute neurovascular syndrome". Multiplication of neurological subspecialties has been facilitated by the development of diagnostic tools and the discovery of effective new drugs. The specialization led to narrowing of interest and competency of clinicians. Several new neurological scientific societies were founded for the representation of specific disorders. In Hungary, between 1993 and 2000 nine scientific societies were grounded within the field of clinical neurology. These societies should be thankful to the pharmaceutical industries for their existence. In some European countries in 2007 only three neurological subspecialties were accepted, which are neurophysiology, neuro-rehabilitation and child-neurology. Neuro-radiology is in the hands of general radiologists, the specialization is not granted for neurologists. Because of the subspecialization the general professionalism of neurologists has diminished. Among young neurologists the propedeutic skills suffered most seriously. Subspecialisation of teachers also interferes with the practice oriented teaching of medical students and residents.
MeSH term(s)	Brain Ischemia/complications ; Brain Ischemia/etiology ; Cerebral Hemorrhage/complications ; Controlled Clinical Trials as Topic ; Europe ; Evidence-Based Medicine ; Hospitalists/education ; Humans ; Intensive Care Units ; Ischemic Attack, Transient/drug therapy ; Medicine ; Neurology/education ; Neurology/trends ; Radiology ; Randomized Controlled Trials as Topic ; Stroke/drug therapy ; Stroke/etiology ; Stroke/surgery ; Terminology as Topic ; Thrombolytic Therapy/methods ; United States
Language	Hungarian
Publishing date	2010-05-30
Publishing country	Hungary
Document type	English Abstract ; Journal Article ; Review
ZDB-ID	2240317-6
ISSN	0019-1442
ISSN	0019-1442
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Article: A gondolkodás és a beszéd neurológiája Sántha Kálmán közleményeiben és ma.

Szirmai, Imre

Orvosi hetilap

2008 Volume 149, Issue 18, Page(s) 825–830

Abstract: Based on histopathological investigation of the brain of exceptionally talented persons Sántha found increased volume of parietal association areas with abundance of cells. He supposed that the angular gyrus may be a "memory field". In his publication ... ...

Title translation	Neurology of cognition and language in the publications of Kálmán Sántha and today.
Abstract	Based on histopathological investigation of the brain of exceptionally talented persons Sántha found increased volume of parietal association areas with abundance of cells. He supposed that the angular gyrus may be a "memory field". In his publication Genius and inheritance he expressed that: "Talent is a child of the present, but the genius is born for eternity." He discussed the localization of sensory and motor amnestic aphasia analysing the signs of patient with brain tumor and called attention to concomitant psychological symptoms. He found crossed aphasia in twice as many lefthanded than righthanded persons. This may explain the recent observations that the restitution of aphasia is predetermined; speech ability of ambidexterous or latent lefthanded persons improve better. He analysed the topography of emotional and voluntary facial palsy. The currently accepted hierarchical concept of mental and speech ability can be derived from the ouevre of Sántha and his predecessors. Sántha can be honoured as a forerunner of the modern theories of aphasia localization.
MeSH term(s)	Aphasia, Broca/history ; Aphasia, Broca/pathology ; Aphasia, Broca/physiopathology ; Brain/pathology ; Brain/physiopathology ; Brain Mapping ; Cognition ; History, 20th Century ; Humans ; Hungary ; Language ; Neuroanatomy/history ; Neuroanatomy/trends ; Neurophysiology/history ; Neurophysiology/trends ; Speech
Language	Hungarian
Publishing date	2008-04-21
Publishing country	Hungary
Document type	Biography ; Historical Article ; Journal Article ; Portrait
ZDB-ID	123879-6
ISSN	1788-6120 ; 0030-6002
ISSN (online)	1788-6120
ISSN	0030-6002
DOI	10.1556/OH.2008.28280
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Article ; Online: Characteristics of Tremor Induced by Lesions of the Cerebellum.

Kovács, Andrea / Kiss, Máté / Pintér, Nándor / Szirmai, Imre / Kamondi, Anita

Cerebellum (London, England)

2019 Volume 18, Issue 4, Page(s) 705–720

Abstract: It is a clinical experience that acute lesions of the cerebellum induce pathological tremor, which tends to improve. However, quantitative characteristics, imaging correlates, and recovery of cerebellar tremor have not been systematically investigated. ... ...

Abstract	It is a clinical experience that acute lesions of the cerebellum induce pathological tremor, which tends to improve. However, quantitative characteristics, imaging correlates, and recovery of cerebellar tremor have not been systematically investigated. We studied the prevalence, quantitative parameters measured with biaxial accelerometry, and recovery of pathological tremor in 68 patients with lesions affecting the cerebellum. We also investigated the correlation between the occurrence and characteristics of tremor and lesion localization using 3D T1-weighted MRI images which were normalized and segmented according to a spatially unbiased atlas template for the cerebellum. Visual assessment detected pathological tremor in 19% while accelerometry in 47% of the patients. Tremor was present both in postural and intentional positions, but never at rest. Two types of pathological tremor were distinguished: (1) low-frequency tremor in 36.76% of patients (center frequency 2.66 ± 1.17 Hz) and (2) normal frequency-high-intensity tremor in 10.29% (center frequency 8.79 ± 1.43 Hz). The size of the lesion did not correlate with the presence or severity of tremor. Involvement of the anterior lobe and lobule VI was related to high tremor intensity. In all followed up patients with acute cerebellar ischemia, the tremor completely recovered within 8 weeks. Our results indicate that cerebellar lesions might induce pathological postural and intentional tremor of 2-3 Hz frequency. Due to its low frequency and low amplitude, quantitative tremorometry is neccessary to properly identify it. There is no tight correlation between lesion localization and quantitative characteristics of cerebellar tremor.
MeSH term(s)	Adult ; Cerebellar Diseases/complications ; Cerebellar Diseases/diagnostic imaging ; Cerebellum/diagnostic imaging ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurologic Examination ; Prevalence ; Tremor/diagnostic imaging ; Tremor/etiology ; Tremor/physiopathology
Language	English
Publishing date	2019-04-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2112586-7
ISSN	1473-4230 ; 1473-4222
ISSN (online)	1473-4230
ISSN	1473-4222
DOI	10.1007/s12311-019-01027-3
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Article ; Conference proceedings: Beszámoló az Európai Neurológiai Szakképzési Bizottság üléséról.

Szirmai, Imre

Ideggyogyaszati szemle

2004 Volume 57, Issue 3-4, Page(s) 105

Title translation	Report from the Meeting of the Committee of European Neurology Specialty Education.
MeSH term(s)	Biomedical Research ; Certification ; Education, Medical, Graduate/trends ; Europe ; Humans ; Hungary ; Licensure ; Neurology/education
Language	Hungarian
Publishing date	2004-03-20
Publishing country	Hungary
Document type	Congresses
ZDB-ID	2240317-6
ISSN	0019-1442
ISSN	0019-1442
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