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  • 1
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Schizophrenia Research 6 (1991), S. 25-30 
    ISSN: 0920-9964
    Keywords: (Schizophrenia) ; Basal ganglia ; Brain alteration ; Motor coordination ; Neurological soft sign
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 0165-1781
    Keywords: Computed tomography ; negative symptoms ; neurological soft signs ; psychopathological subsyndromes ; ventricular size
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Spätdepression ; Strukturelle Veränderungen ; MRT ; Volumetrie ; Key words Late-onset depression ; Structural changes ; MRI ; Volumetry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A number of observations including clinical manifestation, course, outcome, and family history, support the view that patients presenting with a major depression occurring first in late life should be treated as a nosological subgroup. In this study quantitative magnetic resonance imaging (MRI) was used to investigate volumes of different brain structures in 19 patients with late onset major depression (age of onset 〉50) and 13 age matched controls. 3-D MRI sequences were acquired using a Siemens 1.5T scanner. Whole brain volume, CSF volume, volume of the frontal and temporal lobes and the volume of the amygdala-hippocampus complex were assessed using the software NMRWin. Compared to the controls, depressed patients showed a significantly lower whole brain volume and a significantly higher CSF volume, whereas volumes of the frontal and temporal lobes as well as the amygdala-hippocampus complex volumes were not significantly decreased. In addition, depressed patients exhibited a higher ventricle-brain ratio suggesting a higher degree of central atrophy compared to healthy individuals. Our results indicate that cerebral changes involving subcortical structures are of relevance in the pathogenesis of late-onset depression. Defining the aetiology of these lesions may be important for the development of preventive treatment of depression in the elderly.
    Notes: Zusammenfassung Klinische, neuroradiologische und pathoanatomische Befunde legen nahe, Spätdepressionen als nosologische Subgruppe innerhalb der affektiven Störungen zu betrachten. Mit dem Ziel, zerebrale Veränderungen bei dieser Erkrankung volumetrisch zu erfassen, wurden 19 Patienten mit einer Spätdepression (Ersterkrankungsalter 〉50 Jahre) und 13 altersangeglichene gesunde Kontrollpersonen untersucht. Die Bildgebung erfolgte MR-tomographisch mittels eines 1,5-T-Siemens-Scanners. Mit der Software „NMR-Win” wurden das Ganzhirnvolumen, das Liquorraumvolumen und die Volumina der Amygdala-Hippocampus-Komplexe sowie der Frontal- und Temporallappen bestimmt. Zusätzlich wurde die „ventricle brain ratio” (VBR) ermittelt. Depressive Patienten zeigten im Vergleich zu Kontrollpersonen ein signifikant kleineres Ganzhirnvolumen bei größerem Liquorraumvolumen und größerer VBR. Im Gegensatz dazu unterschieden die Volumina der Temporal- und Frontallappen sowie der Amygdala-Hippocampuskomplexe nicht zwischen den Gruppen. Unsere Ergebnisse lassen vermuten, daß strukturelle zerebrale Veränderungen bei der Spätdepression pathogenetische Relevanz haben und vorwiegend subkortikale Strukturen betreffen. Die Frage nach der Ätiologie der beschriebenen Veränderungen könnte in Hinsicht auf präventive Therapieansätze der Spätdepression von Bedeutung sein.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 0942-0940
    Keywords: Intracerebral haemorrhage ; evacuation ; case-control study ; prognostic factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Surgical intervention in supratentorial intracerebral haemorrhage (ICH) is still controversial. We assessed the value of haematoma evacuation with a case-control study. 145 consecutive patients with supratentorial spontaneous ICH without tumour or vascular abnormalities were analysed. Haematoma evacuation was performed in 24 patients. Age, sex, Glasgow Coma Scale (GCS), level of consciousness, pupillary reaction on admission, localisation, aetiology and volume of the haematoma, presence of ventricular blood, and Glasgow Outcome Scale (GOS) on discharge were analysed. From statistical analysis 40 patients 〉80 years and with haematoma volume 〈10ml, who were always treated conservatively, were excluded. Prognostic factors retained from a multiple regression model with the dichotomised GOS scale (GOS 1–3, 4+5) as response variable were GCS, haematoma volume and location. The only difference between all medically treated and “operated” patients was haematoma volume, which was larger in the “operated” patients. All 24 evacuated cases could be matched to a medically treated control regarding age, haematoma volume and location, GCS, and pupillary reaction. Significant differences between the two groups could not be detected. Outcome was not different between the two groups. After separating the sample into patients with and without ventricular haemorrhage, there was no different outcome between the two groups either. We conclude that haematoma evacuation did not improve outcome in supratentorial spontaneous ICH. Since haematomas were evacuated mainly in clinically deteriorating patients, our data suggest that the only effect of haematoma evacuation is to stop progressive deterioration rather than to improve overall clinical outcome.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1459
    Keywords: Key words Cerebellar infarction ; Treatment ; Decompression surgery ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Surgical intervention (ventricular drainage or decompressive craniotomy) may be necessary in patients with cerebellar infarction if mass effect develops. However, patient selection and timing of surgery remain controversial, and there are few data on clinical signs in the early course that are predictive for outcome. The clinical course and neuroradiological features of 84 patients (aged 22–78, mean 58.5 years) with massive cerebellar infarction confirmed by computed tomography were prospectively observed for 21 days after admission and at 3-month follow-up using a standardized protocol. Data were gathered from 1992 to 1996 in 17 centers. The patients were assigned to three treatment groups depending on the decision of the primary caretaker: 34 underwent craniotomy and evacuation, 14 received ventriculostomy, and 36 were treated medically. Treatment groups differed regarding the level of consciousness, signs of mass effect in computed tomography and signs of brainstem involvement. The overall risk for poor outcome depended on the level of consciousness after clinical deterioration (odds ratio = 2.8). Subgroup analysis of awake/ drowsy or somnolent/stupor patients revealed no relationship to treatment. The vascular territory involved did not affect outcome. Surgical treatment for massive cerebellar infarctions was not found to be superior to medical treatment in awake/ drowsy or somnolent/stupor patients. Half of all patients deteriorating to coma treated with ventricular drainage or decompressive craniotomy had a meaningful recovery. We were unable to compare surgical versus medical therapy in this subgroup due to lack of control group. This study supports the notion that the level of consciousness is the most powerful predictor of outcome, superior to any other clinical sign and treatment assignment. Deterioration of consciousness typically occurred between days 2 and 4, with a maximum on day 3.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1435-1420
    Keywords: Key words Neurocritical care ; evoked potentials ; outcome ; space occupying infarctions ; intracranial pressure ; Schlüsselwörter Evozierte Potentiale ; Raumforderung ; Koma ; Hirndruck ; Basilaristhrombose ; Kleinhirninfarkt
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Evozierte Potentiale sind ein wichtiges Hilfsmittel zur Beurteilung von Verlauf und Prognose bei Patienten der neurologischen Intensivmedizin, bei denen die klinische Beurteilung durch fehlende Kooperation oder Medikamenteneffekte eingeschränkt ist. Das Indikationsgebiet umfaßt dabei vertebrobasiläre Zirkulationsstörungen mit Hirnstammbeteiligung oder akute Raumforderungen in der hinteren Schädelgrube sowie supratentorielle Raumforderungen unterschiedlicher Ätiologie wie das intrazerebrale Hämatom, den raumfordernden Hirninfarkt oder die Subarachnoidalblutung mit Komplikationen wie Hirnödem oder Hydrozephalus. Eine Prognoseabschätzung ist dabei insbesondere bei Hirnstammaffektion (Basilaristhrombose, raumfordernder Kleinhirninfarkt) möglich. Evozierte Potentiale können darüber hinaus eine Hilfe bei der Indikationsstellung und Therapieevaluierung invasiver Therapieverfahren wie der Thrombolyse oder der Entlastungstrepanation bei raumforderndem Mediainfarkt sein.
    Notes: Summary Evoked potentials (EP) are a valuable tool when assessment of neurocritical care patients is impaired by loss of consciousness and lack of co-operation. Different modalities of short latency EP can be applied to evaluate sensory, auditory and visual systems. In this review we discuss EP studies in patients with thrombosis of basilar artery, space occupying cerebellar infarction and supratentorial mass lesions of different aetiology. Prognostic value of EP examinations can be expected in thrombosis of basilar artery and space occupying cerebellar infarction. In supratentorial mass lesions monitoring of therapy of elevated intracranial pressure can be performed with brainstem auditory evoked potentials of short latency, however, prognostic statements can be expected only later during clinical course. Decisionmaking for or against invasive measures can be supported by EP findings in thrombosis of basilar artery (thrombolysis) or space occupying supra- or infratentorial infarctions (decompressive craniotony). Enhanced strategies of evaluation (calculation of crosscorrelation coefficient, mean absolute amplitude) are unaffected by pathologic waveforms where determination of latencies is impaired (e. g. VEP). However the value of off-line evaluation in clinical management of neurocritical patients is reduced due to difficult interpretation of these results.
    Type of Medium: Electronic Resource
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