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  • 1
    ISSN: 1432-1459
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei 156 wegen eines lumbalen Bandscheibenschadens hemilaminektomierten Patienten wurden die Ergebnisse der präoperativen elektromyographischen und myelographischen Befunde mit denen der Operationsprotokolle mittels einer Kovarianzanalyse verglichen. Die Operations-und Myelographiebefunde wurden in vier Schweregrade, in mono- und bisegmentalen Befall und je nach der Lage des Bandscheibenschadens in laterale, extrem laterale und mediale Vorfälle unterteilt. Das Elektromyogramm (EMG) der Bein- und autochtonen lumbalen Rückenmuskulatur wurde nach Myotomen geordnet und in sechs Stadien eingeteilt. Die statistische Auswertung zeigt, daß das EMG in 69,2% exakt Höhe und Ausmaß einer lumbalen Discushernie feststellen kann und der Myelographie mit 31,2% an Treffsicherheit (bisegmentaler Befall bei monosegmentaler Diagnose oder umgekehrt) deutlich überlegen ist. Zusätzlich liegt eine Teilübereinstimmung mit dem Operationsbefund beim EMG in 19,5%, bei der Myelographie in 33,8% vor. Das EMG versagt bei akuten radikulären Syndromen innerhalb der ersten 14 Tage und bei Discushernien am thorakolumbalen Übergang. An Hand der Operations-und EMG-Befunde werden die Kennmuskeln für die Myotome L1–S1 festgelegt. Denervierungszeichen in drei Kennmuskeln eines Myotoms und Ableitung aus mehreren Myotomen erhöhen die Treffsicherheit elektromyographischer Diagnosen. Denervierungszeichen in der autochtonen lumbalen Paravertebralmuskulatur sind immer ein sicheres Zeichen für eine Nervenwurzelbeteiligung. Die Elektromyographie ist eine ambulante Untersuchungsmethode und ohne Risiko für den Patienten, während die Myelographie nur stationär durchgeführt werden kann und für den Patienten eine wesentlich größere Belastung darstellt. Die diagnostische Aussagekraft eines EMG ist bei unserer Fragestellung in den meisten Fällen der einer Myelographie überlegen. Nur wenn das EMG nicht exakt Höhe und Ausmaß eines radikulären Syndroms feststellen kann, ist eine präoperative Myelographie indiziert.
    Notes: Summary Preoperative electromyographical and myelographical findings in 156 patients undergoing surgery because of lumbar radiculopathy were compared with the corresponding surgical reports by means of covariance analysis. The EMG's of leg and lumbar paravertebral muscles were rated according to severity of pathological signs using a rating scale of 6 stages. The EMG's were also divided into groups according to myotomes involved. The surgical and myelographical reports were divided into 4 groups according to severity of the process and further classified according to mono- or bisegmental lesions and to localization of the herniated disc, i. e. lateral, extremely lateral and medial. The statistical analysis proved that the EMG accurately revealed level and extent of the lumbar radiculopathy in 69.2% of the cases with a respective figure of 31.2% for the myelography. There was a partial agreement between findings during surgery and those of the EMG in 19.5% and those of myelography in 33.8%. The EMG was inconclusive during the first 2 weeks of acute radicular syndromes as it was in herniated discs of the thoracolumbar region and in symptoms arising from affections of the cauda equina. The crucial muscles for the myotomes L1 to S1 as determined by comparing the findings during surgery with the EMG recordings of the ventral leg muscles were as follows: L1 and L2: M. adductores; L3: M. quadriceps femoris; L4: M. quadriceps femoris and M. tibialis anterior; L5: M. extensor hallucis longus, M. tibialis posterior and Mm. peronei, and S1: M. triceps surae and M. extensor digitorum brevis. Signs of denervation in three crucial of one myotome and in the lumbar paravertebral muscles were enhancing the diagnostic accuracy of the EMG. While the EMG may be performed on an outpatient basis without risk there is some stress inherent in myelography requiring the patient to stay in the hospital. Apart from the aforementioned exceptions recording the EMG from leg and paravertebral muscles should be preferred over myelography in cases of lumbar radiculopathy because of its greater diagnostic conclusiveness.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Journal of neurology 239 (1992), S. 223-227 
    ISSN: 1432-1459
    Keywords: Cerebellar dysarthria ; Ataxic dysarthria ; Cerebellar ischaemia ; Speech disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Twelve patients with cerebellar infarction, 8 in the region supplied by the posterior inferior cerebellar artery (PICA) and 4 in the territory of the superior cerebellar artery, underwent formal perceptual examination for speech deficits. With respect to topography the results firstly underline the significance of the paravermal region of the superior cerebellar portion for speech functions. In all patients with dysarthric impairment the lesion extended to this area, whereas patients with PICA infarction sparing the superior portion of the cerebellum showed no speech deficits. Secondly the findings do not corroborate the notion of an exclusively left-sided cerebellar speech motor control, since 3 of the 4 dysarthric subjects had unilateral right-sided ischaemia. This study thirdly demonstrates that lesions of the cerebellar cortex without involvement of the dentate nucleus can cause dysarthric impairment. Phonetic analysis revealed irregularly distributed articulatory deficits and slowed speech tempo as the most common dysarthric features.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    European archives of psychiatry and clinical neuroscience 239 (1990), S. 370-372 
    ISSN: 1433-8491
    Keywords: Foix-Chavany-Marie syndrome ; Opercular syndrome ; Automatic-voluntary dissociation ; Motor system degeneration ; Primary lateral sclerosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A patient is described with slowly progressive supranuclear motor system degeneration (primary lateral sclerosis) characterized by pure bulbar spasticity for six years until a spastic tetraparesis developed. Clinically and electrophysiologically there was and still is no evidence of lower motor neuron involvement. Recently the patient presented with a syndrome of complete inability to move face and tongue voluntarily with preservation of the ability to move them “automatically”, e.g. within gestures: automatic-voluntary motor dissociation. Loss of voluntary innervation of the facio-pharyngo-glossomasticatory muscles with preservation of involuntary innervation are the features of the Foix-Chavany-Marie syndrome, which to date has most often been described in association with bilateral vascular lesions of the opercula or their cortigofugal projections.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    European archives of psychiatry and clinical neuroscience 241 (1991), S. 57-60 
    ISSN: 1433-8491
    Keywords: Superficial siderosis ; Chronic subarachnoid haemorrhage ; Triethylenetetramine ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The course of a patient suffering from superficial siderosis of the central nervous system for 37 years is presented and diagnostic and therapeutic approaches are evaluated. The syndrome is clinically defined by slowly progressing deafness, cerebellar ataxia, myelopathy and neuropsychological deficits in combination with recurrent xanthochromia of the cerebrospinal fluid with siderophages. The diagnosis may be confirmed by computed tomography, which shows degeneration of the cerebellar vermis, and by magnetic resonance imaging, demonstrating iron deposits on the surface of brain, brain stem and spinal cord. Therapy should seek to identify and remove the source of bleeding, since pharmacotherapy with iron-depleting drugs is of limited effectiveness.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    European archives of psychiatry and clinical neuroscience 215 (1972), S. 167-180 
    ISSN: 1433-8491
    Keywords: Stretch Reflex ; H-Reflex ; Facio-Facial Reflex ; Orbicularis Oris and Mentalis Muscles ; Man ; Eigenreflex ; H-Reflex ; Facio-facialer Reflex ; M. orbicularis oris und mentalis ; Mensch
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei 5 von 15 Versuchspersonen wurde durch elektrische Reizung des N. facialis am Foramen stylomastoideum mit isolierten Semimikroelektroden in den ipsilateralen M. m. orbicularis oris und mentalis ein Reflexpotential abgeleitet, das immer eine längere Latenz als die direkte Muskelantwort aufwies. Das Potential zeigte eine niedrigere Reizschwelle als die direkte Muskelantwort, eine konstante Latenz von 13,2 msec (SD±0,1) und ein reizabhängiges, gegenüber der direkten Muskelantwort reziprokes Amplitudenverhalten. In einem Fall registrierten wir eine posttetanische Bahnung des Reflexpotentials. Die niedrige Reizschwelle und die konstante Latenz des Reflexpotentials sprechen für einen elektrisch ausgelösten Eigenreflex der mimischen Gesichtsmuskulatur und schließen eine Rückschlagwelle nach antidromer Erregung von Facialismotoneuronen aus. Als Beweis, daß es sich bei dem Potential nicht um einen trigemino-facialen Reflex handelt, leiteten wir bei einem Fall mit Trigeminusdurchtrennung das Potential auch auf der operierten Seite ab. Im Zusammenhang mit dem histologischen Nachweis von Muskelspindeln in der Facialismuskulatur des Menschen halten wir das Potential für einen facio-facialen Reflex, dessen afferente Bahn über proprioceptive Facialisfasern verläuft. Es wird angenommen, daß der Reflex auch über ein proprioceptives feedback analog der Gamma-Schleife des Spinalnerven reguliert wird.
    Notes: Summary Reflex potentials were recorded from the orbicularis oris and mentalis muscles in five of fifteen normal subjects. These potentials exhibited a longer latency than the direct muscle response elicited by electrical stimulation of the facial nerve with insulated semi-microelectrodes. The secondary response appears ipsilaterally at a lower threshold than the direct response and has a constant latency of 13.2 msec (SD±0.1); its amplitude decreases when the strength of the stimulus increases. In one case we found a posttetanic facilitation of the reflex amplitude. It is assumed that this secondary response is a monosynaptic reflex similar to the H-wave of leg muscles. In order to show the facio-facial reflex pathway we recorded the same reflex potential from the operated side of retrogasserian rhizotomy in trigeminus neuralgia. This response had a lower threshold than the direct muscle response; therefore, the secondary response cannot be due to antidromic induced recurrent discharge. Since some histological evidence for muscle spindles was found in some human facial muscles, it is concluded, that at least the perioral facial muscles in some persons have proprioceptive feedback loops.
    Type of Medium: Electronic Resource
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