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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Journal of neurology 242 (1995), S. 689-694 
    ISSN: 1432-1459
    Keywords: Cardiac myxoma ; Aneurysm ; Dementia ; Computed tomography ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract From 1980 to 1992 we followed 12 patients with cardiac myxomas for an average of 4.4 years (8 months–11 years). Presenting symptoms were neurological in four patients (hemiparesis, aphasia, visual field deficits, progressive dementia or vertigo), progressive dyspnoea in six, pulmonary embolism in one, and peripheral arterial or renal emboli in three. The diagnosis was suspected clinically in 11 patients. It was confirmed by echocardiography in ten and by thoracic CT in one. All these patients had cardiac surgery. One diagnosis was made at autopsy; the patient died unexpectedly during surgery for emboli to the leg arteries. At follow-up, two additional patients had died, one from myocardial infarction and one from rhabdomyosarcoma. Only one of the nine surviving patients had recurrent symptoms after cardiac surgery. His dementia continued to progress. The patients without new symptoms after cardiac surgery had normal MRI of the brain or residual ischaemic lesions. MRI of the patient with progressive dementia showed multiple cerebral lesions with a bright centre and a dark rim on T1- and T2-weighted spin-echo images. On CT there were many calcified lesions. CT, MR angiography and contrast angiography revealed multiple fusiform aneurysms. The rare occurrence of progressive neurological symptoms after myxoma resection with multiple cerebral lesions and aneurysms should suggest myxoma metastases to the brain.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Journal of neurology 245 (1998), S. 137-142 
    ISSN: 1432-1459
    Keywords: Key words Tinnitus ; pulsatile ; Differential diagnosis ; Vascular diseases ; Glomus tumour ; Angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Pulsatile tinnitus can be annoying for a patient and can also be the only clue to a potentially devastating and life-threatening disease. In order to understand its clinical spectrum and management better we analysed the files of 84 patients seen at our institution over a 10-year period. Noninvasive techniques (ultrasound, computed tomography, magnetic resonance imaging) and angiography were employed as investigations tailored to the individual patient. A vascular disorder [i.e. arteriovenous fistula, dissection of the internal carotid artery (ICA), fibromuscular dysplasia, aneurysm of the ICA and sinus thrombosis] was found in 36 patients (42%), most commonly a dural arteriovenous fistula or a carotid-cavernous sinus fistula. In 26 patients with a vascular abnormality, pulsatile tinnitus was the presenting symptom. In 12 patients (14%), nonvascular disorders such as glomus tumour or intracranial hypertension with a variety of causes explained the tinnitus. We conclude that patients with pulsatile tinnitus should be investigated with noninvasive techniques. If these are negative or to clarify abnormal findings of noninvasive techniques selective angiography is needed for diagnosis and to guide treatment
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Magnetresonanztomographie ; Diffusion ; Echo-planar ; Zerebrale Ischämie ; Key words MRI ; Diffusion ; Echo - planar ; Cerebral ischemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Magnetic resonance imaging represents today the most important tool in neuroradiology for both clinical pratice and research. MRI allows imaging of the human body in 2 or 3 dimensions with variable tissue contrast. The natural diffusion of tissue protons can now be used as a supplementary contrast mechanism. Different MRI techniques can be used to obtain clinically useful diffusion-weighted images. These techniques all require the use of strong gradient pulses in order to obtain the diffusion contrast. In the current article, the most important physical principles of diffusion measurement are presented. After a short introduction into the basic physical principles, we will present the prerequisites and limitations of clinically relevant applications today. Finally a few select examples of clinical use of these techniques in the acute diagnosis of stroke will be presented.
    Notes: Zusammenfassung Die Kernspintomographie (Magnetresonanztomographie, MRT) ist das zentrale diagnostische Instrument der Neuroradiologie für die Routinediagnostik, aber auch für Fragestellungen, die Forschung und Lehre betreffen, geworden. Zu den bereits bekannten und erprobten MR-Bildkontrasten ist die Diffusion der Protonen als neuer zusätzlicher Kontrastmechanismus hinzugekommen. In letzter Zeit wurden verschiedene kernspintomographische Techniken beschrieben, die zur Diffusionsbildgebung herangezogen werden können. Dabei verlangen MR-Diffusionssequenzen den Einsatz starker Gradientenpulse, die den Diffusionskontrast erzeugen. Andere, weniger bekannte Techniken lassen sich aber auch auf MR-Geräten mit schwächeren Gradienten einsetzen. Untersuchungen die belegen, daß Art und Ausmaß eines Schlaganfalls mit der MR-Diffusionsbildgebung sehr früh mit hoher Sensitivität nachzuweisen ist, haben diese neue MR-Bildgebungstechnik in das Zentrum von Therapiestrategien für diese häufige Erkrankung gerückt. In der vorliegenden Arbeit werden die wichtigsten physikalischen Grundlagen der MR-Diffusionsmessung vorgestellt. Die heute klinisch einsetzbaren Techniken, deren technische Voraussetzungen und Einschränkungen werden erläutert. Im abschließenden Teil wird die klinische Anwendung dieser neuen Bildgebungstechnik zur Diagnostik von akuten Hirninfarkten anhand einiger Beispiele beschrieben.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1459
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 38 (1996), S. 734-737 
    ISSN: 1432-1920
    Keywords: Key words Cerebral arteriovenous malformation ; Transcranial colour-coded duplex sonography ; Transcranial Doppler sonography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A transcranial colour-coded duplex sonography (TCCD) study was performed to evaluate the sensitivity of detection and the feasibility of visualising details of cerebral arteriovenous malformations (AVMs). We prospectively examined 15 patients with 2 large (〉 4 cm), 7 medium-size (2–4 cm) and 6 small (〈 2 cm) radiologically proven supratentorial AVMs of the brain using TCCD. A feeding vessel was diagnosed if the velocities and/or the relative interhemisphere velocity difference between feeding and non-feeding anterior, middle and posterior cerebral arteries were more than two standard deviations above the means of 136 age- and sex-matched normals. The sonographer was blinded to the results of cerebral angiography. Using TCCD it was possible to detect all large and medium-size lesions, and 4 of 6 small ones, because 23 of 29 (79 %) feeding arteries showed abnormal haemodynamics. In addition, 8 of 46 (17 %) feeding branches of cerebral arteries were shown. However, all but 2 large draining veins and sinus were not detected. In view of the availability of MRI, MRA and angiography, TCCD is not the method of choice in screening for cerebral AVMs. However, careful assessment of the velocities in the intracranial arteries permits incidental detection of cerebral AVMs and characterisation of the haemodynamics in the feeding arteries.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 42 (2000), S. 184-191 
    ISSN: 1432-1920
    Keywords: Key words Ischaemic stroke ; Diffusion weighted imaging ; Fibrinolysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Diffusion-weighted (DWI) echo-planar (EPI) MRI has been used for imaging acute ischaemic stroke. We used DWI and conventional spin-echo (SE) MRI to study the dynamics of ischaemic human stroke. We examined 30 patients (mean age 57.5 years, range 27–82 years, median 57 years) with a diagnosis of stroke. They were examined in the acute (120 min to 47 h, mean 15.3 h), subacute (8 days) and chronic (2–3 months) stages of ischaemia using clinical scores and MRI. Imaging was performed on an 1.5-T imager. Anisotropic DWI with diffusion gradients in all three axes, an isotropic tensor trace pulse DWI sequence and SE MRI were used. In all patients both DWI sequences showed a decrease in the apparent diffusion coefficient (ADC) in the acute stage, even when SE images did not reveal signal abnormalities. Clinical features correlated with lesion site but not size. The ADC was initially 19.6–43 % less than that of nonischaemic tissue and increased to normal after 7 days in conventionally treated patients and after 2–5 days in patients who underwent intra-arterial fibrinolysis. In the chronic stage the ADC rose by up to 254.4 %. In patients who did not undergo fibrinolysis DWI changes correlated with the final infarct size (P 〈 0.05). It was possible to differentiate acute from chronic ischaemic lesions. We conclude that DWI is a sensitive and practicable tool for detecting early cerebral ischaemia. It is possible to predict in the acute stage the final size of an infarct. DWI may be helpful for clinical decisions and for monitoring therapy.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-1920
    Keywords: Key words Magnetic resonance imaging ; Diffusion-weighted ; Carotid artery ; Stents ; Carotid stenosis ; Angioplasty
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Carotid stenting is increasingly considered as treatment for carotid artery disease. A reliable noninvasive method is desirable for assessing the safety of the procedure. Diffusion-weighted MRI (DWI) is sensitive to early brain ischaemia which becoming widely available and might therefore serve this purpose. We prospectively studied 19 patients referred for investigation of carotid artery disease by echo-planar whole-brain DWI before and within 24 h of stenting. The images obtained at a high b value were examined by two independent blinded reviewers for new high-signal areas consistent with ischaemia. We found that 15 patients had no new changes after stenting. One patient showed enlargement of a posterior watershed lesion after the procedure, which correlated with an increase in neurological deficit. Three other patients had presumed small embolic infarcts on DWI; two were asymptomatic and one had weakness at the hand that corresponded to an embolic infarct with a lesion on DWI in the hand notch. There were no false- positive or -negative results on DWI, when compared to clinical findings. DWI is thus a new method that can demonstrate neurologically silent or asymptomatic infants. It can be used to help to assess the safety and efficacy of neurovascular intervention.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 33 (1991), S. 123-125 
    ISSN: 1432-1920
    Keywords: magnetic resonance ; Angiography ; Stereoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Recent developments in magnetic resonance (MR) allow high resolution imaging of flowing blood. To overcome the tomographic nature of conventional MR acquisitions, projection angiograms can be produced. These angiograms are similar in their display of blood vessels to plain film or digital subtraction angiograms. However, the three-dimensional information inherent in them is partly lost when single projections are viewed. We describe a method of three-dimensional display consisting of stereo pairs of the MR angiograms. With these an examiner experienced in stereo viewing can recover depth perception.
    Type of Medium: Electronic Resource
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