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  • 1
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Stroke Unit ; Schlaganfallspezialstation ; Hirninfarkt ; Zerebrale Ischämie ; Monitoring ; Transkraniale Dopplersonographie ; Key words Stroke unit ; Cerebral ischemia ; Monitoring ; Stroke treatment ; Transcranial Doppler sonography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary We studied the effects of stroke unit care in an acute Neurology department on the outcome and the length of hospital stay in acute stroke patients. After an emergency evaluation on admission including CCT, ultrasound studies and ECG the patients were treated on a specialist stroke unit for an average 3.9 days. For 48 ± 24 h monitoring of blood pressure, ECG, pO2 and transcranial Doppler sonography was instituted. Stroke unit treatment reduced the length of hospital stay from an average 15.8 days in the time period before institution of the stroke unit to 12.9 days. This effect was especially marked in patients with acute occlusion of major intracranial arteries (before stroke unit treatment: n = 33; hospital stay 22.5 days; after stroke unit treatment: n = 54; hospital stay 13.9 days). Clinical deterioration in acute ischemic stroke was related to reduction of cerebral blood flow velocities due to blood pressure changes or space occupying effects. Monitoring on the stroke unit allowed immediate treatment of systemic hypotension, cerebral edema or cardiac arrhytmias. Transcranial Doppler sonography revealed HITS in 6/55 acute stroke patients without new clinical symptoms. Monitoring on the stroke unit improved the specific care for acute stroke patients. The length of hospital stay was reduced after stroke unit care.
    Notes: Zusammenfassung Wir untersuchten die Effekte einer Stroke Unit in einem neurologischen Akutkrankenhaus auf das Outcome und die Länge des Krankenhausaufenthalts nach akutem Schlaganfall. Nach einer notfallmäßigen Diagnostik bei der Aufnahme einschließlich CCT, Ultraschalldiagnostik und EKG wurden die Patienten auf einer spezialisierten Stroke Unit für durchschnittlich 3,9 Tage behandelt. Für 48 ± 24 h erfolgte ein Monitoring von Blutdruck, EKG, pO2 und transkranialer Dopplersonographie. Durch die Behandlung auf der Stroke Unit ließ sich die Länge des Krankenhausaufenthalts von durchschnittlich 15,8 Tagen in dem Zeitraum vor Einrichtung der Stroke Unit auf 12,9 Tage verkürzen. Dieser Effekt war besonders ausgeprägt bei Patienten mit akutem Verschluß intrakranialer Gefäße (vor der Behandlung auf der Stroke Unit: n = 33; Krankenhausaufenthalt für 22,5 Tage; nach Einrichtung der Stroke Unit: n = 54; Länge des Krankenhausaufenthalts 13,9 Tage). Eine klinische Verschlechterung bei Patienten mit akuter zerebraler Ischämie zeigte sich bei einer Reduktion der Blutflußgeschwindigkeiten durch Blutdruckschwankungen oder zerebrale Raumforderung. Das Monitoring auf der Stroke Unit machte die sofortige gezielte Behandlung einer systemischen Hypotension, eines zerebralen Ödems bzw. kardialer Arrhythmien möglich. Das Monitoring mittels transkranialer Dopplersonographie zeigte HITS bei 6 von 55 akuten Hirninfarktpatienten, ohne daß neue neurologische Symptome oder eine Befundverschlechterung auftraten. Das Monitoring auf der Stroke Unit verbessert die spezifische Behandlung akuter Hirninfarktpatienten. Die Länge des Krankenhausaufenthalts läßt sich durch die Behandlung auf einer Stroke Unit verkürzen.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Aneurysma ; Transkranielle Duplexsonographie ; Embolisation ; Subarachnoidalblutung ; Key words Aneurysm ; Transcranial Duplex sonography ; Coil embolization ; Subarachnoid hemorrhage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary We investigated 88 Patients with a total of 102 angiographically diagnosed intracranial aneurysms by means of transcranial colour coded Duplex sonography (TCCD) during a time period of 15 months. Both the size and teh localization of teh aneuryms were determined. Seventy aneurysms (77%) with a diameter of 16±8 mm (6-55mm) were detectable, with excellent visualization in 36 (42%), moderate visualization in 34 (40%), and no sufficient visualization in 16 (16%) aneurysms, respectively. In another 16 cases (16%) there was no sufficient vone window. Thrombotic material inside the aneurysm was detectable in 16/20 cases (75%), visualization of coil embolized aneurysms in 12/25 patients (48%). TCCD allows the follow up of cerebral aneurysms, with the detection of thrombosis and treatment effects after embolization. The method is not valid for the detection of intracranial aneurysms
    Notes: Zusammenfassung Innerhalb eines Zeitraumes von 15 Monaten wurden 88 Patienten mit 102 angiographisch nachgewiesenen intrakraniellen Aneurysmen unter Verwendung einer 2-MHz-Sonde mit der transkraniellen farbkodierten Duplexsonographie (TCCD) untersucht. Es wurden die Größe und der genaue Aneurysmasitz bestimmmt. Insgesamt konnten 70 (77%) Aneurysmen mit einem Durchmesser von 16±8 mm (6–55 mm) dargestellt werden. Eine sehr gute Darstellung der Aneurysmen gelang bei 36 (42%), eine mäßige bei 34 (40%) Aneurysmen, 16 (16%) Aneurysmen konnten trotz ausreichender Bildqualität nicht dargestellt werden. Bei weiteren 16 (16%) Aneurysmen war kein ausreichendes Knochenfenster vorhanden. Thrombosierte Anteile innerhalb der Aneurysmen konnten bei 16 (75%) von 20, der mit Coils behandelte Anteil bei 12 (48%) von 25 Aneurysmen erfolgreich dokumentiert werden. Die Methode ist zum Nachweis von teilthrombosierten Anteilen, von Behandlungserfolgen nach Coilembolisation und zur Verlaufskontrolle nicht behandelbarer Aneurysmen geeignet. Die Darstellbarkeit kleiner Aneurysmen ist begrenzt durch das Auflösungsvermögen und die teilweise ungünstigen Beschallungswinkel, somit eignet sich die TCCD nicht als Screeningmethode zum Nachweis von Aneurysmen.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Journal of neurology 246 (1999), S. 162-164 
    ISSN: 1432-1459
    Keywords: Key words Cerebrospinal fluid ; (CSF) leakage ; Postural headache ; Intracranial hypotension ; Pseudo-chiari type-I malformation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Cerebrospinal fluid (CSF) leakage may occur spontaneously, iatrogenically or from spinal trauma. Postural headache is the cardinal symptom; dizziness, diminished hearing, nausea and vomiting are additional symptoms. In neurological examinations cranial nerve palsies may be found. Due to low CSF pressure neuroimaging studies may reveal dural enhancement and vertical displacement of the brain. We describe a patient with the history of an uncomplicated lumbar discectomy at the level L4-5 and the typical clinical symptoms of intracranial hypotension. MRI of the craniocervical junction schowed typical features of a Chiari type-I malformation. After neurosurgical ligation of a CSF leak at L4-5 caused by lumbar disc surgery, the patient was free of orthostatic headache. A repeated MRI showed a striking reduction of the previous downward displacement of the cerebellar tonsils and pons.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Journal of neurology 243 (1996), S. 9-12 
    ISSN: 1432-1459
    Keywords: Arteriovenous malformations ; Spinal cord ; Motor evoked potentials ; Somatosensory evoked potentials ; Electromyography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Eighteen patients with dural arteriovenous fistulas or intradural arteriovenous malformations underwent clinical and neurophysiological examination. Bladder disturbances, pain, sensory abnormalities and involvement of both upper and lower motor neurons were commonly observed. Abnormal findings were obtained both in electromyography (11/18) and somatosensory evoked potentials (16/18). The motor evoked potentials were abnormal in all but one patient and showed a prolonged central (n = 14) or peripheral motor conduction time (n = 6). In three cases both values were prolonged. The results of nerve conduction studies in the patients with prolonged peripheral motor conduction times were normal. These neurophysiological findings may indicate root involvement in some patients, probably due to venous congestion and consequent hypoxia, as there were no signs of root compression on neuroradiological evaluation in any of these six patients. Motor evoked potentials may provide an additional clue to the diagnosis, although patients with spinal stenosis or motor neuron disease may present with similar findings.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Journal of neurology 245 (1998), S. 731-733 
    ISSN: 1432-1459
    Keywords: Key words Activated protein C ; Activated protein C resistance ; Dural arteriovenous fistula ; Venous ; thrombosis ; Thrombophilia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Resistance to activated protein C (APCR), shown to be the most common genetic risk factor for venous thrombosis, is mostly caused by a mutation in the factor V (FV) gene leading to FV Leiden. As dural arteriovenous fistulas (DAVFs) are associated with cerebral venous thrombosis, we looked for the FV Leiden mutation in seven patients with such fistulas. The APCR ratio was determined according to standard procedures. For APCR ratios considered pathological (less than 2.0), mutation analysis was done by a reverse hybridization assay. Three of the seven patients with DAVFs showed pathological APCR ratios and heterozygosity for FV Leiden mutation. Thus, it is hypothesized that FV Leiden might be involved in the pathogenesis of DAVFs.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-1920
    Keywords: Aneurysm ; Transcranial colour-coded duplex sonography ; Embolisation ; Subarachnoid haemorrhage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We examined 72 patients with 89 angiographically confirmed intracranial aneurysms, using transcranial colour-coded duplex sonography (TCCD) to determine the location and size of the aneurysm. The patients were admitted for coil embolisation of their aneurysm following subarachnoid haemorrhage or because of a cranial nerve palsy. Using a 2/2.25 MHz transducer, 42 aneurysms (47%) were seen satisfactorily through the temporal bone window or foramen magnum. In 24 cases (27%) image quality was insufficient as a result of a poor bone window, of the aneurysm having a diameter of less than 6 mm or of its being in an unfavourable location. In 23 other cases (26%) it was not possible to detect the aneurysm. Thrombosed structures could be demonstrated using TCCD in 8 of 12 giant intracavernous or basilar artery aneurysms, and in 15 of 19 aneurysms treated by platinum coil embolisation. TCCD offers a noninvasive method for monitoring progressive intra-aneurysmal thrombosis following coil embolisation and for follow-up of patients with untreatable fusiform aeurysms, should this be required. Detection of small aneurysms is limited by spatial resolution and insonation angles.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-1920
    Keywords: Key words Aneurysm ; Transcranial colour-coded duplex sonography ; Embolisation ; Subarachnoid haemorrhage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We examined 72 patients with 89 angiographically confirmed intracranial aneurysms, using transcranial colour-coded duplex sonography (TCCD) to determine the location and size of the aneurysm. The patients were admitted for coil embolisation of their aneurysm following subarachnoid haemorrhage or because of a cranial nerve palsy. Using a 2/2.25 MHz transducer, 42 aneurysms (47 %) were seen satisfactorily through the temporal bone window or foramen magnum. In 24 cases (27 %) image quality was insufficient as a result of a poor bone window, of the aneurysm having a diameter of less than 6 mm or of its being in an unfavourable location. In 23 other cases (26 %) it was not possible to detect the aneurysm. Thrombosed structures could be demonstrated using TCCD in 8 of 12 giant intracavernous or basilar artery aneurysms, and in 15 of 19 aneurysms treated by platinum coil embolisation. TCCD offers a noninvasive method for monitoring progressive intra-aneurysmal thrombosis following coil embolisation and for follow-up of patients with untreatable fusiform aneurysms, should this be required. Detection of small aneurysms is limited by spatial resolution and insonation angles.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    HNO 46 (1998), S. 296-300 
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Schwindel ; Vertebrobasiläre Ischämie ; Kleinhirninfarkt ; Elektronystagmographie ; Vestibularorgan ; Key words Vestibular labyrinth ; Vertigo ; Vertebrobasilar ischemia ; Cerebellar infarction ; Oculography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary An isolated vertigo may occur in vertebrobasilar ischemia, especially as the first symptom of cerebellar ischemia or basilar artery occlusive disease. Based on neuroanatomical findings, these short-lasting vertigo attacks result from transient insuffiency of the anterior inferior cerebellar artery (AICA), which supplies the inner ear and leads to ischemia of the upper parts of the vestibular labyrinth. Persisting vertigo with or without lateropulsion may occur in cerebellar infarctions with involvement of the medial inferior hemispheres due to occlusion of the medial branch of the posterior inferior cerebellar artery. Caloric testing with oculography can usually differentiate cerebellar infarction and peripheral vestibular disease. Since ischemic lesions with AICA insufficiency may cause pathological results in caloric testing, both clinical and neurophysiological analysis of associated oculomotor signs is essential for a correct diagnosis.
    Notes: Zusammenfassung Ausgehend von neuroanatomischen Überlegungen wird der Frage nachgegangen, ob und wie isolierte Schwindelattacken bei vertebrobasilärer Ischämie auftreten können. Als Prodromalsymptom vor Kleinhirninfarkten und Warnsymptom bei arteriosklerotischen Basilarisprozessen wird eine isolierte Vertigosymptomatik häufig beschrieben, wobei die Minuten dauernden Schwindelattacken auf eine Durchblutungsstörung der vorderen unteren Kleinhirnarterie (AICA) hinweisen. Zugrunde liegt eine Durchblutungsstörung der oberen Anteile des vestibulären Labyrinths. Anhaltende Schwindelbeschwerden mit oder ohne Lateropulsion können Ausdruck eines Infarktes der medialen unteren Kleinhirnhemisphären sein bei Okklusion des medialen Astes der hinteren unteren Kleinhirnarterie (PICA). In der Differenzierung des pseudovestibulären Kleinhirninfarktes vom peripheren Vestibularisausfall hilft die Elektronystagmographie mit Kalorik. Bei AICA-Durchblutungsstörungen kann auch die kalorische Testung pathologisch sein, so daß die klinische und neurophysiologische Analyse assoziierter Okulomotorikstörungen für die Differentialdiagnose entscheidend ist.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Clinical autonomic research 7 (1997), S. 131-135 
    ISSN: 1619-1560
    Keywords: heart rate variability ; blood pressure waves ; deep breathing ; spectral analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The measurement of heart rate variation during forced breathing (HRDB) is a well-known clinical test of parasympathetic function. It is known that normal values of HRDB are strongly dependent on age. However, little is known about other physiological factors that may lead to reduced HRDB values that may mimic parasympathetic failure. Thirty-two normal subjects (age 56.7±12.4 years) and 32 neurological patients with pathological autonomic test findings (age 57.9±10.2) were studied. Oscillations in heart rate and in mean arterial blood pressure were recorded in the supine position during forced breathing (6 cycles/min) using the Finapres monitor. Amplitudes of heart rate and blood pressure waves at 6 cycles/min (HR6 and ABP6) as well as gain values (Gain6=HR6/ABP6) and phase differences ({ie131-1}) between HR and ABP waves were calculated by means of spectral analysis. The mean (±SD) HR6 in normal subjects was 6.34±3.36 cycles/min with a mean ABP6 of 5.11±2.49 mmHg. HR6 correlated significantly with age (r=−0.426) and with ABP6 (r=0.602). No significant correlation was found between HR6 and mean blood pressure, mean heart rate or sex. From 24 patients with pathological findings in the classical HRDB value, only nine could be classified as pathological when the effect of ABP6 was considered. In conclusion, ABP variations significantly influence the amplitude of heart rate variations during forced breathing. We interpret these findings in terms of a baroreflex mechanism of HRDB including both vagal and sympathetic efferents. Normal reference value tables for clinical HRDB studies should not only consider age but also the amplitude of blood pressure variations.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Clinical autonomic research 7 (1997), S. 311-314 
    ISSN: 1619-1560
    Keywords: idiopathic Parkinson's disease ; sympathetic dysfunction ; autonomic evaluation ; spectral analysis ; baroreflex
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Standard autonomic tests (heart rate response to deep breathing-HR db , heart rate and systolic blood pressure response to tilt-ΔHR and ΔSBP) and spectral analysis of heart rate and arterial blood pressure and their transfer function (for the mid-frequency band a measure of baroreflex sensitivity) were performed in 20 patients with idiopathic Parkinson's disease (IPD) and 20 age-matched controls. Patients showed significantly diminished ΔSBP, and reduced sympathetic vasomotor and cardiomotor outflow (diminished Mayer waves), consistent with an alteration of the efferent arc of the baroreflex. These results were only significant in long-standing IPD (IPD-1, 〉5 years), whereas patients with short disease duration (IPD-s, 〈5 years) showed values comparable to controls. Respiratory-related heart rate variability was slightly reduced in IPD-1 but this was mainly due to diminished respiratory effort, indicated by low respiratoryrelated blood pressure variability. We conclude that autonomic abnormalities are only present in long-standing IPD and consist in reduced sympathetic vasomotor and cardiomotor outflow.
    Type of Medium: Electronic Resource
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