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  • 1
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Hämolytisch-urämisches Syndrom ; Thrombotisch-thrombozytopenische Purpura ; Transkranielle Dopplersonographie ; Vasospasmen ; Key words Haemolytic uremic syndrome ; Thrombotic-thrombopenic purpura ; Vasospasms ; TCD
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Cerebral involvement is typical for thrombotic microangiopathies like haemolytic uremic syndrome (HUS) and thrombotic-thrombopenic purpura (Moschcowitz disease or TTP). Symptoms are irritation, restless behaviour, disorientation, disturbance of consciousness, seizures, and focal neurological deficits. The lack of typical imaging changes or pathological observations may explain the unknown pathophysiological cascade leading to the neurological symptoms. We describe the development of HUS/TTP in a 52-year-old woman after acute pneumonia caused by Diplococcus pneumoniae. The patient showed an increasing psycho-organic syndrome with disorientation, followed by severe loss of consciousness and coma. Initially, computed tomography showed slight diffuse brain oedema, which was not found in later follow-up images. Magnetic resonance imaging was normal. The TCD examination revealed general velocity increases and vasospasms (especially MCA, ACA and PCA bilateral and BA). The reduction in blood flow velocities in the basal arteries was accompanied by a marked clinical improvement. The development of vasospasms may be an explanation for the neurological deficits in HUS/TTP. The origin of the vasospasms may be found in disturbed prostacyclin production, increased serotonin or platelet factor IV release, and leucocyte activation with consecutive endothelial damage.
    Notes: Zusammenfassung Mikroangiopathische hämolytische Anämien (thrombotisch-thrombozytopenische Purpura = TTP oder Moschcowitz-Syndrom, hämolytisch-urämisches Syndrom = HUS) gehen oft mit Beteiligungen des zentralen Nervensystemes einher. Typische Symptome sind Gereiztheit, Ruhelosigkeit, Verwirrtheitszustände, Bewußtseinstrübungen, Krampfanfälle oder fokalneurologische Ausfälle. Teilweise fehlende bildmorphologische und pathologisch-histologische Korrelate erschweren die Klärung der Pathogenese. Wir berichten über eine 52 jährige Patienten mit HUS/TTP aufgrund einer Pneumokokkensepsis. Sie entwickelte ein akutes hirnorganisches Psychosyndrom mit progredienter Bewußtseinsstörung bis zum Koma. Die initiale kraniale Computertomographie zeigte eine diskrete, allgemeine Hirnschwellung, welche sich unabhängig von der klinischen Verschlechterung zurückbildete. Die kraniale Kernspintomographie war unauffällig. In der transkraniellen Dopplersonographie fanden sich generalisierte Flußgeschwindigkeitssteigerungen (A. cerebri media, anterior und posterior beidseits sowie A. basilaris). Der ursächliche Zusammenhang zwischen Flußgeschwindigkeitssteigerungen und Bewußtseinsstörungen wird durch die Beobachtung wahrscheinlich gemacht, daß die klinische Besserung analog der Rückbildung der Flußgeschwindigkeitssteigerungen erfolgte. Bei HUS/TTP können Vasospasmen die Ursache neurologischer Ausfälle darstellen. Pathophysiologisch werden ein gestörter Prostacyclinstoffwechsel, eine Erhöhung von Serotonin und Plättchenfaktor IV und eine Leukozytenaktivierung als Ursachen diskutiert.
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  • 2
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Akute Polyradikulitis Guillain-Barré ; Leitungsblock ; Magnetstimulation ; F-Welle ; Motorische Neurographie ; Key words Acute polyradiculitis Guillain-Barré ; Conduction block ; Motor evoked potential ; F-wave ; Motor conduction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A 47-year-old woman developed acute Guillain-Barré-syndrome (GBS) within one day, presenting tetraparesis (muscle strength 1/5 for the upper and 2/5 for the lower extremities) and respiratory failure. On day 5 a cardiac pacemaker was necessary due to severe bradycardia. Electrophysiological studies were performed on days 2, 3, 5, 6, 8, 12, 15, 30 and 40. Our initial findings revealed normal motor conduction velocities and normal spinal motor evoked potentials. However, neither F-waves nor cortical motor evoked potentials could be registered from the upper or lower extremities. The motor conduction of the median nerve remained normal until day 6. The compound motor action potential declined thereafter and disappeared by day 12, indicatign axonal degeneration. No axonal degeneration occurred in the lower extremities. The cervical or lumbar magnetic stimulation excites nerve roots at the level of the foramen intervertebrale. Thus, our findings suggest a conduction block between the foramen intervertebrale and the point where the nerve roots enter the spinal cord.
    Notes: Zusammenfassung Eine 47jährige Patientin entwickelte innerhalb eines Tages eine akute Polyradikulitis Guillain-Barré (GBS) mit einer rein motorischen Tetraparese (Kraftgrad Arme 1/5, Beine 2/5) und Beatmungspflichtigkeit. Am 5. Tag war sie tetraplegisch und wegen Bradykardien schrittmacherpflichtig. Bei dieser Patientin wurden elektrophysiologische Untersuchungen am 2., 3., 5., 6., 8., 12., 15., 30. und 40. Tag durchgeführt. Der initiale Befund zeigte eine unauffällige fraktionierte motorische NLG des N. medianus und eine normale zervikale Magnetstimulation bei ausgefallener Medianus-F-Welle sowie ausgefallener corticaler Magnetstimulation. Die gleiche Konstellation fand sich für den N. tibialis. Die Medianus-NLG blieb bis zum Tag 6 normal, danach reduzierte sich das CMAP bis zum kompletten Ausfall ab dem 12. Tag als Hinweis auf eine sekundäre axonale Degeneration. Dagegen änderte sich die elektrophysiologische Konstellation an der unteren Extremität nicht. Da die Exzitation von Nervenwurzeln durch die Magnetstimulation auf der Höhe des Foramen intervertebrale erfolgt, muß die Läsion bei der initialen Befundkonstellation zwischen Foramen intervertebrale und Eintritt der Nervenwurzel ins Rückenmark liegen.
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  • 3
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Schlaganfall ; Paraneoplastische Hämostasestörung ; Trousseau-Syndrom ; Ovarialtumor ; Atypische Endosalpingiose ; Key words Stroke ; Paraneoplastic hemostasis ; Trousseau’s syndrom ; Ovarian tumor ; Atypical endosalpingiosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Thrombembolic events as paraneoplastic complications in malignant disease account for severe morbidity and mortality in these patients. In some cases disturbance in hemostasis is the first manifestation of a neoplastic process. We report the cases of two patients with cerebral and extracerebral vessel occlusions, in whom epithelial tumors of low malignant potential (borderline-tumors) of ovar and peritoneum were diagnosed later on. In one case the removal of the tumor stopped the coagulation problems. The second patient died a few days after the first symptoms with devastating multiple vessel occlusion. In stroke of unknown aetiology a paraneoplastic process should be kept in mind. The diagnosis is more probable with recurrent thrombembolism in different body regions and when warfarin therapie was ineffective. Thoughtful coagulation studies and a tumor search program is recommended in these cases.
    Notes: Zusammenfassung Thrombembolische Komplikationen treten paraneoplastisch bei malignen Erkrankungen auf und tragen zu Morbidität und Mortalität bei. In einigen Fällen sind Hämostasestörungen die erste Manifestation eines neoplastischen Prozesses. Wir beschreiben die Fälle von zwei Patientinnen mit zerebralen und extrazerebralen Gefäßverschlüssen, bei denen nach der Gefäßmanifestation epitheliale Tumoren mit niedrigem Malignitätspotential (Borderline-Tumoren) an Ovar und Peritoneum diagnostiziert wurden. Paraneoplastische Hämostasestörungen sind bei diesen Tumoren mit per se guter Prognose bisher nicht beschrieben worden. In einem Fall führte die Tumorentfernung zum Sistieren der Gerinnungsstörung. Die zweite Patientin starb wenige Tage nach den ersten Symptomen an den Folgen multipler Gefäßverschlüsse. Bei Schlaganfällen unklarer Ätiologie sollte auch an eine paraneoplastische Genese gedacht werden. Besonders wahrscheinlich ist die Diagnose bei rezidivierenden venösen und arteriellen Gefäßverschlüssen in verschiedenen Körperregionen und bei der Resistenz auf die Therapie mit Vitamin-K-Antagonisten. Eine sorgfältige Gerinnungsdiagnostik und ein Tumorsuchprogramm sind in diesen Fällen zu empfehlen.
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  • 4
    ISSN: 1432-2129
    Keywords: Schlüsselwörter Trigeminusneuralgie ; CSF ; Neurotransmitter ; Substanz P ; Somatostatin ; Key words Trigeminal neuralgia ; Neurotransmitters ; CSF ; Substance P ; Somatostatin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The etiology of trigeminal neuralgia is unknown, but both peripheral and central causes have been suggested. To investigate the role of central neurochemical mechanisms we measured epinephrine, norepinephrine and their breakdown product, vanilly mandelic acid (VMA), in the cerebrospinal fluid (CSF) of 16 patients (53.3 ± 8.3 years) suffering from trigeminal neuralgia. As markers for the dopaminergic system, we determined CSF levels of dopamine and its metabolite homovanillic acid (HVA). As a marker for the serotonergic system, we measured CSF levels of serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA). In addition, levels of the neuropeptides substance P and somatostatin were determined. The concentration of norepinephrine (P 〈 0.01), VMA (P 〈 0.05) and HVA (P 〈 0.05) were significantly decreased in patients with trigeminal neuralgia and correlated with the duration of the disease and depression scores. 5-HIAA was also significantly decreased (P 〈 0.05) compared to control patients. Whereas substance P was significantly elevated (P 〈 0.05), somatostatin was significantly decreased (P 〈 0.05). Various correlations between the classical neurotransmitters and the neuropeptides could be established. We hypothesize than the sum of complex neurochemical changes plays a role in the etiology of trigeminal neuralgia, which can be separated in local and more central proceedings. The increase in substance P, a major nociceptive neuromodulator, supports the concept of a local neurogenic inflammation, possibly located in the trigeminovascular system. Depending on the duration of the disease and depression, the loss of serotonergic, dopaminergic and noradrenergic innervation seems to reflect more central changes, possibly due to alterations in their antinociceptive descending pathways.
    Notes: Zusammenfassung Bei der Trigeminusneuralgie werden periphere und zentrale Entstehungsmechanismen diskutiert. Daher wurden bei 16 Patienten (53,3 ± 8,3 Jahre) mit einer idiopathischen Trigeminusneuralgie in der Zerebrospinalflüssigkeit (CSF) die Neuropeptide Substanz P und Somatostatin, die Neurotransmitter Noradrenalin und Adrenalin sowie die Metaboliten Homovanillinmandelsäure (HVA), Vanillinmandelsäure (VMA) und 5-Hydroxyindoleessigsäure (5-HIAA) bestimmt. Während die Substanz P in der CSF signifikant (p 〈 0,01) erhöht gefunden wurde, war das Somatostatin gegenüber den Kontrollpersonen signifikant erniedrigt (p 〈 0,05). Noradrenalin (p 〈 0,01), 5-HIAA (p 〈 0,01), HVA (p 〈 0,05) und VMA (p 〈 0,05) waren signifikant erniedrigt. Während die Erhöhung der Substanz P einen Hinweis auf eine lokal beschränkte neurogene Entzündung im trigemino-vaskulären System geben könnte, spricht die Reduktion monoaminerger Transmitter für eine zentral gestörte Schmerzmodulation. Diese scheint mit zunehmender Krankheitsdauer und begleitender Depression stärker zu werden. Die zahlreichen Korrelationen der Neuromediatoren untereinander, insbesondere auch zwischen den Neuropeptiden und den klassischen Neurotransmittern, sprechen für komplexe neurochemische Interaktionen im Rahmen der Schmerzentstehung.
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  • 5
    ISSN: 1433-8491
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 6
    ISSN: 0942-0940
    Keywords: Intracerebral haemorrhage ; intracranial pressure ; metanephrine ; normetanephrine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Autonomic nervous system dysfunction is a common complication of severe intracranial disease. The aim of this study was to reveal the autonomic changes in patients suffering from acute intracerebral haemorrhage (ICH). 25 patients with spontaneous ICH within 24 hours of onset of symptoms were included. All patients were treated with standardised medical management and the meta- and normetanephrines were detected by high performance liquid chromatography (HPLC) in 24-hour urine every day. The mean level of normetanephrine (709±579 μg/day) and metanephrine (244±161 mg/day) were significantly elevated in comparison with a control group, p⩽0,01. The norepinephrine elevation was of greater diagnostic and prognostic importance. Maximum urinary catecholamine metabolite levels occurred between day 3 to 10 after the bleeding. Normetanephrines correlated with the prognosis and the complications of ICH: intraventricular involvement resulted in significantly elevated normetanephrine levels (896±520 μg/day versus 311±78 μg/day) p⩽0,01. Patients with a great volume of haematoma developed severe autonomic dysregulation (normetanephrines 1114±493 μg/day), whereas patients with smaller haematoma did not (339±125 μg/day) p⩽0,0001; patients with bad outcome (1014±620 mg/day) had higher levels of normetanephrines than those with a good prognosis (322±110 μg/day) p⩽0,001. A close relationship to elevated intracranial pressure was established. This study demonstrated the feasibility of detecting autonomic nervous system dysfunction in neurological intensive care patients by means of examination of the metabolites of the catecholamines in the urine. The pattern of elevation in ICH and the relation to the clinical situation is presented. Norepinephrine offers the chance of simple and feasible monitoring of autonomic dysfunction.
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  • 7
    ISSN: 1468-2982
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To investigate sympathetic nervous system and neuroendocrine changes in idiopathic trigeminal neuralgia, we determined the plasma level of the catecholamines norepinephrine and epinephrine, as well as cortisol and ACTH in 16 patients (55.38.3 years) with trigeminal neuralgia at four different times during the day (7.00, 13.00, 17.00 and 23.00). Morning and evening values of plasma norepinephrine as well as the daily mean value (dmv) were significantly higher (p〈0.01) in patients with trigeminal neuralgia than in an age- and gender-matched control group. Moreover, morning, afternoon and dmv epinephrine values were also significantly elevated. The dmv norepinephrine levels correlated with the intensity of the attacks (r=0.68, p〈0.01), the frequency of the attacks (r=0.75, p〈0.01) and the duration of the disease (r=0.78, p〈0.01). In addition to elevated catecholamines, trigeminal neuralgia patients also demonstrated significantly increased morning, evening and daily mean values of plasma cortisol. Thus, patients with trigeminal pain have an increased sympathetic nervous system activity for an extended period of time without a direct link to pain attacks, which suggests that the sympathetic nervous system itself is at least co-activated in trigeminal neuralgia and perhaps plays a role in the induction and maintenance of trigeminal pain. The neuroendocrine changes are similar to cluster headache and point to a central dysregulation of the hypothalamic-pituitary-adrenal axis, possibly due to the cyclic phenomena in idiopathic trigeminal neuralgia.
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  • 8
    ISSN: 1432-1459
    Keywords: Key words Emotions ; Evoked ; cerebral blood flow ; Transcranial ; Doppler sonography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The cerebral representation of emotions has previously been investigated by the study of patients with local brain damage, experiments with selective stimulation of only one hemisphere, and more recently by imaging techniques such as positron-emission tomography or magnetic resonance imaging measuring local cerebral blood flow. We investigated the mean flow velocity (FVmean) in the middle cerebral artery (MCA) by transcranial Doppler sonography during emotional stimulation with video scenes in 24 healthy test persons. The videos consisted of an erotic scene and a violent scene shown in contrast to a calming scene. Blood pressure, heart rate, and breathing frequency were monitored continuously by noninvasive measurement. FVmean increased during the erotic scene to 108.5 ± 11.9% (P 〈 0.05) of the baseline value in the right MCA and to 109.0 ± 10.6% (n.s.) in the left MCA. During the violent scene FVmean reached 109.0 ± 8.7% (P 〈 0.05) on the right side and 108.1 ± 13.0% (n.s.) on the left side. The FVmean time course showed a close relationship to the video sequence. During scenes involving great tension FVmean showed a plateaulike state and peaked during sudden actions. Blood pressure, heart rate, and respiratory rate showed no significant changes. However, we observed a tendency towards lower heart rates (lowest value 94.5 ± 13.6%) during the erotic scene and two peaks (103.2 ± 13.3%, 104.8 ± 16.8%) coinciding with sudden violent actions. The significant increase in FVmean in the right MCA supports the theory of a right hemisphere dominance for the processing of emotions.
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Der Radiologe 37 (1997), S. 843-852 
    ISSN: 1432-2102
    Keywords: Key words Focal cerebral ischemia • Penumbra • Brain infarction • Thrombolysis • Neuroprotection ; Schlüsselwörter Fokale zerebrale Ischämie • Penumbra • Hirninfarkt • Thrombolyse • Neuroprotektion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Pathophysiologie des akuten Hirninfarktes wird unter dem Aspekt der Veränderung des zerebralen Blutflusses (CBF) und dem damit verbundenen Penumbrakonzept erläutert. Das alternative Konzept der Periinfarktdepolarisation ergänzt das Penumbra-orientierte CBF-Modell. Wesentliche metabolische Folgen von Ischämie und Reperfusion, wie Energiemangel, exzitatorische Phase mit Glutamatüberladung, Kalziumeinstrom in die Zelle, Bildung freier Radikale, Proteasenaktivierung, Proteinsynthesestörungen, Genexpression und Apoptoseinduktion, Membranstörungen, Ödementwicklung und mikrovaskuläre Störungen werden erläutert. Zusammenfassend liegt bei zerebralen Ischämien und nachfolgenden Reperfusionen ein höchst komplexes Ineinandergreifen verschiedener Kaskaden im Sinne eines Netzwerkes von Schädigungen vor. Die Vorstellung einer monokausalen Ischämiekaskade mit entsprechend einfacher Therapie läßt sich nicht aufrechterhalten. Ein therapeutisches Fenster von in der Regel ca. 6 h für die Akutbehandlung läßt sich aus diesen pathophysiologischen Befunden ableiten. Die derzeit gebräuchlichen Therapieregime zielen auf eine optimierte Basistherapie, Rekanalisation mit Thrombolyse und meist pharmakologische Neuroprotektion. Verschiedene mögliche Eingriffsstellen werden vorgestellt. Moderne und zukünftige Therapien, wie Stroke-unit-Versorgung, Thrombolyse mit Add-on-Neuroprotektion erscheinen prognostisch vielversprechend.
    Notes: Summary This review focuses on the pathophysiological changes in acute cerebral ischemia, with special emphasis on disturbances of the cerebral blood flow (CBF) and the associated penumbra concept. Alternatively, the model of peri-infarct depolarization is demonstrated. Metabolic and molecular changes caused by cerebral ischemia and reperfusion are discussed, namely energy failure, release of glutamate with an excitatoric burst, calcium influx in neurons, generation of free radicals, activation of different proteases, disturbances of protein synthesis, induction of gene expression and apoptosis, loss of membrane integrity, edema formation and microvascular disturbances. In summary, the pathophysiological changes after focal cerebral ischemia and reperfusion are most adequately described by a network of interacting different mechanisms of tissue alterations. The simple concept of a cascade of ischemic effects which would be easy to block seems to be less applicable. A time window of approximately 6 h for the acute stroke therapy is postulated on the base of the above mentioned pathophysiological changes. The recently introduced treatment regimen with optimized basic treatment, recanalization using thrombolysis and neuroprotection by different agents is presented. Different modes of a possible intervention are discussed. Modern concepts of stroke therapy including stroke-unit care and thrombolysis with add-on neuroprotection seem to have potential for improving the outcome of acute stroke patients.
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  • 10
    ISSN: 1435-1463
    Keywords: Cerebrospinal fluid ; Parkinson's disease ; somatostatin-like immunoreactivity ; dementia ; monoamines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary There is some evidence that Parkinson's disease (PD) seems to be a heterogenous and generalized brain disorder reflecting a degeneration of multiple neuronal networks, including somatostatinergic neurons. Somatostatin-like immunoreactivity (SLI) and its molecular forms, high molecular weight form (HMV-SST), somatostatin-14 (SST-14), somatostatin-25/28 (SST-25/28) and Des-ala-somatostatin (Des-ala-SST), as well as homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) were estimated using HPLC and radioimmunoassay in the cerebrospinal fluid (CSF) of 35 aged parkinsonian patients with different stages of intellectual deterioration. The influence of L-dopa-treatment on these neurochemical parameters was evaluated. Without a correlation with dementia scores (p=0.11), SLI was significantly reduced in PD in comparison to the control group (p 〈 0.05). The reduction was related to the progression of the disease. Correlations between SLI, HVA and 5-HIAA indicate a heterogenous brain disorder in PD with alterations of several transmitter systems and functions. Complex qualitative and quantitative changes in the molecular pattern of SLI are compatible with a dysregulated synthesis and/or posttranslational processing. L-dopa-treatment was associated with a significant increase of HVA (p 〈 0.05) and HMV-SST (p 〈 0.05) and a slight, but insignificant increase of SLI (p=0.11).
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