[A rare cause of recurrent cerebral artery embolism: thrombosis of the ascending aorta].
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Aorta↗
Biomedical subjects
D Claus
Publications and source records attributed to D Claus.
Isoflurane anaesthesia in the treatment of convulsive status epilepticus. Case report.
Status epilepticus may be resistant to intravenous anticonvulsive drugs. In these cases treatment with the inhalation anaesthetic agent isoflurane may be helpful in the further management. We describe a 35-year-old female patient who suffered from status epilepticus with partial seizures. In spite of therapy with benzodiazepine and phenytoin the status evolved into tonic clonic seizures. Treatment with thiopentone sodium did not stop seizure activity. Anaesthesia with isoflurane (dosage up to 1.5 vol.%) carried out twice within 72 h finally led to a termination of status epilepticus. From our own experience and reports in the literature we conclude that general anaesthesia with isoflurane can and should be used in the treatment of severe status epilepticus that does not respond to intravenous anticonvulsive agents.
Adult↗
Air fluidization therapy of pressure sores due to Guillain-Barré and Cushing syndrome.
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Adult↗
Corticospinal conduction studied with magnetic double stimulation in the intact human.
A group of 8 healthy normal subjects (24-36 years old, mean age 29 years) were investigated. Transcranial magnetic double stimulation of the motor cortex was carried out at different interstimulus intervals. With both stimuli suprathreshold, an attenuation of the test response was found at interstimulus intervals of less than 200 msec (target relaxed or contracted). The manifestation of this attenuation correlated with central signs in 31 patients with multiple sclerosis. This phenomenon is (at least at longer intervals) probably not a result of the refractory spinal motoneuron pool, but of a supraspinal inhibitory mechanism or lack of corticospinal drive caused otherwise. At interstimulus intervals between 10 and 30 msec, the test response increases significantly (magnetic double stimulation 10% suprathreshold, target relaxed). This result is also seen with voluntary muscle contraction and with vibration applied to a relaxed target muscle. The facilitatory effect is probably caused by slowly conducted corticospinal volleys enabling summation, with descending impulses generated by the test stimulus. With the conditioning stimulus subthreshold and target muscle relaxed an intracortical inhibition of the test response could be confirmed at short interstimulus intervals.
Adult↗
The influence of the shape of mechanical stimuli on muscle stretch reflexes and SEP.
Stretching of human thenar muscle was carried out using mechanical stimuli of different amplitudes and velocities in 50 normal subjects. Amplitudes of early M1 and late M2 reflex responses as well as cortical evoked potentials were recorded. M1 and M2 increased with a larger mechanical stimulus. Steeper mechanical stimuli generated larger M1 amplitudes, whereas M2 remained unaffected. Amplitudes of early cortical evoked potentials increased with increase of both rise-time and amplitude of muscle stretch. The shape of the mechanical stimulus is critical for the resulting reflex response. The different behaviours of M1 and M2 with increasing stimulus velocity are in favour of their different origins. Our results support a participation of slowly conducting muscle spindle afferents in the generation of the late M2 response in distal human hand muscles.
Adult↗
Influence of caffeine, sweating and local hyperemisation on "Marstock" thermotesting.
Marstock thermotesting evaluates A-delta- and C-fiber functions. To optimize this method, intraindividual variations of vasodilatation, blood flow and sympathetic activity probably biasing thermotest results were imitated by exogenous stimuli which strongly exaggerated these intraindividual variations. In 20 healthy subjects, warm (WT), cold (CT), and heat-pain (HT) thresholds were determined in the morning at the thenar (th), the volar wrist (wr), and behind the malleolus internus (mi). Thresholds at the thenar and the volar wrist were compared with those during severe sweating induced by Minor's test, and to those measured when sympathetic activity had been increased by the ingestion of a high dose of caffeine (0.5 g). Furthermore, the intraindividual variation of local capillary blood flow and vasodilatation was imitated by a rubefacient liniment (Forapin) applied to the three sites. After a local hyperemisation had been induced thermal thresholds were measured and compared to those measured without any stimulation. Local hyperemia did not influence thermal thresholds significantly. Sweating only lowered cold thresholds at the thenar significantly and only slightly raised warm and heat-pain thresholds at the thenar. Caffeine significantly lowered warm thresholds and raised heat-pain thresholds at the thenar. To conclude, the tested exogenous interferences do not disturb thermal perception markedly, especially when testing is not performed at the thenar, but at the volar wrist and when the testing-procedure and parameters are standardised.
Adult↗
[Peripheral facial paralysis as the first symptom of unknown metastatic primary tumor].
The spread of metastases to the brain and the leptomeninges is usually a terminal event in patients with known malignancies. We report on two patients, in whom the diagnosis of a diffusely metastasizing carcinoma was considerably delayed by the initial symptom of a peripheral facial nerve paralysis. The clinical, neuroradiologic and cerebrospinal fluid findings are discussed. A malignant neoplasm with diffuse or focal metastasis to the leptomeninges is a rare cause of peripheral facial paralysis of unclear genesis. The necessity of a lumbar puncture plus magnetic resonance imaging of the brain to enable an early diagnosis is emphasized.
Adenocarcinoma, Mucinous↗
Motor potentials evoked in tibialis anterior by single and paired cervical stimuli in man.
Latencies of compound muscle action potentials evoked in lower limb muscles after transcranial stimulation shorten and amplitudes enlarge when the target muscle is contracted. After transcutaneous stimulation of the cervical cord with single electrical stimuli, the latency is not affected by muscle contraction. This is thought to be due to a lack of temporal summation at the spinal motoneurones. Results are different when paired stimuli are used. With contraction most motoneurones respond to the first cervical stimulus while in a relaxed condition they respond to the second. Temporal summation brings motoneurones to their firing threshold. Therefore, cervical double stimulation is more effective than single stimuli. It is however less powerful than cortical stimulation. Paired stimuli are most powerful at an interval of 2 ms similar to the D I-wave interval after cortical stimulation.
Action Potentials↗
[Treatment of spasmodic torticollis with local injections of botulinum toxin A].
Sixty patients (30 men, 30 women, mean age 45.5 [18-71] years) with various forms of spasmodic torticollis were treated with local injections of botulinus A toxin. The results of treatment were assessed on an arbitrary scale (0-4) by the patients, by an examiner and by a neurologist who studied video recordings without knowing at what stage they had been recorded. After the first course of injections (a maximum of three injections of 10-40 ng in four weeks) 50 patients (83%) reported a better than 50% improvement; the mean score on the four point scale fell from 3.6 to 1.85 (P less than 0.001). The severity of the disorder as judged from the video recordings fell from a mean of 3.23 to 1.71 (P less than 0.001). The effect lasted for an average of 14 weeks. 6 patients developed mild dysphagia, in two further cases severe dysphagia occurred which lasted for up to four weeks. Twenty patients were followed up for more than one year: in nine of them the interval between courses of injections, the dose being unaltered, remained the same (12-14 weeks), but thereafter the abnormal movements returned with the same severity as before treatment. In eight patients the intervals between courses grew longer and the abnormal movements became less severe. Two patients have been symptom free for 20 and 13 months respectively, but one female patient failed to respond owing to the presence of antibodies against botulinus A toxin. The results indicate that local injection of botulinus toxin is a successful treatment for spasmodic torticollis.
Adolescent↗
Continuous multivariable monitoring in neurological intensive care patients--preliminary reports on four cases.
Evoked potential monitoring is a standard examination method in neurological intensive therapy units. Previously, multimodality observation was only possible in follow-up examinations. First experience with a new bed-side system continuously monitoring 12 neurophysiological and clinical parameters is reported. It consists of a personal computer and various stimulation units. EEG activity, median nerve somatosensory evoked potentials (SEPs) and brainstem auditory evoked potential (BAEPs) are recorded. Additionally, EEG spectral band power, heart rate, heart rate variability, intracranial pressure, body temperature, expiratory PCO2, blood pressure and transcutaneously measured oxygenation can be monitored. This paper reports on 4 exemplary cases of the 33 patients we have monitored to date, illustrating the principles and main advantages of the system. The system was developed to support the observation of ICU patients as well as to aid therapeutic decisions. It supports the clinical determination of brain death by specifying the deterioration of various neurological systems.
Aged↗
Liver transplantation in children with biliary atresia and polysplenia syndrome.
Biliary atresia is the most common indication for orthotopic liver transplantation (OLT) in children. The polysplenia syndrome anomalies, which occur in approximately 10% of children with biliary atresia, may represent special difficulties at liver transplantation. We have reviewed our experience with this syndrome in 116 children with biliary atresia who underwent liver transplantation between March 1984 and December 1989. The main features of the polysplenia syndrome, which included absence of the inferior vena cava, preduodenal portal vein, midgut malrotation, aberrant hepatic artery, and situs inversus, were encountered in 12 of the 116 children (10.3%). Severe portal vein hypoplasia (3.5 mm or smaller) was also present in 7 of these children. Eight patients received a complete and four received a reduced liver graft. The vascular anomalies increased the technical difficulty of OLT but could be surmounted, although they did contribute to the peroperative death of one child. The 1-month survival rate was 83% for the 12 children with features of the polysplenia syndrome and 88% for the other 92 children with biliary atresia alone.
Abnormalities, Multiple↗
[Successful treatment of the neuroleptic malignant syndrome using i.v. dantrolene sodium in the neurologic intensive care station].
The neuroleptic malignant syndrome (NMS) is one of the most dramatic psychiatric disorders every doctor in intensive care medicine can be confronted with. Two cases of successful treatment of NMS with intravenous application of dantrolene are presented. Although we used two very different doses, the treatment results were the same. Further studies will therefore be necessary to assess the optimal doses for this therapy.
Adult↗
Magnetic stimulation: technical aspects.
When the voltage induced in a measuring coil by different magnetic stimulators was assessed, the strongest stimulus was generated by Cadwell followed by Novametrix, Dantec and then Digitimer. The Cadwell produced a polyphasic pulse, while the other stimulators generated monophasic stimuli. This is the reason that reversing coil polarity does not influence the site of nerve excitation with the Cadwell equipment, but does with the other stimulators. The magnetic method has proved to be most useful for transcranial excitation of the motor cortex. Magnetic stimuli at C7 excite cervical roots submaximally. Electrical stimuli excite cervical roots supermaximally. No advantage was found in the use of small coils for cervical transcutaneous root stimulation. Electrical stimulation (60-85% output) excited lumbar motor roots supramaximally in each healthy subject. However, magnetic stimulation at T12/L1 (100% output) evoked responses in only 8 (Novametrix) and 12 (Cadwell) out of 18 trials without any difference between right and left. The most reliable method for transcutaneous non-invasive excitation of motor roots is electrical stimulation.
Action Potentials↗
[Magnetic stimulation using double coils--methodology and normal findings].
Magnetic stimulation of the motor cortex and spinal nerve roots was investigated in a group of 45 normal subjects using double coils. Figure of eight coils allows for an isolated excitation of the motor cortex of one hemisphere which cannot be achieved with circular coils. To evoke compound responses in hand muscles the optimal position of the figure of eight coil is with its centre about 5 cm lateral of the vertex and contralateral to the target muscle. The coil handle is in frontal position (occipito-frontal direction of the stimulation current in the coil; physical current definition is used resembling the electron flow from - to +). For the excitation to leg muscles the double coil centre is over the vertex with the handle contralateral to the target muscle (frontal current direction). Cervical roots can easily be stimulated using figure of eight coils with the handle contralateral to the target muscle and the coil centre over the root segment.
Adult↗
[Therapy of polyneuropathies].
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Alcoholism↗
[The diagnosis of polyneuropathies].
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Diagnosis, Differential↗
Hereditary motor and sensory neuropathies and hereditary spastic paraplegia: a magnetic stimulation study.
Central motor conduction to the small hand muscles was investigated in 59 patients with peroneal muscular atrophy and hereditary spastic paraplegia (HSP) by using transcranial magnetic brain stimulation. These comprised 20 patients with type I hereditary motor and sensory neuropathy (HMSN I), 15 with type II (HMSN II), 4 with HMSN I and 10 with HMSN II with associated pyramidal features, and 10 with the "pure" form of HSP. Central motor conduction was usually normal in HMSN I, HMSN II, and HSP. In HMSN I with pyramidal signs, central motor conduction time was greatly prolonged bilaterally. This result may reflect an associated involvement of the central motor pathways in these patients. In HMSN II with accompanying pyramidal features, 6 of the 10 patients had abnormal central motor conduction, although conduction times were only slightly prolonged, suggesting a different pathophysiological pattern.
Adolescent↗
Central motor conduction: method and normal results.
Normal results of CMCT to upper extremities do not correlate with height, age, or sex. In cases of peripheral conduction slowing, upper limits of CMCT must be adapted. Cervical root excitation can be carried out by electrical or magnetic stimulation. The F wave technique also produces reliable results. Electrical stimulation of lumbar roots produces the most reliable results when measuring CMCT to leg muscles. CMCT to the tibialis anterior correlates with height, but not with age or sex. The same is true for intraspinal motor conduction time. Contraction of the target muscle enlarges CMAP amplitudes after cervical and transcranial stimulation. However, a latency shortening is only seen after brain stimulation. This is thought to be at least partially due to spatial summation of D and I waves. Age affects peripheral nerve conduction and central nerve conduction in different ways.
Adult↗