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Biomedical subjects

H Brückmann

Publications and source records attributed to H Brückmann.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Carbon monoxide poisoning: the importance of computed and magnetic resonance tomographic cranial findings for the clinical picture and follow-up].

Clinical, CT and MR imaging findings of 5 patients are presented who suffered from sudden coma due to carbon monoxide intoxication. Follow-up investigations were done for up to three years. 4 patients recovered with only minor deficits, while one patient survived with a severe choreatic syndrome. Cranial computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated typical lesions in the globus pallidus, the cerebral white matter and the cortex. Initial lesions of the cerebral white matter rather than of the globus pallidus seem to indicate a doubtful clinical prognosis. In the CT of the severe case progressive white matter atrophy was visible still after half a year. In contrast, in two cases with good outcome repeated MRI showed no progressive white matter changes.

Adult↗
PubMed1992

[Cervical lymph node metastasis as a primary manifestation of esthesioneuroblastoma].

A 51-year-old male patient presented with right-sided swelling of the neck and a 2-year history of decreasing olfaction that had culminated in complete anosmia. CT and MRI showed a calcified ethmoid tumor and destruction of the lamina cribrosa extending into the anterior fossa and frontal lobes. Contrast material demonstrated marked enhancement on the CT and MRI. Bilateral angiography of the external and internal carotid arteries failed to show tumor vascularity typical for an esthesioneuroblastoma but rendered an olfactory meningioma unlikely. Histological findings of cervical lymph nodes removed during neck dissection showed infiltration by an esthesioneuroblastoma (Kadish C classification). Tumor calcifications in these neoplasms are generally well seen on CT and--while not specific--may suggest the diagnosis. CT and MRI are the most sensitive methods of demonstrating local tumor growth, metastasis and bone destruction.

Combined Modality Therapy↗
PubMed1991

[Dissections of the internal carotid artery--new diagnostic and pathogenetic aspects].

Initial and follow-up investigations were done systematically in 15 cases of internal carotid artery (ICA) dissections by means of angiography, computerized tomography, Magnetic Resonance Imaging, extracranial and transcranial Doppler sonography, as well as B-mode imaging. Cerebral hemodynamic reserve was evaluated by means of both SPECT and CO2-dependent vasomotor reactivity. The findings are focussed on two major issues: Do modern diagnostic tools permit to make the diagnosis of ICA dissection without angiographical proof? What is the pathogenesis of brain infarctions due to ICA dissections? Our findings demonstrate that the diagnosis of carotid artery dissection can reliably be done noninvasively by means of ultrasound techniques and MRI. These methods also allow for frequent follow-up investigations without any inconvenience for the patient. Embolic brain infarctions caused by carotid artery dissections are equally frequent as low flow induced lesions. Acute and follow-up findings suggest that surgical intervention is contraindicated in the acute phase, but may be considered for chronic pseudoaneurysms. Initial anticoagulation with high dose heparin is safe and seems to be efficacious. In certain cases, subsequent cumarine therapy may be indicated for a maximum of six months. Measures improving hemodynamics, e. g. induced hypertension, are reasonable, as long as the vasomotor reserve is exhausted.

Carotid Artery Diseases↗
PubMed1990

[Dissections of the vertebral artery following cervical chiropractic manipulations].

In a 37-year-old female patient complaining of increasing pain in the neck and occiput, chiropractic manipulations at the cervical vertebral column were associated with ischaemias of the brain stem presenting as vertigo, transient "locked-in" syndrome followed by vomiting, and sensorimotor hemiparesis. Digital subtraction angiography (DSA) revealed complete obstruction of the right and slight dissection of the left vertebral artery. The symptoms receded within a few days after heparinisation with 1000 IU/h intravenously. A 39-year-old female patient developed vertigo, nystagmus, tetraparesis and dysarthria two days after chiropractic intervention because of refractory pain in the neck and occiput. DSA showed embolism of the basilar artery and extensive dissections of the vertebral arteries. The basilar artery was completely recanalized after local intraarterial fibrinolysis with 50,000 IU urokinase. During the further course of treatment the symptoms receded under heparin and phenprocoumon over a period of 8 months, except for hemiparesis on the left side especially affecting the arm. Trivial traumas can result in dissections of the vertebral arteries. Severe neck pain is a frequent, typical early symptom. Hence, patients with cervical vertebral column syndromes should receive chiropractic treatment only after careful diagnosis.

Adult↗
PubMed1990

Complex hyperkinesia during recovery from left temporoparietal cortical infarction.

A 51-year-old man with preexistent lacunar infarctions in the basal ganglia and pons developed complex involuntary movements of his right arm 1 day after a purely cortical-subcortical ischemic infarction in the territory of the left middle cerebral artery sparing the basal ganglia. The movements were stereotyped and repetitive, affecting hand and fingers or proximal arm muscles alternatively or together. Although hyperkinesia after basal ganglia lesion has been described many times in the literature, it has not yet been reported after cortical-subcortical ischemic infarctions sparing the basal ganglia.

Cerebral Infarction↗
PubMed1990

Brainstem auditory evoked potentials and somatosensory evoked potentials in pontine haemorrhage. Correlations with clinical and CT findings.

Electrophysiological studies were performed on 17 patients with pontine haemorrhage. Most had had massive hypertensive bleeding, leading to death in 12 of them within 3 months. Of the 5 surviving patients, 2 had a poor outcome and 3 a moderately good outcome. Brainstem auditory evoked potentials (BAEPs) and somatosensory evoked potentials (SEPs) were recorded in all patients, mostly with serial recordings. BAEPs were pathological in all patients. The most important finding was a reduction in amplitude or loss of waves. With a loss of waves after wave II bilaterally all patients died; the 2 patients with a normal amplitude of waves I-V at least on one side, survived in good condition. Further prognostic conclusions were not possible. The correlation with the clinical state was limited and was best for small unilateral tegmental haemorrhages. Eleven of the 17 patients suffered bilateral loss of the N20 component of the median nerve SEP. All these patients died. In patients with unilateral loss of the SEP the outcome could be favourable even if the bleeding extended across the midline. 'Subcortical' SEPs were not significantly altered. EEG findings in 15 and visual evoked potentials in 4 patients showed preserved forebrain electrical activity even in patients in poor condition.

Adult↗
PubMed1990

Loss of brainstem acoustic evoked potentials with spontaneous breathing in a patient with supratentorial lesion.

The loss of brainstem acoustic evoked potentials (BAEP) is considered as a confirmatory test for the diagnosis of brain death in patients with supratentorial lesions. We report a patient with ischemia in the territory of the left middle and anterior cerebral artery, who showed a loss of BAEP waves III-V as a sign of brainstem compression, but maintained spontaneous breathing and EEG activities. We conclude that occasionally BAEP may provide misleading results in the diagnosis of brain death.

Aged↗
PubMed1990

Clinical features of proven basilar artery occlusion.

Our study describes the early symptoms and signs of 85 patients with either basilar artery occlusion or bilateral distal vertebral artery occlusion documented by selective angiography. The most common prodromal symptoms were vertigo, nausea, and headache, which occurred during the 2 weeks before the stroke. Angiographic findings of 49 patients were classified into proximal, middle, and distal basilar artery occlusions. Twenty-two of these patients had additional vertebral artery lesions. A fourth group was composed of 36 patients with bilateral distal vertebral artery occlusion without opacification of the basilar artery through a vertebral artery injection. Onset was sudden in 20 patients; sudden, but preceded by prodromal symptoms in 11 patients; and progressive in 54 patients. Patients with progressive strokes often had bilateral vertebral artery occlusions. Most patients with acute onset had occlusion of the middle and distal basilar artery. An embolic origin of basilar artery occlusion from an arteriosclerotic vertebral artery lesion was assumed to be an important mechanism. An embolus reaching the basilar artery may not necessarily reach the top of the artery, but may also become lodged more proximally.

Adult↗
PubMed1989

Putaminal haemorrhage after recanalization of an embolic MCA occlusion treated with tissue plasminogen activator.

We present the case of a 42-year-old female, who suffered an embolic occlusion of the right middle cerebral artery (MCA). Recanalization was achieved with tissue plasminogen activator (t-PA) within 7 h after onset of stroke. Post-t-PA infusion angiographic and CT examinations revealed fragmentation of the thrombus and a small putaminal haemorrhage associated with early reperfusion of the MCA. No clinical deterioration was observed and complete recovery occurred within 10 days.

Adult↗
PubMed1989

[How certain is the diagnosis of intracerebral tumor bleeding in magnetic resonance tomography?].

Three patients with intracerebral malignant tumours were examined with high-field strength MRI and CT to determine what differences might exist between a haemorrhagic tumour and a genuine intracerebral haemorrhage. Recent literature hint on characteristic signal abnormalities in comparison to pure intracerebral haematoma. However, two of our three patients showed no significant variation, in particular no delay in the evolution of methaemoglobin and no irregular haemosiderin deposition. Up to now the MRI does not seem to be the method of choice to evaluate the aetiology of intracerebral bleeding.

Adenocarcinoma↗
PubMed1988

Evoked potentials in basilar artery thrombosis: correlation with clinical and angiographic findings.

In 28 patients with vertebro-basilar or basilar artery thrombosis brain-stem auditory evoked potentials (BAEPs) and somatosensory evoked potentials (SEPs) have been recorded. Visual evoked potentials (VEPs) were recorded in 7 of these 28 patients. In 24 patients the diagnosis was angiographically proven and in 4 patients Doppler sonography and computerized tomography suggested this diagnosis. The BAEP and SEP findings were correlated to clinical and angiographical signs. BAEPs could be classified into 6 different patterns. In more than half of the patients different BAEP patterns from the two ears could be found. A pathological IV/V complex was most often found in comatose patients and in patients with a basilar artery occlusion distal to the anterior inferior cerebellar artery. Prolonged interpeak latency of I-III was mainly found in alert or drowsy patients with caudal occlusions. The frequent occurrence of a BAEP with only wave I preserved, or with no waves preserved, in patients with brain-stem functions suggests that BAEPs are not useful in the diagnosis of brain death when basilar artery thrombosis is suspected. SEPs were either absent bilaterally or else severely altered on one side in all comatose patients. In alert patients, including those with 'locked-in' syndrome, SEPs were never absent bilaterally. Increased N13-N20 interpeak latency was an uncommon finding in this series. There was no correlation between the SEP and the angiographically proven location of the occlusion. In the 'locked-in' syndrome both SEP and BAEP findings were non-uniform. Normal SEPs were sometimes found in combination with severely altered BAEPs, suggesting partial deafferentation. Since basilar artery thrombosis is now a treatable condition, early diagnosis and documentation of functional deficits moves into a more important clinical area than heretofore.

Adult↗
PubMed1988

Effects of enzymatic blood defibrination in subcortical arteriosclerotic encephalopathy.

Plasma hyperviscosity is a striking abnormality in patients suffering from subcortical arteriosclerotic encephalopathy (SAE) and is thought to perpetuate the chronic ischaemic demyelinating process of the periventricular white matter. Ancrod, a defibrinating enzyme, was given to 10 patients with SAE in an attempt to reduce plasma fibrinogen, which would thus normalise hyperviscosity. This was paralleled by a significant improvement of the initially abnormal retinal arteriovenous passage time, as well as a significant augmentation of the CO2-induced cerebral vasomotor response. This did not lead, however, to any clinical improvement with respect to performance of neuropsychological tests, recurrences of strokes during a 6 month observation period or improvement of various audiological parameters. The findings indicate that hyperviscosity in patients with SAE is merely an epiphenomenon. A potentially reversible, chronic penumbral state of the brain tissue apparently does not exist in SAE.

Aged↗
PubMed1988

Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease.

In this retrospective analysis we report our treatment experience in 65 consecutive patients with clinical signs of severe brainstem ischemia with angiographically demonstrated thrombotic vertebrobasilar artery occlusions who received either local intra-arterial thrombolytic therapy (urokinase or streptokinase) (43 patients) or conventional therapy (antiplatelet agents or anticoagulants) (22 patients). We analyzed the data with respect to cerebral artery occlusion patterns, posttreatment arterial recanalization, and the clinical categories of favorable/unfavorable outcome and survival/death. In subgroup analyses, recanalization in patients who received thrombolytic therapy correlated significantly with clinical outcome; in 19 of 43 patients, recanalization was demonstrated angiographically, while in 24 patients the occlusion persisted. All patients without recanalization died, but 14 of the 19 patients displaying recanalization survived (p = 0.000007), 10 with a favorable clinical outcome. Only three of the 22 patients who received conventional therapy survived, all with a moderate clinical deficit. When we compared the treatment groups, highly significant differences in both outcome quality (p = 0.017) and survival (p = 0.0005) were found to depend on establishing recanalization. Our data support the concept that technically successful thrombolysis of vertebrobasilar artery occlusions is associated with beneficial clinical outcome.

Acute Disease↗
PubMed1988

Local intra-arterial fibrinolytic therapy in acute carotid territory stroke. A pilot study.

The possibility that intra-arterial local infusion of fibrinolytic agents may achieve recanalization of previously occluded carotid territory arteries in acute stroke was tested in a prospective angiography-based open pilot study at two centers. Fifteen of 20 patients with acute symptoms (mean treatment-onset interval 7.6 hours) demonstrated complete recanalization; 10 of the 15 patients exhibited clinical improvement of varying degree by the time of hospital discharge. Four of the 20 patients suffered hemorrhagic transformation of the infarcted territory without clinical deterioration or demise. Because of the study format and the limited number of patients, dose responses for recanalization and risk relations were not established. We conclude that local intra-arterial fibrinolytic therapy may lead to cerebral arterial recanalization in acute carotid territory thrombotic stroke. The particular implications and limitations of this approach are discussed.

Acute Disease↗