Subcortical arteriosclerotic encephalopathy (Binswanger's disease).
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Aged↗
Biomedical subjects
H Zeumer
Publications and source records attributed to H Zeumer.
The role of continuous-wave Doppler sonography in the diagnosis and management of basilar and vertebral artery occlusions, with special reference to its application during local fibrinolysis ("Vertebrobasilar disease. Time for a new strategy." Louis R. Caplan, 1981).
In general, the prognosis of bilateral vertebral or basilar artery occlusions is very poor. No satisfactory management of this condition is known; in addition, the early diagnosis of severe lesions of the "intradural vertebrobasilar artery" on the basis of clinical signs and symptoms alone is difficult and regularly requires invasive procedures. Continuous-wave Doppler sonography has proved to be of great value in the primary diagnosis of vertebrobasilar thrombosis. In two cases, in whom bilateral intracranial vertebral artery lesions and basilar thrombosis were successfully treated with the help of local intraarterial fibrinolysis, Doppler sonography proved to be a reliable diagnostic tool for the evaluation and the non-invasive follow-up of thrombolysis. Clinical, Doppler sonographic and angiographic findings are presented and correlated.
Adult↗
A quantitative approach to measuring the cerebrospinal fluid space with CT.
A method for measuring the subarachnoid space by using an independent CT evaluation unit is described. The normal values have been calculated for patients, according to age, and three examples are presented demonstrating reversible decrease of brain volume in patients suffering anorexia nervosa and chronic alcoholism.
Adolescent↗
[Multi-infarct dementia under CT aspects].
Multiinfarct- or vascular dementia can primarily be defined clinically by means of the combination of intermittent neurological deficits and progressive mental deterioration. Cranial computerized tomography is not capable of proving the intellectual state, but if there is clinical appearance of mental impairment, CCT is an important aid in providing some further clues as to the etiology of the complaints.
Cerebrovascular Disorders↗
[Indicative constellation of symptoms in Canavan-van Bogaert-Bertrand disease].
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Child, Preschool↗
[Neurophysiologic findings in subcortical arteriosclerotic encephalopathy (Binswanger disease)].
The subcortical arteriosclerotic encephalopathy may be diagnosed intra vitam by CT. From the pathoanatomical point of view subcortical arteriosclerotic encephalopathy probably is related to cerebral small vessel disease, leading to lacunar state and white matter demyelination. Brainstem lacunes are rarely found by CT. But electrophysiological methods are easily employed to demonstrate brainstem dysfunction and demyelinating lesions. We now report our electrophysiological findings in 43 patients showing clinical and CT-morphological signs of subcortical arteriosclerotic encephalopathy. The latencies of visual evoked potentials (VEP) in 36% of these patients were found to be significantly different from those measured in healthy persons aged more than 65 years. About 75% of the subcortical arteriosclerotic encephalopathy patients had abnormalities of the electrically elicited blink reflex. In 26 patients blink reflex and VEP were examined. In only 6 of them the electrophysiological findings were normal.
Aged↗
[Three cases of left-sided parieto-occipital lesions with dysgraphia and dyscalculia (author's transl)].
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Adult↗
[Computed tomographic brain scanning in the diagnosis of metastatic neoplasms (author's transl)].
Clinical investigations and computed brain scanning were done in 305 patients with primary extracerebral malignant tumours. One third of the patients had cerebral metastases. In most patients with brain metastases extracerebral secondary tumours were known already. Silent brain metastases were present in only 0.6% of all investigated tumour patients. All other patients had either objective neurologic-psychiatric defects or a least symptoms (headache, vomiting). Use of cranial computed tomography in all tumour patients as a pure screening method is thus not justified. The indication for the investigation is dependent on the clinical symptomatology. However, not only objective neurologic-psychiatric defects must be taken into account, but also occurrence of new symptoms.
Brain Neoplasms↗
EEG controlled occlusion of the internal carotid artery during angiography.
It became evident in two patients during cerebral angiography that ligation of an internal carotid artery would probably be necessary in the course of a subsequent neurosurgical operation. A balloon catheter was inserted and the internal carotid artery was occluded. A continous EEG recording was made with a Fourier transformed frequency analysis before and during the occlusion; the motor functions of the corresponding side of the body were observed simultaneously on the conscious patient. EEG alterations indicative of cerebral ischemia were not demonstrated in either patient during an occlusion period of 7 min. Unilateral neurosurgical ligation of the common carotid artery and the internal carotid artery was performed on one patient. As predicted no neurological deficit occurred.
Adolescent↗
[Subcortical arteriosclerotic encephalopathy--clinical, CT-morphological and electrophysiological findings (author's transl)].
The article reports on 38 patients with subcortical arteriosclerotic encephalopathy (SAE). The clinical, electrophysiological, computer tomographical and pathoanatomical findings are described and explained by means of typical examples. Intermittent and fluctuating neurological signs--often appearing at intervals of several years--as well as a slowly progressing dementia, can be a clinical indication of SAE, especially in patients who have been known to suffer from hypertension for many years. Since, however, the clinical complex of signs is usually unspecific, clinical diagnosis must be confirmed by a morphological findings. This has now become possible by making use of computerised tomography. However, it should not be overlooked that the extent of the morphological changes observed need not agree in any way with the severity of the clinical complex of signs; case histories are given in detail as examples. Since pathologico-anatomically identified severe arteriosclerotic changes of the long medullary arteries are most probably the cause of the hypoxically conditioned diffuse vacuolous demyelinisation of the medullary layer, computerised tomography yields an important indirect pointer to the condition of the cerebral vascular periphery. This additional information seems to be important in arriving at an indication for invasive diagnostic or surgical procedures relating to the vascular system.
Aged↗
[Computed tomography in subdural effusions of infancy (author's transl)].
31 out of 128 infants with abnormal neurological signs show areas of decreased radiodensity of computed tomography (CT) over the cerebral hemispheres, primarily frontal. It is emphasized, that the diagnosis of subdural effusions is permitted in cases with decreased density over the frontal lobes and hardly visible cerebral sulci as well as wedge-shaped widening of the interhemispheric fissure. But in cases with decreased density over the frontal regions and prominent cerebral sulci a subdural effusion cannot be excluded. In association with signs of increased intracranial pressure these CT findings are yet indicative of subdural effusion. Are there to delimitate two spaces of different density between skull and cortex the diagnosis of subdural effusion is certain already by means of CT-morphological criteria. The therapeutic regimen is dependent upon the clinical symptoms.
Diagnosis, Differential↗
[Benign intracranial hypertension in childhood following mastoiditis (author's transl)].
Case report concerning a three years old boy with benign intracranial hypertension. The typical symptoms are results of increased intracranial pressure, associated with headache, vomiting, choked disk, occasionally dehiscence of cranial sutures and sixth nerve paresis. In computed tomography there were no tumor signs. In childhood a possible cause in thrombosis of the lateral sinus following an occult mastoiditis after antibiotic therapy. Mastoidectomy, intensive antibiotic therapy as well as serial lumbar punctures led to complete recovery in most cases.
Abducens Nerve↗
[Lacunar infarcts in computerized tomography. Angiographic findings and differential diagnostic viewpoints].
Eighty-four patients with ischaemic cerebral lesions are described, in whom no lesion of the cortex could be demonstrated by CT. Lacunar lesions of the basal ganglia up to 2 cm. usually fail to show any angiographic findings. The clinical prognosis in these cases is favourable. Lesions larger than 2 cm. are usually due to haemodynamically significant stenoses. Prognosis depends not only on the size of the lesion, but also on its localisation, particularly its relationship to the motor radiation. The indications for angiography and therapy depend in part on a proper evaluation of the differential diagnosis of the lesions.
Brain↗
[Computer tomography in herpes simplex encephalitis. Stages in the development of CT changes (author's transl)].
The CT findings in six patients with confirmed herpes simplex encephalitis were analysed and compared with the literature. Thirty-four examinations were performed, 27 within the first 14 days of the illness. The early findings show three characteristic features: The CT may be entirely normal up to the fourth day. Consistent with clinical and E.E.G. findings there then develops a hypodense temporal lesion which, even at this stage, acts as an expanding lesion in half the patients. Between the sixth and eighth day there is frequently involvement of the contra-lateral temporal lobe, not as a continuation, but as a new lesion. At the same time, or after several days, there is involvement of the basal portions of the frontal lobes. In this later phase there may be necrosis in the basal ganglia, thalamus or other parts of the brain. The CT findings in this late phase are uniform and characteristic of the disease. For early diagnosis and treatment the early clinical, electrophysiological and neuro-radiological findings are important. A normal CT scan two days after the onset of clinical symptoms may be regarded as significant.
Cerebral Angiography↗
Computed tomographic findings in congenital hemiparesis in childhood and their relation to etiology and prognosis.
40, 1-14-year-old children suffering from congenital hemiparesis were re-examined neurologically and admitted to CT. According to our morphological results we found three different types of CT patterns: 1. unilateral enlargement of the lateral ventricle or parts of it (20 patients), 2. cavity in the cortex and subcortical white matter within the supply area of the middle cerebral artery (17 patients), 3. normal CT scans (3 patients). Patients with a cortical and subcortical cavity consistently had a moderate to severe hemiparesis and suffered more often from epilepsy and intellectual impairment than patients with unilateral ventricular enlargement and those with normal CT findings. Most patients with cortical defects had a history of perinatal complications, while abnormal pregnancies and prematurity prevailed in patients with unilateral ventricular enlargement. We believe that a cavity in the cortex and subcortical white matter is of arterial-ischemic origin, whereas unilateral ventricular enlargement with destruction of the deep white matter is related to venous hemorrhage. But it must be emphasized that CT cannot detect the causes, mechanisms and timing of the underlying brain lesions in congenital hemiparesis.
Adolescent↗
A refined method to relate morphological and functional aspects of aphasia.
A method is described to relate brain morphology and neuropsychological disturbances such as aphasia. By mapping lesions with computerized tomography onto a grid model of five brain slices, it is possible to compare aphasiological information and lesion site by data processing, allowing the quantitative and qualitative manipulation of a large number of data. The soundness of the method is investigated in a pilot study on the localization of aphasic disturbances. Data processing was performed on a preliminary group of 70 patients with different aphasic syndromes (Broca, Wernicke, and global aphasics with and without recurring utterances). The results confirmed the findings of older studies, with the typical locus of Wernicke's aphasia being Wernicke's area. In conformity to more recent studies, the main lesion for Broca aphasics was found to be in the insular cortex, with a relatively important participation of the frontal white matter. The implications of this refined method for more vigorous aphasiological and neuropsychological research are briefly indicated.
Adult↗
Cerebellar ataxia. Clinical and CT findings in two cases of rare etiology.
Two low density lesions of the cerebellum which did not occupy space are reported. The neuropathological diagnosis of one case was subacute leucencephalitis. In the other case, the diagnosis of a Pelizaeus-Merzbacher's disease is discussed, taking into consideration the clinical observation, development and the CT findings.
Adolescent↗
[Early prognosis of cerebral haemorrhage in premature infants with birth weights less than 1500 g. A clinical and computed tomographic study (author's transl)].
22 premature infants with a birth weight less than 1500 g were studied by computed tomography. All of them needed intensive care therapy and had symptoms, which may have been caused by cerebral haemorrhage. In 15 cases (= 68%) we found subependymal and intraventricular bleeding. Clinical data showed that ventilated premature infants with subependymal and intraventricular haemorrhage needed respiratory support in the first hours p.p. because of hyaline membrane and aspiration syndroms. Premature infants without cerebral haemorrhage were ventilated much later (mean 96 h. p.p.). All patients with intraventricular haemorrhage and ventricular enlargement with and without parenchymal haemorrhage (grade III and IV) died. Prematures with subependymal haemorrhage (grad I) and intraventricular haemorrhage without ventricular dilation (grade II) may survive, depending on eventually present pulmonary complications. The introduction of computed tomography in the examination of the CNS on prematures can therefore help to give an early prognosis.
Birth Weight↗