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J van der Naalt

Publications and source records attributed to J van der Naalt.

17 recordsLinked to original sources
PubMed2003

[Abdominal complaints and neurological symptoms as an early sign of lung cancer: a manifestation of the anti-Hu syndrome].

In two patients, women aged 73 and 46 years, gastrointestinal symptoms were initially not recognised as a paraneoplastic syndrome due to small-cell lung cancer. This led to redundant diagnostics as well as a delay in final diagnosis. The anti-Hu syndrome is characterised by the presence of anti-Hu antibodies and neurological symptoms. About a quarter of the patients with the anti-Hu syndrome will develop gastrointestinal motility disorders in the course of their illness. The primary tumour is usually a small-cell lung cancer. Whereas the presence of anti-Hu antibodies appears to be beneficial for the oncological prognosis, the neurological outcome is less favourable.

Aged↗
PubMed2003

P300 component identification using source analysis techniques: reduced latency variability.

P300 latency variability in normal subjects is a complicating factor in clinical event-related potential studies because it limits diagnostic applicability. The current study was conducted to determine whether identification of P300 (P3A and P3B) components using source analysis techniques can reduce variability in P300 parameters. Data were recorded with a 128-channel EEG system in 18 healthy subjects. The authors used a standard, auditory two-tone oddball paradigm with targets of 2000 Hz and standards of 1000 Hz. Two simple source analysis models with one or two rotating dipoles were applied to grand average data and individual data. Dipole time courses were combined with mapping results to extract P3A and P3B component latencies. Latencies obtained with conventional P300 analysis were compared with source analysis results. The source analysis method identified both P3A and P3B components in a substantially larger percentage of subjects (88% vs. 33%) than the conventional method. The source analysis method yielded a later mean P3B latency (357 msec vs. 323 msec, P < 0,001) with a smaller standard deviation (9 msec vs. 23 msec, P = 0,003) than the conventional P300 method. The relative contribution of the temporally separate P3A and P3B components to the P300 complex amplitude is highly variable. This explains the larger latency standard deviation in conventional P300 analysis. The source analysis method was able to identify P300 components in a large percentage of the cases. The result is a considerable reduction of P300 latency variability in normal subjects. This could have important consequences for clinical event-related potential research, because diagnostic sensitivity and specificity of P300 latency may improve with this method.

Adult↗
PubMed2001

Prediction of outcome in mild to moderate head injury: a review.

This paper reviews the functional outcome of patients sustaining mild and moderate head injury (HI). Discrepancies across studies in the definition of minor, mild, and moderate HI are discussed in terms of hindering the interpretation of recovery. The predictive value of acute severity indices, neuroimaging findings, and the results of other techniques are summarized. Measurement of outcome based solely on the Glasgow Outcome Scale (GOS) is critiqued, and it is recommended that a differentiated outcome scale involving emotional, behavioral, cognitive, and physical domains should be used.

Amnesia↗
PubMed2000

Comparison of serum S-100 protein levels following stroke and traumatic brain injury.

Temporal changes in serum S-100 protein levels were compared between patients with ischemic stroke, transient ischemic attack (TIA) and traumatic brain injury (TBI). In addition, S-100 levels were correlated with clinical severity and outcome. Measurements were done with a LIA-mat((R)) Sangtec((R)) 100 using an automated immunoluminometric assay. Serum S-100 was measured in 21 stroke patients, 18 TIA patients and ten TBI patients on days 1 (0-24 h), 2, 3, 4, 5 or 6 and 8 or 9. In a control group of 28 healthy volunteers one measurement was done. For the stroke and TIA patients, National Institutes of Health Stroke Scale (NIHSS) scores were obtained on admission and on day 10. For the TBI patients, Glasgow Coma Scale (GCS) scores were obtained on admission and Glasgow Outcome Scale (GOS) scores were obtained after 6 months. Changes in serum S-100 levels over the first 3 days were significantly different between stroke and TBI patients (P=0.014) and between stroke and TIA patients (P=0.006). Peak concentrations of S-100 were most often observed on day 3 or 4 after stroke and on day 1 or 2 after TBI. In the stroke patients individual S-100 peak levels correlated well with the NIHSS score on admission (r=0.58 P=0.014) and the change in NIHSS score between day 10 and day 1 (r=0.65, P=0. 005). In the TBI patients a good correlation between individual peak levels of S-100 and the GCS score on admission (r=-0.81, P=0.010) and the GOS score 6 months after the trauma was found (r=-0.87, P=0. 004). We conclude that there is a significant difference in temporal changes of S-100 levels between ischemic stroke and TBI patients. This suggests different pathophysiological mechanisms. The results of this study further confirm that peak levels of serum S-100 correlate with neurological deficit resulting from either stroke or TBI.

Adult↗
PubMed2000

Acute behavioural disturbances related to imaging studies and outcome in mild-to-moderate head injury.

The frequency of behavioural disturbances early after injury in relation to outcome was prospectively investigated in a series of 67 patients with mild-to-moderate head injury (as defined by GCS on admission). In more than half of the patients, behavioural disturbances were observed. Restlessness occurred in 40% of patients, whereas agitation was seen in 19% of patients. In all patients, restlessness and agitation disappeared before resolution of PTA. In multiple regression analysis, restlessness and PTA were found to be separate factors in predicting outcome. On imaging studies, twice as many lesions were seen in patients with restlessness and agitation (81% compared to 39%), mainly localized in the frontotemporal region. In two thirds of patients with early behavioural disturbances, residual emotional and cognitive impairments were seen 1 year after injury. This study suggests that behavioural disturbances in the early phase after injury are related to frontotemporal lesions and lends support for the view of the existence of a separate profile of patient behaviour in mild-to-moderate head injury.

Acute Disease↗
PubMed1999

Computed tomography and magnetic resonance imaging in mild to moderate head injury: early and late imaging related to outcome.

Serial magnetic resonance imaging (MRI) and computed tomographic (CT) studies were performed in mild to moderate head injury to evaluate whether early and late imaging have additional value in predicting outcome in this category of patients. During 1-year follow-up of a series of 67 patients, a CT scan on admission was performed together with MRI studies within 1 to 3 months and 6 to 12 months after injury. With CT, intracranial lesions were seen in 62% of patients compared with 44% with early and 19% with late MRI, located predominantly in the frontal and temporal regions. More than half of the lesions revealed with CT resulted in focal atrophy on MRI. Outcome was found to be worse in patients with edema and lesions on CT. Likewise, abnormalities detected with MRI were associated with poor outcome scores. In multiple regression analysis, only lesions in the frontal regions detected with early MRI were found to be predictive of outcome. With late MRI, only focal atrophy in the frontotemporal regions was found to be predictive of outcome. The findings in this study suggests that MRI studies may be valuable for predicting long-term outcome in patients with mild to moderate HI.

Adolescent↗
PubMed1999

Management of acute ischaemic stroke.

Over the past few years there have been enormous changes in the management of stroke patients. General practitioners, ambulance personnel/paramedics and the general public need to be well informed that stroke is a medical emergency. Prevention of secondary brain damage by normalising vital parameters and combating fever should already start at the scene or in the ambulance. Early recognition of stroke symptoms, immediate transfer to a suitable treatment facility, and rapid in hospital triage protocols should bring thrombolysis to a larger number of stroke victims. Admission to a unit that is dedicated to the care of stroke patients helps to reduce mortality and morbidity.

Brain Ischemia↗
PubMed1999

One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work.

OBJECTIVES: To determine the prognostic value of characteristics of acute injury and duration of post-traumatic amnesia (PTA) for long term outcome in patients with mild to moderate head injury in terms of complaints and return to work. METHODS: Patients with a Glasgow coma score (GCS) on admission of 9-14 were included. Post-traumatic amnesia was assessed prospectively. Follow up was performed at 1, 3, 6, and 12 months after injury. Outcome was determined by the Glasgow outcome scale (GOS) 1 year after injury and compared with a more detailed outcome scale (DOS) comprising cognitive and neurobehavioural aspects. RESULTS: Sixty seven patients were included, mean age 33.2 (SD 14.7) years and mean PTA 7.8 (SD 7.3) days. One year after injury, 73% of patients had resumed previous work although most (84%) still reported complaints. The most frequent complaints were headache (32%), irritability (34%), forgetfulness and poor concentration (42%), and fatigue (45%). According to the GOS good recovery (82%) or moderate disability (18%) was seen. Application of the DOS showed more cognitive (40%) and behavioural problems (48%), interfering with return to work. Correlation between the GOS and DOS was high (r=0.87, p<0.01). Outcome correlated with duration of PTA (r=-0.46) but not significantly with GCS on admission (r=0.19). In multiple regression analysis, PTA and the number of complaints 3 months after injury explained 49% of variance on outcome as assessed with the GOS, and 60% with the DOS. CONCLUSIONS: In mild to moderate head injury outcome is determined by duration of PTA and not by GCS on admission. Most patients return to work despite having complaints. The application of a more detailed outcome scale will increase accuracy in predicting outcome in this category of patients with head injury.

Adolescent↗
PubMed1997

[Concussion and contusion of the brain].

A summary of the presentation, diagnosis and therapy of head injury is given. The article is focussed on mild head injury, the most frequent type of head injury. The difference between concussion and contusion is explained. Symptoms and abnormalities found at neurological examination are discussed. The Glasgow Coma Scale is described as a tool to diagnose the severity of head injury. The value of additional radiological investigation is discussed. The therapy which depends on the severity of head injury and concomitant complications, is given. Information about eventual persisting complaints and deficits is important. After-care depends on the severity of the injury and the persistence of neurological signs and symptoms. Outcome measurement is done by the Glasgow Outcome Scale. It is emphasized that patients may exhibit persistent complaints although they return to work or school.

Brain Concussion↗
PubMed1996

Cobalt-55 positron emission tomography in traumatic brain injury: a pilot study.

Traumatic brain injury is usually assessed with the Glasgow coma scale (GCS), CT, or MRI. After such injury, the injured brain tissue is characterised by calcium mediated neuronal damage and inflammation. Positron emission tomography with the isotope cobalt-55 (Co-PET) as a calcium tracer enables imaging of affected tissue in traumatic brain injury. The aim was to determine whether additional information can be gained by Co-PET in the diagnosis of moderate traumatic brain injury and to assess any prognostic value of Co-PET. Five patients with recent moderately severe traumatic brain injury were studied. CT was performed on the day of admission, EEG within one week, and MRI and Co-PET within four weeks of injury. Clinical assessment included neurological examination, GCS, neuropsychological testing, and Glasgow outcome scale (GOS) after one year. Co-PET showed focal uptake that extended beyond the morphological abnormalities shown by MRI and CT, in brain regions that were actually diagnosed with EEG. Thus Co-PET is potentially useful for diagnostic localisation of both structural and functional abnormalities in moderate traumatic brain injury.

Brain Injuries↗
PubMed1996

Influence of the intra-aortic balloon pump on the transcranial Doppler flow pattern in a brain-dead patient.

BACKGROUND: Confirmation of clinical brain death with transcranial Doppler (TCD) has been described. With the introduction of mechanical assist devices, it is important to know how these devices influence TCD measurements. CASE DESCRIPTION: A patient who fulfilled the clinical criteria for brain death after cardiac arrest is described. An intra-aortic balloon pump (IABP) was necessary to maintain hemodynamic stability. A TCD examination was performed as an adjunct to the clinical diagnosis of brain death. A pattern of reversal of blood velocity typical of brain death was observed. With the IABP functioning, an increase of mean forward flow velocity without appreciable increase in the net flow velocities was seen. The results of the TCD measurements with the IABP functioning are not in concordance with values reported in the literature that confirm the clinical diagnosis of brain death. CONCLUSIONS: Application of TCD in a patient with an IABP could lead to false interpretation of results if the TCD mean velocities are not registered with the IABP on standby or if the net flow velocities are not calculated.

Blood Flow Velocity↗
PubMed1996

The fronto-temporal component in mild and moderately severe head injury.

The history of the identification of the so-called (fronto-)temporal lobe contusion is reviewed. Treatment of minor head injuries actually starts with the right diagnosis. Injuries of the temporal lobe, characterized by a comparatively long period of post-traumatic amnesia should be distinguished from minor head injuries (cerebral concussion). Treatment of minor head injuries should include good information and explanation of the medical aspects of minor head injuries to prevent the so called post-concussional syndrome, with long lasting sequelae. Changes of neurotransmitter metabolism in various kinds of head injuries have been known for many years. Treatment with precursors of neurotransmitters (particularly physostigmine and L-DOPA) can be useful in unconsciousness and amnestic syndromes.

Brain Concussion↗
PubMed1991

Vibration perception threshold, complaints and sensory examination in diabetic patients.

The vibration perception threshold (VPT) was investigated by means of a biothesiometer among 40 patients with insulin dependent diabetes mellitus. The age as well as the duration of the disease affected the VPT. However, a correlation between the VPT and the rate of metabolic control measured through the glycolysed Hb (HbAlc) could not be demonstrated. In early stages abnormalities were already detectable in the feet. The VPT was elevated in 13 of 20 patients with sensory complaints and in 4 of 20 patients without complaints. Routine neurological examinations such as light touch and pinprick sensation were less sensitive to diagnose neuropathy. In detecting early signs of diabetic neuropathy in an outpatient population the determination of the VPT is a sensitive tool.

Adolescent↗
PubMedDate not supplied

Divided attention years after severe closed head injury: the effect of dependencies between the subtasks.

Lesions of white matter which connects distant brain areas are characteristic for closed head injury (CHI). It was predicted that this impairs divided attention only if dependent subtasks are used which require communication between corresponding brain processes. Fourteen chronic severe CHI patients (mean age 42 years) and 14 healthy controls, matched on age, gender, and education, participated in an experiment on divided attention. A typical left hemisphere task and a typical right hemisphere task must be simultaneously performed in a condition where they are completely independent and in conditions with dependencies between the tasks. Only in the dependent conditions the CHI group showed poor divided attention performance.

Adult↗