What is the relevance of the endothelins in subarachnoid haemorrhage?
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Cisterna Magna↗
Biomedical subjects
K Schimrigk
Publications and source records attributed to K Schimrigk.
Penile sympathic skin response in erectile dysfunction.
Penile sympathic skin response (PSSR) was measured in 20 normal patients and in 46 patients with erectile dysfunction (ED). PSSR could be registered in 80% of normal patients. The latencies were 1,100-1,600 ms. In patients with ED, latencies were 1,240-3,640 ms. A reproducible normal latency of PSSR (< 1,600 ms) indicates a normal sympathic innervation of the penis. Long latencies (> 1,800 ms) indicate neuropathy of unmyelinated nerval fibers. The loss of a reproducible answer however allows no exact diagnostic information. PSSR is a useful diagnostic test for detecting neuropathy of unmyelinated nerval fibers as a possible cause of ED.
Adult↗
Assessment of cerebral vasomotor reactivity by transcranial Doppler ultrasound and breath-holding. A comparison with acetazolamide as vasodilatory stimulus.
BACKGROUND AND PURPOSE: Evaluating cerebrovascular vasomotor reactivity seems to be of prognostic relevance for patients with occlusive internal carotid artery disease. To evaluate its clinical usefulness, the recently introduced breath-holding maneuver as a carbon dioxide-dependent vasodilatory stimulus was compared with the acetazolamide challenge by means of transcranial Doppler ultrasound and stable xenon-enhanced computed tomography. METHODS: In a total of 134 middle cerebral arteries of 74 patients (mean +/- SD age, 62 +/- 9 years) with unilateral or bilateral occlusive carotid artery disease, vasomotor reactivity was estimated by the increase of middle cerebral artery mean blood velocity by transcranial Doppler ultrasound, comparing the breath-holding maneuver and 1 g IV acetazolamide as vasodilatory stimuli. The carotid artery findings were classified as normal, stenosis of 50% to < 70%, 70% to < 90%, 90% to 99%, and occlusion. Eighteen of the 74 patients additionally underwent stable xenon-enhanced computed tomography to calculate the increase of mean cortical regional cerebral blood flow in the middle cerebral artery territory after acetazolamide stimulation. RESULTS: The percentage of mean regional cerebral blood flow changes (n = 36 hemispheres) correlated best with the absolute mean blood velocity changes while breath-holding (P = .007, r = .4332). The absolute mean regional cerebral blood flow changes correlated best with the percentage of mean blood velocity changes after acetazolamide stimulation (P = .004, r = .4580). On all 134 middle cerebral arteries, both vasodilatory stimuli correlated highly significantly (P < .0001) when comparing increases in absolute (r = .5448) or relative (r = .3516) mean blood velocity. Both stimulation techniques similarly indicated significantly reduced vasomotor reactivity with increasing degree of internal carotid artery lesions (P < or = .01). However, the acetazolamide challenge differentiated more accurately between the various groups of internal carotid artery findings. CONCLUSIONS: The assessment of vasomotor reactivity by transcranial Doppler ultrasound correlates with cerebral blood flow changes even when different vasodilatory stimuli are used. In cooperative patients the breath-holding maneuver as vasodilatory stimulus seems clinically useful for a first estimation of cerebral vasomotor reactivity.
Acetazolamide↗
Clinical relevance and frequency of transient stenoses of the middle and anterior cerebral arteries in bacterial meningitis.
BACKGROUND AND PURPOSE: We sought to examine the frequency and clinical relevance of intracranial artery stenoses in patients with bacterial meningitis in whom the occurrence of stroke has angiographically been reported to be associated with stenoses or occlusions of the large basal cerebral arteries. METHODS: Thirty-five unselected patients (24 men, 11 women; mean age, 51 +/- 18 years) with bacterial (n = 33) or fungal (n = 2) meningitis prospectively underwent serial transcranial Doppler sonography recordings of mean blood velocity (MBV) and pulsatility index in the middle (MCA) and anterior (ACA) cerebral arteries, as well as recordings of the ratio of the MBV of the MCA and internal carotid artery (MCA/ICA ratio) on days 1, 3, 5, 8, 14, and 21 after admission. The results were correlated with the Glasgow Coma Scale (days 1 to 14), the occurrence of focal cerebral signs, and the Glasgow Outcome Scale (short-term outcome, day 21). An MCA stenosis was diagnosed by an MBV of 120 cm/s or more or an MCA/ICA ratio of more than 3. An ACA stenosis was diagnosed by an MBV of 100 cm/s or more. RESULTS: Transient stenoses occurred most frequently between days 3 and 5 and were detected in 18 patients (51%). Seventeen patients remained without a stenosis. Patients with stenoses showed a significantly poorer mean Glasgow Coma Scale score from day 3 (9 +/- 4) to day 14 (11 +/- 4) than patients without a stenosis (day 3: 13 +/- 4, P < .01 by t test; day 14: 14 +/- 1, P < .05). The mean Glasgow Outcome Scale score was not significantly different between both groups. The occurrence of mainly transient focal cerebral signs was significantly related to the number of narrowed vessels per patient (P < .05, chi 2 test). CONCLUSIONS: Stenoses of the intracranial arteries occur frequently in bacterial meningitis and are associated with a complicated course of the disease.
Adult↗
[Transcranial Doppler ultrasound monitoring of patients with viral infections of the central nervous system].
Serial (days 1, 3, 5, 8, 14, 21 after admission) transcranial Doppler ultrasound measurements of the mean blood velocity (Vmean) and the pulsatility index (PI) in the middle, anterior and posterior cerebral arteries (MCA, ACA, PCA) and the basilar artery were performed in 35 consecutive patients (male, 20, female, 15, mean age: 37 +/- 19 years) with acute meningitis or meningoencephalitis thought to have arisen from viral infections. The Glasgow Coma Scale (GCS) and the TCD findings on days 1-8 were compared with the Glasgow Outcome Scale on day 21 (GOS, short-term outcome). Compared with the reference values recorded in 69 healthy volunteers, Vmean was significantly elevated in the MCA, ACA and PCA on days 1-3, and on day 5 in the MCA (P< 0.01-0.05). The PI was significantly increased on days 1-8 in all intracranial arteries (P < 0.001-0.05). With respect to the outcome, patients with a poor outcome (GOS score 1-3) were found to have had significantly more markedly elevated PI in all vessels on days 3-8 (P < 0.05) than the patients with a good outcome (GOS score 4 and 5). The linear regression coefficient for the relationship between the PI on days 3-8 and the GOS ranged from r = 0.35 to 0.48 (P < 0.01) in all vessels. However, the coefficient (r) between the GCS score on days 3-8 and GOS was more marked (day 3: r = 0.7545, P< 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Sympathetic skin response in Parkinson syndrome].
Several tests of cardiovascular and gastrointestinal function have been approved for the diagnosis of autonomic regulation dysfunction in Parkinson's disease. In the present study we compared the diagnostic value of the sympathetic skin response (SSR) with the established methods. Ninety percent of the 20 patients we examined (10 women, 10 men, 46 to 80 years) showed pathological results in the cardiovascular function test. Fifty-five percent had a prolonged colon transit, indicating a gastrointestinal dysfunction. We saw pathologically prolonged latencies of the SSR in 35% of the patients, 55% had borderline results. Three of the 20 patients had pathological results in all of the functions examined. Half of the patients had two pathological results, whereas 7 patients were pathological in only one of the three examinations. We were unable to establish any correlation between the SSR and other results, and we also found no relationship between prolonged SSR and the duration of the disease.
Aged↗
[Intracerebral hemorrhage and multiple brain abscesses caused by Bacillus cereus within the scope of acute lymphatic leukemia].
Multiple hematogenic brain abscesses in immunosuppression are occasionally caused by rare and primary apathogenic causative agents. We report a first case of an isolated CNS infection by Bacillus cereus, which led to death from multiple brain abscesses and an intracerebral hemorrhage, probably caused by the infection, within 4 days. The underlying disease leading to immunosuppression was acute lymphatic leukemia in complete remission. In spite of antibiotic therapy the chemotherapy-induced neutropenia enabled unhindered spreading of the necrotizing infection, which was verified by histological analysis. The production of potent toxins such as hemolysin and cerelolysin by B. cereus leads to rapid and fulminant tissue destruction usually involving the walls of blood vessels.
Adult↗
Transcranial Doppler ultrasound in the evaluation of collateral blood flow in patients with internal carotid artery occlusion: correlation with cerebral angiography.
PURPOSE: To determine the accuracy of transcranial Doppler (TCD) ultrasound for evaluation of collateral supply through the circle of Willis in patients with internal carotid artery (ICA) occlusion. METHODS: The evaluation of the collateral pathways through the circle of Willis with TCD ultrasound and with cerebral angiography was compared in 40 patients (30 men, 10 women; mean age, 55 +/- 9 years) in a total of 44 ICA occlusions of which 43 had a suitable ipsilateral temporal bone window for TCD examination. RESULTS: By TCD, a patent anterior communicating artery is indicated by a reversal blood flow in the A1-segment of the anterior cerebral artery or by a prompt fall of blood velocity in the middle cerebral artery after compression of the nonoccluded contralateral carotid artery. In 42 of 43 instances of ICA occlusion, TCD and angiography agreed in the evaluation of a present or absent anterior communicating artery collateral supply. TCD's sensitivity was 95%, its specificity 100%. A collateral supply through the basilar artery was assumed with TCD when there was: (a) a basilar artery blood velocity of more than 70 cm/s; (b) a marked increase of basilar artery blood velocity after compression of the nonoccluded carotid artery; (c) an evident side-to-side asymmetry of the blood velocity of the posterior cerebral arteries with high blood velocity ipsilateral to the ICA occlusion. For evaluating the collateralization via the basilar artery, TCD and angiography agreed in 37 of 40 ICA occlusions. TCD's sensitivity was 87%, its specificity 95%. CONCLUSIONS: TCD is a reliable tool for the evaluation of the collateral supply in patients with ICA occlusions.
Adult↗
Eye movement in amyotrophic lateral sclerosis: a longitudinal study.
Eye muscles and the sphincter muscles of the bowel and bladder were formerly thought to be spared in amyotrophic lateral sclerosis (ALS), a neurodegenerative disorder. As frequent subclinical impairment of the anal sphincter muscles in ALS has recently been reported, We suspected an earlier and more frequent, if subclinical, involvement of the oculomotor system than hitherto described. Starting in 1993, we repeatedly studied oculomotor involvement in eight patients with (ALS) using routine orthoptic examination techniques as well as electro-oculographic recordings of ocular movements. Three patients had consistently normal clinical examinations but progressive changes in electro-oculography (EOG). Three patients showed intermittent impairment of eye movements with normal EOG (one patient) or with progressive changes on EOG examination. In two patients, both clinical examination and EOG were progressively pathologic. These findings provide further evidence of early oculomotor involvement, e.g., prior to respiratory failure, in ALS than previously suspected. Since EOG changes seemed to be detectable in all but one patient, EOG changes may allow earlier, subclinical detection of impaired eye movement and thus reveal even an increased frequency of oculomotor impairment in ALS. Due to the heterogeneity of ALS the number of patients examined to settle finally the question of oculomotor involvement in ALS needs to be increased. Newly developed software will allow further interpretation and comparison of more data and, thus, should offer further help in detecting early changes.
Adult↗
HES 200/0.5 is not HES 200/0.5. Influence of the C2/C6 hydroxyethylation ratio of hydroxyethyl starch (HES) on hemorheology, coagulation and elimination kinetics.
The plasma clearance of hydroxyethyl starch (HES) depends on the initial molecular weight and the degree of substitution. So far, little attention has been paid to the clinical relevance of the C2/C6 substitution ratio of hydroxyethyl starch. 10 patients with cerebrovascular circulatory disturbance received hemodilution therapy for 10 days, consisting of 10% HES 200/0.5 (mean molecular weight 200 kD, degree of substitution 0.5) with a C2/C6 ratio of 13.4. A second group of 10 patients received a starch solution with identical initial molecular weight and degree of substitution but with a C2/C6 ratio of 5.7. After the administration of a single dose, no significant differences between the two groups were observed. After repeated administration, significant differences could be detected in hemorheology, coagulation and elimination (p < 0.01). The larger C2/C6 ratio led to a higher intravascular mean molecular weight (95 vs. 84 kD), which in turn led to a higher increase in serum concentration during the therapy (14.7 vs. 8.6 mg/ml). Hematocrit was lowered more (-30.5 vs. -23.5%) and plasma viscosity was increased more. There was also a more pronounced increase in partial thromboplastin time (+30% vs. +13%) and a factor of 2 larger decrease of factor VIII/von Willebrand factor-complex (p < 0.01), which exceeded the dilution effect. The higher C2/C6 ratio of HES 200/0.5/13.4 slows down enzymatic degradation. After repeated administration of this starch, large molecules accumulate which are inefficiently degraded. The same effect has been observed after therapy with highly-substituted HES. This accumulation of large molecules leads to a beneficial longer lasting volume effect. The disadvantages include an increase in plasma viscosity and coagulation disturbances, which cannot be explained with the respective dilution effect alone. For these reasons, the C2/C6 ratio is of clinical relevance and should be included in the product labeling in the future.
Alkylation↗
Surface versus needle electrodes in determination of motor conduction time to the external anal sphincter.
Patients were referred to our neurophysiological department in order to investigate anorectal function. By the means of magnetic stimulation the total motor conduction can be determined. Only patients with normal latency of the pudendal nerve and normal EMG of the external anal sphincter were examined. Stimulation was carried out above the motor cortex with a MO between 80 and 100%. The recording was carried out in 22 patients with concentric needle electrodes and in the other 18 patients with surface electrodes. The mean latency in the group with surface electrodes was 19.4 ms (SD 1.7), and in the group with needle electrodes 23.4 ms (SD 4). Our results suggest, that in magnetic stimulation above the motor cortex and recording with a concentric needle electrode, the range and the mean was higher than with surface electrodes. In our opinion surface electrodes are preferable to needle electrodes in determining motor conduction time to the external anal sphincter.
Adult↗
Are heart rate responses reproducible in the tilt-table test?
Measurement of blood pressure and heart rate in active orthostasis has proven to be effective in the diagnosis of autonomic regulatory dysfunctions. The following study was carried out in order to clarify to what extent reproducible heart rate reactions also occur in passive orthostasis. 61 people with normal results in five standardized tests were examined. All 61 test persons had individually differing courses of heart rate. After an initial increase of frequency an almost straight line results from a superimposed projection of the graphs. In 20 of these cases the tilt-table test was repeated in order to detect intra-individual regularities. Even when the test was repeated, no reproducible intraindividual heart rate reactions occurred. And here as well, projection of the graphs produced an almost straight line. We could not find any quotient, such as the 30/15 ratio in active orthostasis, during our tests with the tilt-table.
Adult↗
Magnetic stimulation of the pudendal nerve.
UNLABELLED: Electroneurography of the pudendal nerve is extremely important in the diagnosis of neurogenic fecal incontinence and a pudendal canal syndrome. PURPOSE: The aim of this study was to determine pudendal nerve motor latency of the overall distance by stimulation of nerve root S3 by discharging a magnetic coil. METHODS: This can be achieved by positioning an earth electrode between the site of stimulation and the registration electrode. We investigated 18 volunteers by this method. RESULTS: The average latency period was 2.51 milliseconds (SD = 0.32) on the right and 2.49 milliseconds (SD = 0.33) on the left side. CONCLUSION: This method enables precise diagnosis in neuropathies of the pudendal nerve more so than with conventional electric stimulation.
Adult↗
Therapy of anal fissure using botulin toxin.
PURPOSE: With chronic anal fissure, sphincterotomy to relieve sphincter spasm is the recommended therapy. This breaks the vicious circle of inflammation-pain-spasm. This obvious success is weighed against the possible risk of the operation and the risk of subsequent fecal incontinence. The following report describes a therapy for anal fissure involving injection of the external anal sphincter with botulin toxin. METHODS: We have used this new method in 12 cases (7 females and 5 males; mean age, 37 years). We injected 0.1 ml of diluted toxin on both sides lateral to the fissure. RESULTS: The fissure healed thanks to a time-limited paresis of the sphincter in ten cases. In one case there was a recurrence within the first six months. Two patients could not be healed and had to undergo surgery. CONCLUSION: Injection of botulin toxin gives us a possible new mode of therapy in the treatment of chronic, uncomplicated anal fissures with increased sphincter tone. It is well tolerated, can be performed as an outpatient, does not cause any lesion of the continence organ, and subsequently does not lead to any permanent latent or apparent fecal incontinence.
Adult↗
Therapy of anal fissure using botulin toxin.
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Botulinum Toxins↗
A new method to determine pudendal nerve motor latency and central motor conduction time to the external anal sphincter.
By placing the earth electrode between the site of the stimulus and the site of derivation, peripheral motor latency to the external anal sphincter can be determined and thus central motor conduction time (CMCT) can be calculated. In 18 volunteers we found a total motor conduction time of 19.4 msec (S.D. 1.71) after stimulation of the motor cortex and recording above the external anal sphincter. Latency was 5.6 msec (S.D. 0.66) when stimulated above L1 and pudendal latency (MEPuL) after stimulation above S3 was 2.5 msec (S.D. 0.32). CMCT to L1 (TMCT minus MCT to L1) was 13.8 msec (S.D. 1.13) and to S3 (TMCT minus MEPuL) it was 16.9 msec (S.D. 1.67). This method allows us to locate spinal dysfunction more precisely and also improves diagnosis of a possible neuropathy of the pudendal nerve.
Adult↗
A comparative assessment of cerebral haemodynamics in the basilar artery and carotid territory by transcranial Doppler sonography in normal subjects.
In 69 healthy volunteers (34 males, 35 females, age range 17-80 years) we compared the following haemodynamic parameters between the basilar artery and carotid artery system, assessed by transcranial Doppler sonography: mean blood velocity, pulsatility index and the hemispheric indices as ratios of the middle, anterior and posterior cerebral arteries with the internal carotid artery (MCA/ICA, ACA/ICA, PCA/ICA) and of the PCA with the basilar artery (PCA/BA), as well as the ACA/MCA and the MCA/BA ratio. In all arteries (ICA, MCA, ACA, PCA and BA) mean blood velocity decreased significantly with advancing age (p < 0.01) and was significantly higher in females as compared to males (p < 0.05). The pulsatility index increased significantly with age in the ICA, MCA, ACA and BA (p < 0.01) and showed no sex differences in any of the intracranial arteries except for the ACA. The MCA/ICA and ACA/ICA index declined significantly with advancing age (p < 0.005, p < 0.05, respectively) and with increasing heart rate (p < 0.01 for both arteries), while the ACA/MCA, the PCA/BA and the MCA/BA ratio remained unchanged by age and heart rate. We conclude that there is no striking difference in the cerebral haemodynamics of the basilar artery and the carotid artery supplied territories.
Adolescent↗
[Neuropsychological analysis of transitory partial performance disorders. A video and MRI supported study].
Apraxia is an impairment of voluntary movements not caused by paresis, sensory deficits or aphasia. It appears mainly after left-hemispheric parietal or callosal lesions. Our patient had a temporary apraxia that could be correlated with the development of the perifocal area around a left parietooccipital cerebral bleeding. These neuropsychological disorders belonged to the development and the disappearance of the perifocal area as seen via several MRI.
Adult↗