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M Brainin

Publications and source records attributed to M Brainin.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Etiologic classification of cerebral infarct. Experience from a prospective data register].

Most classifications of stroke include clinically heterogeneous subgroups and therefore are of limited value for comparative studies or clinical protocols. The view is held that a classification according to stroke etiology is clinically more reasonable and more consistent for therapeutic strategies. In order to determine the frequency of various etiological subgroups in a series of stroke cases, the results of the Klosterneuburger Schlaganfall-Datenbank (KSDB) are reported. This stroke registry has prospectively recorded over 300 items on all stroke cases referred to one center since March 1988. Investigation rates include CT in almost 100% and the investigation of cerebral vessels in over 90% of all cases. By applying defined etiological categories (undetermined etiology, atherosclerosis of the large craniocervical vessels, cardiogenic embolism, lacunar, primary hemorrhage, and multiple and other causes) to the first 420 patients registered within the first two years it can be shown that even with CT and neurosonology in routine use, in 29% of all cases the cause of the stroke cannot be determined. To investigate this largest subgroup by means of additional new methods as well as by investigating the long-term natural course represents an important challenge for clinical stroke research.

Adult↗
PubMed1989

[Neurotoxicity in long-term lithium therapy: an electroneurographic study].

In a series of 16 patients on long-term lithium therapy pathological changes were found in peripheral nerve conduction. Such changes correlated with the duration of lithium therapy (mean: 8.3 years, range: 3-15 years; p less than 0.05). No patient showed clinical signs of polyneuropathy or any other disease known to be frequently associated with peripheral nerve lesions. Compared with an age-matched normal control group (n = 27) the nerve conduction velocity of the sural nerve was reduced (p less than 0.05), for which a chronic neurotoxic effect is considered to be the most probable mechanism.

Adult↗
PubMed1989

Changes within the "normal" cerebral white matter of multiple sclerosis patients during acute attacks and during high-dose cortisone therapy assessed by means of quantitative MRI.

Changes in the apparently unaffected cerebral white matter of multiple sclerosis (MS) patients were studied during acute attacks as well as during high-dose prednisolone therapy. Serial MR scans of patients with a clinically definite diagnosis were performed on four defined occasions: before an episode, within three days after its onset, after 10 days of therapy as well as four weeks later. Thirteen patients agreed to cooperate in forming a MRI data base and to be rescanned immediately after the onset of an acute relapse. Within one year, six patients had such episodes, one of them had a second bout. Both T1 and T2 relaxation times within the apparently normal white matter were significantly prolonged in all cerebral lobes compared to a control group of healthy volunteers. During the acute attacks as well as during therapy the T1 values remained as before. The T2 values were elevated only in two out of six cases during the episode. After therapy a considerable clinical improvement was seen in all cases, but a significant T2 decrease as a possible effect of cortisone was noted in only one case. We conclude that the prolonged relaxation times T1 and T2 within the apparently normal cerebral white matter of MS patients are the result of a number of molecular events differing considerably among individual patients and that serial measurements of these relaxation times do not consistently change during an acute relapse and do not reflect clinical improvement after high dose prednisolone therapy.

Acute Disease↗
PubMed1989

[Involvement of apparently normal white brain substance in the disease process of multiple sclerosis].

In a group of patients with a clinically definite diagnosis of multiple sclerosis (MS) the cerebral white matter was investigated by means of quantitative nuclear magnetic resonance imaging (MRI). Measurements were taken from plaque-free regions and compared to a control group of healthy volunteers. A significant prolongation of T1 and T2 values was seen for all regions investigated (frontobasal, temporal, temporoparietal, and upper parietal white matter). In a comparison of MS patients with a short duration of the disease (mean: 1.7 years) with MS patients with a long-standing course of the disease (mean: 15.2 years) a significant prolongation of T2 relaxation times was found in the upper frontal and upper parietal white matter only for the latter group. In keeping with neuropathological findings the noted prolongation of T2 values might most probably be due to an increase of extracellular water secondary to astroglial proliferation. The increase of relaxation times could either be due to degeneration of commissural fibers or be the result of an exhausted capacity for remyelination. Both events are known to occur predominantly in the later stage of the disease. It is concluded that MS represents a disease which is not restricted to limited areas of demyelination but rather involves the entire cerebral white matter. These findings imply possibilities for the assessment of disease progression as well as for therapy.

Adult↗
PubMed1988

Structural brain correlates of anterograde memory deficits in multiple sclerosis.

Progressive decline of anterograde memory functions has been increasingly recognized as a frequent symptom in chronic multiple sclerosis. In order to investigate the brain structures involved, magnetic resonance imaging was performed in 20 patients. Neuropsychological assessment included the WAIS and WMS subtests information, picture completion, similarities, digit span, logical memory, and paired associate learning. All patients with severely impaired memory functions (n = 5) showed bilateral lesions in the medial temporal lobe, whereas in those patients with moderate (n = 10) or no measurable impairment of memory testing (n = 5) either no lesions were seen in the medial temporal lobes or these lesions were restricted to one side. A post hoc cluster analysis strikingly confirmed these results. The differences could not be related to the age of the patients, the disease duration, or the level of education. Extensive lesions in the white matter of the frontal lobes, thinning and lining of the corpus callosum, and bilateral involvement of the anterior cingulate gyrus had no bearing on the neuropsychological results. These findings indicate that bilateral demyelination in the hippocampal regions is the most likely explanation for the impairment of anterograde memory in such patients.

Adult↗
PubMed1987

Topological characteristics of brainstem lesions in clinically definite and clinically probable cases of multiple sclerosis: an MRI-study.

Disseminated lesions in the white matter of the cerebral hemispheres and confluent lesions at the borders of the lateral ventricles as seen on MRI are both considered acceptable paraclinical evidence for the diagnosis of multiple sclerosis. Similar changes are, however, also found in vascular diseases of the brain. We therefore aimed at identifying those additional traits in the infratentorial region, which in our experience are not frequently found in cerebrovascular pathology. We evaluated MR brain scans of 68 patients and found pontine lesions in 71% of cases with a clinically definite diagnosis (17 out of 24) and in 33% of cases with a probable diagnosis (14 out of 43). Lesions in the medulla oblongata were present in 50% and 16%, respectively, and in the midbrain in 25% and 7%, respectively. With rare exceptions all brainstem lesions were contiguous with the cisternal or ventricular cerebrospinal fluid spaces. In keeping with post-mortem reports the morphological spectrum ranged from large confluent patches to solitary, well delineated paramedian lesions or discrete linings of the cerebrospinal fluid border zones and were most clearly depicted form horizontal and sagittal T2 weighted SE-sequences. If there is a predilection for the outer or inner surfaces of the brainstem, such lesions can be considered an additional typical feature of multiple sclerosis and can be more reliably weighted as paraclinical evidence for a definite diagnosis.

Brain Stem↗
PubMed1987

[Primary chronic neurobrucellosis].

Brucellosis involving the nervous system usually shows meningomyelitis and/or radiculoneuritis and can by their clinical appearance not be differentiated from other chronic proliferative diseases of the nervous system. Sporadic cases can only be suspected on clinical grounds if a previous exposition is known. The cerebrospinal fluid showing a proliferative or granulomatous cytological picture is strongly suggestive of the diagnosis, which is confirmed by two rising titer values in the complement binding reaction for Brucella-specific antigen. The agglutination method of Widal is not reliable due to blocking incomplete antibodies. A 46 year-old man developed a transverse myelitis within several months accompanied by fluctuating meningeal signs, segmental irritation and transient cranial nerve palsies. No involvement of other organs and no general symptoms of infectious diseases were seen throughout the clinical course. Most importantly, starting treatment as early as possible is decisive for the outcome using a combination of streptomycin, sulfonamides, gentamycin, rifampicin and tetracyclines.

Abattoirs↗
PubMed1984

BAEP abnormalities in tardive dyskinesia.

To evaluate brainstem dysfunction, brainstem auditory-evoked potentials (BAEPs) were recorded in 13 patients with tardive dyskinesia. Only patients under 60 years of age were included because of the spontaneous dyskinetic syndromes that frequently occur in elderly persons. Clinical assessment was performed with the Abnormal Involuntary Movement Scale (AIMS). BAEP measurements were taken in order to detect lesions in the brainstem. In 14 of 26 pathways (13 patients), abnormalities in the BAEPs were found which corresponded well to lesions found in former neuropathological reports of patients with tardive dyskinesia. The functional disturbance causing abnormal BAEPs may be an expression of structural brain changes in tardive dyskinesia patients.

Adult↗
PubMed1983

[Primary unrecognized severe craniocerebral injuries in psychiatry].

Among 11,136 psychiatric patients admitted between 1977 and 1982 14 cases of initially unrecognized severe head injuries were originally admitted for psychiatric disorders in connection with alcohol abuse. While the overall incidence at 0.13% was low, this figure increased for the 1310 alcoholic patients of this period to 1.06% and 2.1% respectively, depending on the ready availability of computerized tomography. Plain skull X-rays showed fractures in only 2 patients and in 6 cases trivial head injuries indicated a more severe trauma. In the lucid period 2 patients talked of having fallen. Information from relatives revealed in 10 cases that the patients had had a fall, the majority during an epileptic fit in a predelirant state. Five patients underwent surgery on the day of diagnosis, 4 patients died before a correct diagnosis could be made. The avoidable factors contributing to death included above all, the failure to recognize an extracerebral hematoma.

Adolescent↗
PubMed1983

Venous hemodynamics of arteriovenous meningeal fistulas in the posterior cranial fossa.

The etiology of arteriovenous meningeal fistulas (AVMFs) of the posterior fossa often remains unclear. Analyses of three personal cases, however, suggest a change in venous hemodynamics due to a primary lesion, the cases being of sinus thrombosis, intracerebral abscess with oedema and arteriovenous malformation. It is suggested that increase of venous pressure in the posterior fossa leads to increased drainage and, consequently, to dilatation of infratentorial veins and of meningeal branches of the external carotid and vertebral artery. Clinical findings and anatomical facts underlying AVMF lesions tend to confirm the view that the concept of a congenital malformation decompensating with age cannot be upheld for all AVMFs, especially when located in the posterior fossa and when clinical symptoms arise in middle age. It is proposed that a pressure activated mechanism of growth results in widening of normally insignificantly small dural vessels.

Adult↗
PubMed1983

Tardive dyskinesia: clinical correlation with computed tomography in patients aged less than 60 years.

In a prevalence study of 335 psychiatric in-patients 49 patients (14.6%) with tardive dyskinesia were found. In view of the high prevalence of spontaneous dyskinetic syndromes in elderly patients only patients under 60 years were included (n = 21; mean age: 44.9). Clinical rating was performed with the AIMS-scale. CT measurements of ventricular enlargement and cortical atrophy were obtained. Tardive dyskinesia cases did not differ significantly from healthy controls, though some patients with severe dyskinesia showed signs of brain atrophy. These findings did not provide evidence to support neuropathological reports describing neuronal cell loss and midbrain gliosis in such patients. It is concluded that such structural brain changes in tardive dyskinesia patients are not detectable with present CT technology: they may either be due to concurrent aging processes or, in the case of younger patients, can be confirmed only by more functional methods of testing.

Adult↗
PubMed1982

[Acute viral encephalitis with primary psychotic symptoms--diagnosis, course and prognosis].

In 13 cases referred to psychiatric treatment between 1974 and 1980 acute viral encephalitis was diagnosed in the further course of the illness. The majority were female patients. Positive virological or pathological evidence was obtained in 38% of all cases. The most frequent etiology to be found was the herpes-simplex virus. These findings correspond to 36 cases from the literature. 90% of all cases showed neurological symptoms within two weeks of hospital admission. EEG and cerebrospinal fluid examinations proved to yield most in diagnosis, whereas angiography and brain scanning did not have special diagnostic importance. The present diagnostic value of CT is mainly restricted to the detection of herpes-simplex virus encephalitis and acute leukoencephalitis. Initially psychopathological findings varied largely and fluctuations in the level of consciousness were a prominent feature in most cases. In others no difference to schizophrenic psychosis could be noted on admission. Compared to other studies on acute viral encephalitis with initial neurological symptoms, patients with a psychotic onset of the illness tend to have a higher morbidity, while the mortality remains the same.

Acute Disease↗
PubMed1982

[Diagnosis of infratentorial aneurysms (author's transl)].

Within a period of two years ten infratentorial aneurysms have been diagnosed. Seven have been operated on. Only rarely the diagnosis of an aneurysm of the posterior fossa can be postulated on clinical grounds or by means of computerized tomography alone. Selective catheter angiography proves to be superior to retrograde brachial angiography in five cases investigated by both methods. In those cases visualisation of an aneurysm could only be achieved by selective catheterisation. Retrospective comparison of angiographic with operative findings shows the junction of the cerebellar inferior posterior artery with the vertebral artery to be the most crucial region for diagnosis.

Adult↗