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Michael Forsting

Publications and source records attributed to Michael Forsting.

At least 55 records · Page 3Linked to original sources
PubMed2004

Decompressive craniectomy in acute cerebral ischemia in rats. Is there any benefit in smaller thromboembolic infarcts?

Early craniectomy has shown to reduce infarction size in experimental large MCA infarction probably due to improved leptomeningeal perfusion. Based on the hypothesis that craniectomy may also be beneficial in smaller MCA infarction we evaluated the effects of craniectomy on infarction size in small thromboembolic cerebral infarction in rats. Therefore, thromboembolic cerebral ischemia was induced in 40 rats by endovascular injection of autologous, fibrin-rich emboli. Twenty-one animals with a diffusion-weighted MR imaging (DWI)-derived infarction size of 50-100 mm3 (involving one- to two-third of the MCA territory) at 1 h after injection were randomly assigned to two groups. Eleven animals of group 1 immediately underwent craniectomy, ten animals of group 2 (controls) were not treated. Serial DWI was performed at 4 and 24 h. Infarction size was assessed by TTC-staining at 48 h after emboli injection. As result, prior to treatment, at 1 h after emboli injection, infarction size in groups 1 and 2 was 65.9 +/- 16.0 mm3 and 67.9 +/- 17.8 mm3, respectively. At 4 and 24 h, infarction size in group 1 was 73.5 +/- 22.1 mm3 and 85.2 +/- 24.7 mm3, and 76.3 +/- 21.0 mm3 and 83.4 +/- 22.9 mm3 in group 2, respectively. TTC-derived infarction size was 84.0 +/- 23.3 mm3 and 82.7 +/- 21.5 mm3, respectively. There was no significant difference between the two groups (P > 0.79). In conclusion, our results demonstrate that for small thromboembolic MCA infarction early craniectomy is not beneficial.

Animals↗
PubMed2004

MR-based full-body preventative cardiovascular and tumor imaging: technique and preliminary experience.

Recent improvements in hardware and software, lack of side effects, as well as diagnostic accuracy make magnetic resonance imaging a natural candidate for preventative imaging. Thus, the purpose of the study was to evaluate the feasibility of a comprehensive 60-min MR-based screening examination in healthy volunteers and a limited number of patients with known target disease. In ten healthy volunteers (7 men, 3 women; mean age, 32.4 years) and five patients (4 men, 1 woman; mean age, 56.2 years) with proven target disease we evaluated the performance of a comprehensive MR screening strategy by combining well-established organ-based MR examination components encompassing the brain, the arterial system, the heart, the lungs, and the colon. All ten volunteers and five patients tolerated the comprehensive MR examination well. The mean in-room time was 63 min. In one volunteer, insufficient colonic cleansing on the part of the volunteer diminished the diagnostic reliability of MR colonography. All remaining components of the comprehensive MR examination were considered diagnostic in all volunteers and patients. In the five patients, the examination revealed the known pathologies [aneurysm of the anterior communicating artery ( n=1), renal artery stenosis ( n=1), myocardial infarct ( n=1), and colonic polyp ( n=2)]. The outlined MR screening strategy encompassing the brain, the arterial system, the heart, the lung, and the colon is feasible. Further studies have to show that MR-based screening programs are cost-effective in terms of the life-years saved.

Adult↗
PubMed2004

Specific cerebellar activation during Braille reading in blind subjects.

The traditional view that the cerebellum is involved only in the control of movements has been changed recently. It has been suggested that the human cerebellum is involved in cognition and language. Likewise, besides cortical activity in sensorimotor and visual areas, an increased global activation of the cerebellum has been revealed during Braille reading in blind subjects. Our purpose was to investigate whether there is cerebellar activation during Braille reading by blind subjects other than sensorimotor activation related to finger movements. Early blind and normal sighted subjects were studied with functional magnetic resonance imaging (fMRI) during Braille reading, tactile discrimination of nonsense dots, dots forming symbols, and finger tapping. The experiments were done in block design. Echo planar imaging sequences were carried out on a 1.5-T MR scanner. All blind individuals reading Braille showed robust activation of the posterior and lateral aspects of cerebellar hemispheral lobules Crus I bilaterally but more predominately on the right side. Additionally, activation was present in the medial cerebellum within lobules IV, V, and VIIIA, predominantly on the right. Discriminating nonsense dots did not reveal any activation of Crus I, but did reveal activation within the medial part of lobules IV, V, and VIIIA, predominately on the right. Analysis of sighted subjects during reading of printed text revealed activation of the posterolateral cerebellar hemisphere in Crus I bilaterally, predominantly on the right. Tactile analysis of dots representing symbols revealed an activation in lobules IV and VIII and in right Crus II but not in Crus I. In conclusion, parts of cerebellar activation during Braille reading in blind subjects (i.e., within lobules IV, V, and VIII) overlap with the known hand representation within the cerebellum and are likely related to the sensorimotor part of the task. Cerebellar activation during Braille reading within bilateral Crus I may be due to language processes or inner speech similar to those found during text reading in normal sighted subjects. Object recognition did not account for Crus I activation.

Adaptation, Physiological↗
PubMed2004

Age-related changes of the dentate nuclei in normal adults as revealed by 3D fast low angle shot (FLASH) echo sequence magnetic resonance imaging.

The aim of the present study was to investigate age-related changes in iron-deposition in dentate nuclei using iron-induced susceptibility effects in magnetic resonance imaging. MR images from 74 healthy subjects (age range 20-68 years) were obtained using a three-dimensional (3D) T1-weighted fast low angle shot (FLASH) echo sequence. Signal intensities of the dentate nuclei and cerebellar white matter were bilaterally measured independently by three blinded investigators. The signal intensities of dentate nuclei were intraindividually normalised to the corresponding signal intensities of the cerebellar white matter of corresponding slices. Mean normalised signal intensities were correlated with age and compared between different age decades and gender. Intraclass correlation coefficients were high (dentate nuclei: 0.98, cerebellar white matter: 0.75) indicating sufficient interrater reliabilities for the determination of signal intensities. Bland-Altman analysis confirmed this finding. The normalised mean signal intensity of the dentate nuclei correlated inversely with age (r = -0.462, p < 0.0001). Comparison of age decades revealed that significant decreases took place between the third and fourth decade and to a lesser degree between the fourth and fifth decade. Moreover, variability of normalised mean signal intensities of the dentate nuclei increased significantly with age (r = 0.964, p = 0.008). There were no differences of the normalised mean signal intensities between genders. The present study revealed an age-dependent decrease of signal intensities in dentate nuclei most likely reflecting an age-dependent increase in dentate iron concentration. These age-dependent changes have to be taken into account in interpretation of disease related MR changes of cerebellar nuclei in patients with degenerative or acquired cerebellar ataxia.

Adult↗
PubMed2004

Evaluation of brain injury after coronary artery bypass grafting. A prospective study using neuropsychological assessment and diffusion-weighted magnetic resonance imaging.

OBJECTIVE: Neurocognitive dysfunction is a common complication after cardiac surgery with cardiopulmonary bypass (CPB). Studies using magnetic resonance imaging (MRI) have demonstrated that new focal brain lesions can occur after coronary artery bypass grafting (CABG), even in patients without apparent neurological deficits. Diffusion-weighted MRI is superior to conventional MRI and allows for sensitive and early detection of ischemic brain lesions. We prospectively investigated cerebral injury early and 3 months after CABG using diffusion-weighted MRI and related the findings to clinical data and neurocognitive functions. METHODS: Twenty-nine patients [67.6+/-8.6 (52-85) years, 5 females] undergoing elective CABG with CPB were examined before surgery, at discharge and 3 months after surgery. A battery of standardized neuropsychological tests and questionnaires on depression and mood were administered. Conventional and diffusion-weighted MRI of the brain was performed and new lesions were analyzed. Clinical characteristics, neuropsychological test performance and radiographic data were collected and compared. RESULTS: There was no major neurological complication after CABG. Thirteen patients (45%) exhibited 32 new ischemic lesions on postoperative diffusion-weighted MRI. The lesions were small, rounded and equally dispersed in both hemispheres. Eight patients had at least two lesions. At discharge, significant deterioration of neuropsychological performance was observed in 6 of the 13 tests compared to baseline assessment. By 3 months postoperatively, 5 of the 6 tests returned to preoperative levels. Verbal learning ability, however, remained impaired. The presence of new focal brain lesions was not associated with impaired neuropsychological performance. There was also no correlation between clinical variables, intraoperative parameters and postoperative complications and MRI findings. CONCLUSIONS: Although neurocognitive decline after CABG is mostly transient, memory impairment can persist for months. New ischemic brain lesions on postoperative diffusion-weighted MRI do not appear to account for the persistent neurocognitive decline.

Aged↗
PubMed2004

Albumin targeting of damaged muscle fibres in the mdx mouse can be monitored by MRI.

Increased sarcolemmal permeability has been implicated as a major pathological event in muscular dystrophies. In our study, we evaluated whether damaged muscle fibres can be specifically targeted using albumin as a carrier. We tagged human serum albumin (HSA) with Gadolinium (Gd) and systemically applied this compound (Gd-DTPA-HSA) to wildtype and dystrophin-deficient mdx mice. We performed magnetic resonance imaging before and after intravenous administration of Gd-DTPA-HSA and found localised signal enhancement only in mdx skeletal muscle. We also examined skeletal muscle after contrast enhanced magnetic resonance imaging using anti-human albumin antibodies and demonstrated intracellular accumulation of Gd-DTPA-HSA in clusters of damaged mdx muscle fibres. Comparison of magnetic resonance imaging and histological data emphasised the value of contrast agent enhanced magnetic resonance imaging for the in vivo assessment of fibre damage in muscular dystrophies. Furthermore, our data provide evidence that albumin can be used as a carrier to target covalently bound molecules to degenerating muscle fibres.

Animals↗
PubMed2004

Clipping versus coiling: neuropsychological follow up after aneurysmal subarachnoid haemorrhage (SAH).

Patients treated with microsurgical clipping of ruptured intracranial aneurysms often suffer from neuropsychological deficits in spite of a good neurological outcome. The purpose of this study was to explore if the deficits are related to the type of therapy. Two groups of 16 patients each suffering from aneurysmal SAH, matched for sex, age, aneurysm-site and Hunt and Hess score, and 16 control subjects were examined with a battery of neuropsychological tests including memory, attention, and executive function. Depression, mood, and quality of life were also assessed. One patient group had been treated with surgical clipping, the other with endovascular coiling. Both patient groups showed deficits in verbal and visual memory. Clipped patients were slightly more impaired than coiled patients, especially on measures of affect and on a self-assessment measure of executive function. The pattern of results suggests that the neuropsychological outcome after aneurysmal SAH is affected by both the severity of the bleeding and the type of therapy.

Affect↗
PubMed2004

The angiotensin II type 1-receptor blocker candesartan increases cerebral blood flow, reduces infarct size, and improves neurologic outcome after transient cerebral ischemia in rats.

The goal of the present study was to test the impact of administration time of the angiotensin II type 1-receptor blocker candesartan on cerebral blood flow (CBF), infarct size, and neuroscore in transient cerebral ischemia. Therefore, 1-hour middle cerebral artery occlusion (MCAO) was followed by reperfusion. Rats received 0.5-mg/kg candesartan intravenously 2 hours before MCAO (pretreatment), 24 hours after MCAO, every 24 hours after MCAO, or 2 hours before and every 24 hours after MCAO. Infarct size (mm3) and a neuroscore at day 7 were compared with controls. CBF was quantified by radiolabeled microspheres and laser-Doppler flowmetry. Compared with controls (95 +/- 8), infarct size in candesartan-treated groups was smaller (59 +/- 5, 68 +/- 10, 28 +/- 3, and 15 +/- 3, respectively; P<0.05). Although there was no difference in neuroscore between pretreatment and controls (1.55 +/- 0.18, 1.80 +/- 0.13), other treatment regimens resulted in improved neuroscores (1.33 +/- 0.16, 1.11 +/- 0.11, 0.73 +/- 0.15; P<0.05). CBF in pretreated animals at 0.5 hours after MCAO was significantly higher than in controls (0.58 +/- 0.09 mL x g(-1) x min(-1) and 44% +/- 7% of baseline compared with 0.49 +/- 0.06 mL x g(-1) x min(-1) and 37% +/- 6%, microspheres and laser-Doppler flowmetry; P<0.05). Thus, candesartan reduces infarct size even if administered only during reperfusion. Apart from pretreatment, other treatment regimens result in significantly improved neuroscores. In the acute phase of cerebral ischemia, candesartan increases CBF.

Angiotensin II Type 1 Receptor Blockers↗
PubMed2004

Update on neuroimaging in infectious central nervous system disease.

PURPOSE OF REVIEW: Neuroimaging constitutes an important component in the diagnosis of the underlying infectious agents in central nervous system infection. This review summarizes progress in the neuroimaging of infectious central nervous system disease since January 2003. It focuses on imaging of viral encephalitis, including that caused by exotic and emerging viruses, and on imaging in immunodeficient patients. RECENT FINDINGS: Diffusion-weighted imaging has been shown to be superior to conventional magnetic resonance imaging for the detection of early signal abnormalities in herpes simplex virus encephalitis but also in enterovirus 71 encephalitis and in West Nile encephalitis. Several studies defined the pattern of magnetic resonance imaging signal changes in endemic diseases such as West Nile encephalitis, Murray Valley encephalitis, enterovirus 71 encephalitis and Japanese encephalitis, but also in encephalitides due to ubiquitous viruses such as measles virus and Lyssavirus (rabies). In patients with HIV infection, apparent diffusion coefficient ratios obtained by diffusion-weighted imaging were significantly greater in lesions due to Toxoplasma encephalitis than in primary central nervous system lymphomas. SUMMARY: The diagnosis of unclear infectious central nervous system diseases remains a challenge. More recent magnetic resonance imaging techniques, such as diffusion-weighted imaging and magnetic resonance spectroscopy, provide additional helpful information. However, the mainstay of diagnosis remains the detection of viral DNA or serological markers of specific infectious agents within the cerebrospinal fluid.

Brain↗
PubMed2004

Endovascular treatment of cerebrovascular disease.

PURPOSE OF REVIEW: This review summarizes recent advances in endovascular therapy for cerebrovascular disease. RECENT FINDINGS: For ruptured aneurysms, the only large, randomized, controlled trial comparing surgical and endovascular treatment (the International Subarachnoid Aneurysm Trial) resulted in a significant reduction in death or dependency at 1 year, compared with surgery, providing sound evidence that coiling should be the treatment of first choice. Data from the International Study of Unruptured Intracranial Aneurysms demonstrated that treatment of unruptured anterior circulation aneurysms of under 7 mm with no history of subarachnoid hemorrhage is not justified. Embolization of arteriovenous malformations, as sole therapy, is curative only in a small percentage of cases, but can be part of a multimodal approach for reducing arteriovenous malformation size prior to surgery or radiotherapy. Partial treatment of complex arteriovenous malformations may be more dangerous than no treatment. Protection devices can reduce complication rates in carotid artery stenting, but scientific evidence is still lacking. Until the results of comparative trials are available, carotid artery stenting is indicated only in selected patients. Angioplasty and stenting of intracranial arterosclerotic disease is feasible but remains a high-risk procedure, indicated only in highly selected patients. In acute stroke therapy, new thrombolytics and clot-retrieval devices may result in better recanalization rates. SUMMARY: Advances in endovascular therapy have occurred in all areas of cerebrovascular disease. To obtain maximal patient benefit, endovascular treatment should be performed as an interdisciplinary approach in high-volume centers. Importantly, long-term follow-up review is necessary to clarify the overall role of endovascular treatment in the management of cerebrovascular disease.

Arteriovenous Malformations↗
PubMed2004

Double-stent method: therapeutic alternative for small wide-necked aneurysms. Technical note.

The authors present two cases of patients with small, acutely ruptured, wide-necked aneurysms of the distal vertebral artery that were not amenable to conventional coil embolization and were instead treated by means of a double-stent method in which one stent was placed inside another. Angiography performed immediately after the procedure revealed a significant reduction in aneurysm filling; total occlusion of the lesion was observed after 7 days and confirmed 6 months later in both aneurysms. By placing one stent inside the other, stent permeability can be reduced, which may result in significant hemodynamic changes with accelerated aneurysm thrombosis. This double-stent method may represent a therapeutic alternative, especially in cases of small, wide-necked aneurysms in which conventional endovascular techniques or stent-supported coil embolization is not considered feasible or is believed to be too dangerous, and surgical treatment is contra-indicated.

Cerebral Angiography↗
PubMed2004

Brain tissue water uptake after middle cerebral artery occlusion assessed with CT.

BACKGROUND AND PURPOSE: To study whether computed tomography (CT) can measure the water content of early ischemic edema. METHODS: The authors obtained cranial CT in 5 groups of rats subjected to 1 hour (n = 8), 2 hours (n = 11), 3 hours (n = 13), 4 hours (n = 13), or 6 hours (n = 14) of right middle cerebral artery (MCA) occlusion. Immediately after CT, the authors removed the rats' brains and determined tissue water content by the dry-wet weight method. They correlated brain x-ray attenuation with brain tissue water content. RESULTS: Mean brain tissue water content remained constant in the nonischemic left hemispheres at 77.9% +/- 0.6% and increased up to 79.3% +/- 1.0% in the right hemispheres after 6 hours of permanent right MCA occlusion. X-ray attenuation remained constant in the left hemispheres at 75.6 + 2.2 Hounsfield units (HU) and decreased to 71.7 +/- 3.4 HU in the right hemispheres after 6 hours of right MCA occlusion. The decrease in x-ray attenuation correlated significantly with the increase in ischemic brain tissue water content (y = 217.3 - 1.8x x; r = .55, P < .0001). That means that a 1% increase in hemispheric tissue water content causes a decrease in x-ray attenuation of 1.8 HU. CONCLUSIONS: After MCA occlusion, immediate brain tissue net water uptake is associated with a decrease in x-ray attenuation. CT can monitor ischemic edema in an acute stroke.

Animals↗
PubMed2003

A novel passive functional MRI paradigm for preoperative identification of the somatosensory cortex.

The purpose of this study was to assess the feasibility of a novel passive functional magnetic resonance imaging (fMRI) paradigm for activation analysis of the somatosensory cortex utilizing a specifically designed conductor for electrical stimulation of the median and tibial nerves. Thirteen healthy volunteers underwent electrical stimulation of these nerves with defined frequencies and intensities in a block-designed fashion. Electrical stimuli were applied by two custom-designed magnetoelectrically protected coaxial leads, taking into account the technical difficulties of the application of electrical current in the fMRI environment. Activation effects were analysed in real-time mode and validated by statistical parametric mapping. The shielded conductors suppressed electromagnetically derived artefacts nearly completely. The measurements revealed maximum cortical activation when applying a stimulation frequency of 3 Hz and an intensity of 3 mA above motor threshold. Simultaneous stimulation of both the median and tibial nerves enhanced identification of the central region significantly. A standardized setup for the clinical environment was evolved. With this passive paradigm, the identification of the somatosensory cortex was possible in all evaluated cases. The presented technical setup and paradigm is a reliable and fast method for preoperative identification of the somatosensory cortex and may represent a feasible paradigm for generation of pre- and intraoperative fMRI in functionally disabled patients.

Adult↗
PubMed2003

Sparse imaging of the auditory oddball task with functional MRI.

Cortical reactions to rare task-related stimuli have been studied with electrophysiological methods in the assessment of the P300 component as well as in functional imaging studies with regard to oddball tasks. While functional magnetic resonance imaging studies using auditory stimuli have to deal with interference between auditory stimuli and scanner noise, the aim of our study was to assess auditory target processing with the sparse imaging method. Single volumes of echo-planar imaging were acquired 4 s following the onset of the stimuli of interest. In keeping with previous studies, target stimuli activated the insula, superior temporal gyrus, cingulate gyrus, middle frontal gyrus, parietal cortex and the cerebellum. Our results encourage the application of the sparse imaging method in experiments on cognitive processing elicited by auditory stimulation in a silent environment.

Acoustic Stimulation↗
PubMed2003

Screening with MRI: a new "all inclusive" protocol.

In the past decades, only mammography has been considered to be a valuable radiological screening test in the European community, as the amount of ionizing radiation associated with other radiological imaging modalities did not justify their use for screening. MRI overcomes many limitations inherent to other imaging methods: lack of ionizing radiation, high spatial and temporal resolution, and unsurpassed soft-tissue contrast. Up to now, only few diseases have been screened for with MR: primarily breast cancer and colonic cancer. A new 60-minute comprehensive MR screening protocol is now capable of assessing the central nervous, the peripheral and the cardiovascular system, as well as the colon, allowing for screening of several diseases simultaneously.

Arteriosclerosis↗
PubMed2003

Percutaneous, catheter-based coil embolization of coronary fistula: determination of hemodynamic relevance.

A 55-year-old male with angina-like chest pain and positive thallium-scintigraphy was admitted to our hospital. Cardiac catheterization was performed for suspected coronary artery disease. The coronary angiogram showed no significant epicardial stenosis, but a large coronary fistula, connecting the left anterior descending artery with the pulmonary artery. Swan-Ganz catheter measurements, intracoronary Doppler, and quantitative coronary angiography were used to determine cardiac output, coronary blood flow, and coronary-to-pulmonary artery shunt fraction. These measurements showed a hyperdynamic cardiac output of 17 L/min, a coronary blood flow of 140 mL/min in the left anterior descending coronary artery with an estimated shunt fraction of 58% into the pulmonary circulation. Percutaneous, catheter-based coil embolization was performed to occlude the fistula. After embolization of one coil, coronary angiography showed the fistula's stump only. Cardiac output (9 L/min) and coronary blood flow (48 mL/min) were almost normalized. The patient was discharged from the hospital the day after the procedure. After a 6-month follow-up, there were still no complaints, angina-like symptoms or signs of myocardial ischemia in stress tests.

Cardiac Output↗