Search PubMed⌕ Search

Biomedical subjects

P Berlit

Publications and source records attributed to P Berlit.

At least 55 records · Page 3Linked to original sources
PubMed1996

Lymphocytic encephalomyeloneuritis as a neurologic complication of ulcerative colitis.

Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease (IBD) showing immunologic abnormalities and association with autoimmune states (Snook et al., 1989). Extraintestinal manifestation of UC affect various organ systems (Podolsky, 1991). We describe morphologically documented encephalomyeloneuritis in a 58-year-old white male with UC in full remission providing support for the concept that ulcerative colitis may be complicated by neurologic manifestations affecting both the central and peripheral nervous system.

Colitis, Ulcerative↗
PubMed1996

An increased frequency of patent foramen ovale in patients with transient global amnesia. Analysis of 53 consecutive patients.

OBJECTIVE: Alerted by the number of patients with transient global amnesia (TGA) in whom Valsalvalike activities immediately preceded the onset of TGA, we have investigated the frequency of patent foramen ovale (PFO) as the prerequisite for paradoxical embolism. DESIGN: Case series with comparison to a control group. SETTING: Hospitalized and ambulatory patients at the neurological departments of the Alfried Krupp Hospital, Essen, Germany, and the Rheinisch-Westfälische-Technische Hochschule, Aachen, Germany. PATIENTS: Fifty-three consecutive patients with TGA were evaluated by the 2 centers between 1988 and 1995. RESULTS: Using contrast transcranial Doppler sonography we have observed a PFO in 55% of the patients with TGA, compared with 27% of a control group of 100 patients. This difference was statistically significant (P < .01). Twenty-five patients with TGA (47%), 15 of them with a proven PFO, reported a precipitating activity, such as the lifting of heavy weights, immediately before the TGA occurred. CONCLUSIONS: In addition to other pathological mechanisms, paradoxical embolism with temporobasal ischemia could possibly play a role in the clinical syndrome of TGA. This hypothesis could explain the frequent observation of preceding Valsalvalike activities in patients with TGA.

Adult↗
PubMed1996

Visualisation of intracranial aneurysms by transcranial duplex sonography.

We examined 72 patients with 89 angiographically confirmed intracranial aneurysms, using transcranial colour-coded duplex sonography (TCCD) to determine the location and size of the aneurysm. The patients were admitted for coil embolisation of their aneurysm following subarachnoid haemorrhage or because of a cranial nerve palsy. Using a 2/2.25 MHz transducer, 42 aneurysms (47%) were seen satisfactorily through the temporal bone window or foramen magnum. In 24 cases (27%) image quality was insufficient as a result of a poor bone window, of the aneurysm having a diameter of less than 6 mm or of its being in an unfavorable location. In 23 other cases (26%) it was not possible to detect the aneurysm. Thrombosed structures could be demonstrated using TCCD in 8 of 12 giant intracavernous or basilar artery aneurysms, and in 15 of 19 aneurysms treated by platinum coil embolisation. TCCD offers a noninvasive method for monitoring progressive intra-aneurysmal thrombosis following coil embolisation and for follow-up of patients with untreatable fusiform aneurysms, should this be required. Detection of small aneurysms is limited by spatial resolution and insonation angles.

Aneurysm, Ruptured↗
PubMed1996

Spinal arteriovenous malformations: clinical and neurophysiological findings.

Eighteen patients with dural arteriovenous fistulas or intradural arteriovenous malformations underwent clinical and neurophysiological examination. Bladder disturbances, pain, sensory abnormalities and involvement of both upper and lower motor neurons were commonly observed. Abnormal findings were obtained both in electromyography (11/18) and somatosensory evoked potentials (16/18). The motor evoked potentials were abnormal in all but one patient and showed a prolonged central (n = 14) or peripheral motor conduction time (n = 6). In three cases both values were prolonged. The results of nerve conduction studies in the patients with prolonged peripheral motor conduction times were normal. These neurophysiological findings may indicate root involvement in some patients, probably due to venous congestion and consequent hypoxia, as there were no signs of root compression on neuroradiological evaluation in any of these six patients. Motor evoked potentials may provide an additional clue to the diagnosis, although patients with spinal stenosis or motor neuron disease may present with similar findings.

Adult↗
PubMed1996

Transcranial Doppler during neurocardiogenic syncope.

The purpose of the present study was to investigate changes in cerebral circulation during neurocardiogenic syncope (NCS). Twenty patients with a history of unexplained syncopes were studied over a 45 min period in a tilted position. Heart rate and arterial blood pressure were recorded non-invasively using Finapres. Cerebral blood flow velocity of both middle cerebral arteries was measured with transcranial Doppler (TCD). Ten patients (50%) developed a NCS during the tilt test, with a strong reduction in blood pressure (mean, 48/34 mmHg) and heart rate (mean, 54 beats/min). Simultaneously, diastolic blood flow velocities dropped to values close to zero. However, systolic blood flow velocities did not decrease. In consequence, the pulsatility index (PI) increased considerably from 0.93 to 2.01. The increase in PI suggests that there is a constriction of cerebral resistance vessels during NCS. Despite the drop in blood pressure and the putative increase in cerebrovascular resistance, systolic blood flow velocities remained unchanged in the TCD records. This fact can be explained by a lumen narrowing of the middle cerebral artery at the site of insonation. In conclusion, the typical changes in cerebral blood flow velocity during NCS are probably due to a strong constriction of both the proximal and the peripheral segments of cerebral arteries. It is clear that, in addition to vasodepression and cardiac inhibition, cerebral vasoconstriction is a further mechanism in the pathogenesis of a NCS.

Adult↗
PubMed1996

[Bacterial brain abscess--experiences with 67 patients].

Sixty-seven patients with brain abscess were managed over 19 years (1975-1993). Our series had a 2.5 to 1 male predominance; the age distribution was from 3 days to 81 years. The underlying conditions of hematogenic brain abscesses (n = 33; 49%) included lung infections (n = 16), heart disease (n = 4), sepsis (n = 10), and other foci (n = 3). Otolaryngologic infections led to the abscess in 10 cases; there were 9 traumatic abscesses. The causes remained unknown in 15 cases. There were 47 solitary abscesses (70%) and 20 multiple abscesses. The most frequent presenting signs and symptoms were neurologic deficits (n = 17), disturbances of consciousness (n = 14), seizures (n = 6), and headaches, meningism and vomiting (n = 13). Causative organisms were isolated in 39 cases (58%) and included staphylococci (n = 6), streptococci (n = 6), enterobacteriae (n = 2), and anaerobic pathogens (n = 9). The most reliable laboratory sign of inflammation was an elevated ESR (52/59 patients). With the advent of computed tomography, burr hole aspiration of the abscess with or without drainage was possible in 30 cases; the mortality in this subgroup was 9%. All 4 patients with surgical excision in the pre CT-era died. The mortality of patients treated with antibiotics only was 62% (18/29). Overall mortality was 37% (25/67), including 5 cases with post mortem-diagnosis of brain abscess. Good recovery was achieved in 29/42 survivors. Predictors of a poor outcome were the patient's age, the level of consciousness, multiple abscesses, polybacterial cultures, and a hematogenic etiology, but not the size of the abscess.

Adolescent↗
PubMed1996

Assessment of the posterior communicating artery by transcranial color-coded duplex sonography.

BACKGROUND AND PURPOSE: The aim of this study was to investigate flow velocity and flow direction in the posterior communicating artery (PcomA) by means of transcranial color-coded duplex sonography (TCCD) and to compare the results with angiographic findings. METHODS: Thirty patients with unilateral occlusion of the internal carotid artery (ICA) due to atherosclerosis (n=15) or balloon occlusion (n=15) and 50 normal subjects were included. The circle of Willis was insonated through the temporal bone window. In 24 patients with unilateral ICA occlusion, angiograms were available and were compared with the results of TCCD. RESULTS: The PcomA could be detected unilaterally in 70% of normal subjects and bilaterally in 30%. A retrograde flow direction in the PcomA from the posterior cerebral artery to the ICA was found in 75% of the normal control subjects. The mean peak flow velocity in normal PcomAs was 36 +/- 15 cm/s (+/- SD). No significant differences in flow velocity were found between unilaterally and bilaterally detectable PcomAs or between retrograde and orthograde PcomAs. In patients with unilateral ICA occlusion we observed ipsilaterally a retrograde flow direction, with an elevation of flow velocity (64 +/- 10 cm(s) compared with the contralateral side (27 +/- 14 cm/s; P<.001). CONCLUSIONS: TCCD appears to be a valuable method to determine flow velocity and flow direction not only in the large intracranial vessels but also in the smaller communicating arteries. In the future this method could be useful for the planning of ICA balloon occlusions and in deciding whether to perform extracranial/intracranial bypass surgery. It could furthermore show intracranial collaterals in patients with cerebrovascular disease and help to estimate the risk of watershed infarctions in patients with asymptomatic high-grade ICA stenosis and in patients undergoing carotid endarterectomy.

Adult↗
PubMed1996

[Vasculitis].

Vasculitis, restricted to the central nervous system, may be an iodiopathic disorder or may be secondary to toxins, infections or neoplasm. Alternatively, it may be part of a systemic autoimmune disease. Temporal arteritis presents with headache, jay claudication, polymyalgia rheumatica and constitutional symptoms. Hemispheric strokes occur in 10%, especially in the territory supplied by the posterior or the middle cerebral arteries. Corticosteroids are the treatment of choice. Isolated angitis of the central nervous system is an idiopathic recurrent inflammatory disease of the small and medium-sized vessels, confirmed to the brain and the spinal cord. Persisting headaches, encephalopathy with personality changes, cognitive disorders and memory disturbances as well as multifocal neurologic deficits resulting from recurrent cerebral ischemia and cranial nerve involvement are the most frequent presently symptoms of the disease. Angiography of the intracranial vessels presents segmental stenoses or dilatations of the medium and small vessels; a leptomeningeal biopsy demonstrating vasculitis is the only reliable diagnostic method. Treatment is instituted with prednisone and cyclophosphamide. At least one year of therapy is necessary. The typical dermatological manifestations of Behçet's disease are aphthous stomatitis, genital ulcerations and ocular inflammation. Neurological involvement has been described in 30% of all patients with Behçhet's disease. Sinus thrombosis presents with the signs of intracranial hypertension. A meningoencephalitis with headaches, disturbances of consciousness and focal neurologic symptoms is frequent; spinal cord involvement occurs. The treatment of choice for Behçet's disease consists of steroids in combination with chlorambucil or azathioprine. While polyarteritis nodosa and the Churg-Strauss syndrome most frequently involve the peripheral nervous system. CNS involvement is encountered in Wegener's granulomatosis. In lupus erythematosus and Sjorgren's syndrome, cerebral symptoms are rarely caused by a true vasculitis. In lupus erythematosus, nervous system involvement has been attributed to autoantibodies which interact directly with neurons [antineuronal antibodies] or indirectly lead to thrombotic vasculopathy by influencing the coagulation system [antiphospholipid antibodies].

Behcet Syndrome↗
PubMed1995

Subclinical autonomic disturbances in multiple sclerosis.

We compared results from non-invasive autonomic testing [sympathetic skin responses (SSR), heart beat variation during deep breathing, and orthostatic manoeuvre with transcranial Doppler monitoring in 22 patients] with motor and somatosensory evoked potentials (MEP and SEP) in 30 unselected patients with multiple sclerosis. We found a similarly high yield of pathological results for SSR, MEP and SEP (66.7%, 65.5%, and 69%, respectively). When analysed for each limb (n = 120), SSR were highly correlated with MEP and SEP (for both P < 0.001). Heart beat variation was reduced in only 3 patients. In 4 of 22 patients orthostatic manoeuvre induced a pathological decrease in cerebral blood flow velocity despite normal systemic blood pressure being maintained. We conclude that SSR may be a useful additional diagnostic tool in patients with multiple sclerosis. Cerebral dysautoregulation is a rather frequent finding, although its significance is not known.

Adolescent↗
PubMed1995

Sympathetic skin responses (SSRs) in monofocal brain lesions: topographical aspects of central sympathetic pathways.

Lesions of the central sympathetic pathways are likely to be of clinical relevance. In patients with acute stroke, in particular, they may be responsible for the partially deleterious cardiac arrhythmia. There is little knowledge of the central organization of sympathetic pathways above the brainstem level for both cardio-efferent and sudomotor fibers. We studied the sympathetic skin response (SSR) in 29 patients with brainstem stroke or infarction in the territory of the middle cerebral artery (MCA) in order to evaluate the pathways mediating emotional sweating. In 24 patients (82.8%) the SSR was pathological. These abnormalities were bilateral with no clear asymmetry in 10 patients (34.5%), bilateral with marked contralateral pathology in 8 patients (27.6%), purely contralateral in 5 patients (17.2%) and purely ipsilateral in one patient (3.5%). Bilateral abnormalities were more frequent and more marked in brainstem than in MCA stroke. This is probably indicative of a more generalized sympathetic dysfunction. In contrast, contralateral abnormalities were more pronounced in MCA than in brainstem infarcts. Our results show that sympathetic skin responses are suppressed in the majority of stroke patients. Asymmetric responses may indicate that sudomotor fibers mediating emotional sweating have their origin or receive input from the contralateral MCA territory.

Adult↗
PubMed1995

Phase relationship between cerebral blood flow velocity and blood pressure. A clinical test of autoregulation.

BACKGROUND AND PURPOSE: This study investigates the usefulness, as a test of dynamic autoregulation, of phase shift angle analysis between oscillations in cerebral blood flow velocity (CBFV) and in arterial blood pressure (ABP) during deep breathing. METHODS: Fifty healthy volunteers, 20 patients with occlusive cerebrovascular diseases (OCD), and 10 patients with arteriovenous malformations (AVM) took part in the study. All subjects received transcranial Doppler monitoring of both middle cerebral arteries (MCAs). In addition, continuous blood pressure monitoring was performed with the use of noninvasive servo-controlled infrared finger plethysmography during deep breathing at a rate of 6/min. With the use of a high-pass filter model of autoregulation, autoregulation was quantified as phase shift angle between oscillations in CBFV and ABP at a frequency of 6/min. A phase shift angle of 0 degrees indicates total absence of autoregulation, while 90 degrees can be gauged as optimal autoregulation. In addition, vasomotor reactivity of both MCAs to CO2 stimulation was assessed among patients and calculated as percent increase in CBFV per millimeter of mercury of increase in CO2. RESULTS: All normal subjects showed positive phase shift angles between CBFV and ABP (mean +/- SD, 70.5 +/- 29.8 degrees). OCD patients presented with significantly decreased phase shift angles for the MCA only on the pathological side (51.7 +/- 35.1 degrees; P < .05). Patients with AVM showed significantly reduced phase shift angles on both the affected side (26.8 +/- 13.5 degrees; P < .001) and the unaffected side (40.6 +/- 26.6 degrees; P < .01). In patients' groups, phase shift angle and vasomotor reactivity correlated significantly (r = .66; P < .001) after results from all MCAs were pooled. CONCLUSIONS: Results confirm the high-pass filter model of cerebral autoregulation: Normal subjects showed predicted positive phase shift angles between CBFV and ABP oscillations. Patients with expected autoregulatory disturbances showed significant decreases in phase shift angles. Close correlations existed between autoregulation and CO2-induced vasomotor reactivity.

Adult↗
PubMed1995

Transcranial color-coded duplex sonography in cerebral arteriovenous malformations.

BACKGROUND AND PURPOSE: It is well known that significant changes in cerebral hemodynamics may occur during the treatment of cerebral arteriovenous malformations with the complication of intracerebral hemorrhage and parenchymal edema. We used transcranial color-coded duplex sonography to study alterations in blood flow velocities during staged embolization. METHODS: Forty-one patients aged 40 +/- 13 years (mean +/- SD) with angiographically proven cerebral arteriovenous malformations were studied. The blood flow velocities of the anterior, middle, and posterior cerebral arteries were measured in 16 patients with supratentorial arteriovenous malformations, both before the first and then after each successive embolization (three to seven treatments). RESULTS: In 29 of 41 patients (71%), transcranial color-coded duplex sonography satisfactorily revealed the malformations and their main feeders. After the final embolization, we found a reduction in the peak flow velocity in treated feeders of 23 +/- 28% compared with the values before the first embolization. The untreated feeders showed an increase in peak flow velocities of 12 +/- 23% as an expression of increased collateral flow. After the treatment of the supplying feeders, we observed a reduction in flow velocity of 25 +/- 13% in seven patients, with cross-filling of the arteriovenous malformation through the contralateral anterior cerebral artery and the anterior communicating artery. CONCLUSIONS: The technical advantage of transcranial color-coded duplex sonography compared with transcranial Doppler sonography is that it allows the exact identification of different feeding arteries in arteriovenous malformations. Repeated measurements during stepwise embolization with corrected insonation angle are easily achieved, and noninvasive quantification of hemodynamic changes is possible. The method may be helpful in the planning of the different steps of embolization.

Adult↗
PubMed1995

[Quantitative tilt table study with TCD monitoring. A reliable method for the diagnosis of neurocardiogenic syncope (vasovagal syncope)].

The clinical significance of quantitative tilt-table examination with TCD monitoring in the diagnosis of neurocardiogenic syncope is evaluated. A 50-year-old male suffered a neurocardiogenic syncope during tilt-table examination with a strong drop in blood pressure, an increase in cerebrovascular resistance as evidenced by transcranial Doppler monitoring, and a 30-s cardiac asystole, followed by a generalized seizure. No further syncope could be elicited during tilt-table examination after beta-blocker treatment. It was hypothesized that hyperactivity of the left ventricular mechanoreceptors due to increased force of ventricular contraction during a state of reduced venous backstream to the heart was responsible for eliciting the neurocardiogenic syncope. Tilt-table examination with an upright position for at least 45 min enables the diagnosis of a neurocardiogenic syncope to be made with sufficient sensitivity and specificity. Several studies have shown that medication with beta-blockers is successful in the treatment of neurocardiogenic syncope. The implantation of cardiac pacemakers should only be considered if medication is not successful.

Adrenergic beta-Antagonists↗
PubMed1994

Intravascular lymphomatosis of the CNS: clinicopathologic study and search for expression of oncoproteins and Epstein-Barr virus.

Five cases of intravascular lymphomatosis (IVL) are reported. Diffuse or focal cerebral signs suggestive of vascular disease occurred in four cases, but case 5 presented with symptoms similar to Creutzfeld-Jakob disease. Clinical course ranged from two to eight months and diagnosis was made in all cases by autopsy. Neoplastic lymphoid cells mainly lodged in lumina of small vessels in many organs, but infarction was confined to the CNS. Some extravascular tumor cells were regularly seen. All cases corresponded to high-grade Non-Hodgkin lymphomas of B-cell type and displayed high proliferation indices. Different from findings in primary cerebral and nodal lymphomas, neither p53 nor bcl-2 oncoproteins were detectable. Absence of EBV genome and EBV latent membrane protein from IVL was demonstrated for the first time.

Aged↗