[Successful surgical management of dementia symptoms].
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Aged↗
Biomedical subjects
P Lyrer
Publications and source records attributed to P Lyrer.
[Intensive monitoring of patients with acute cerebral ischemia within the scope of a coordinated stroke treatment concept: initial experiences].
QUESTIONS UNDER STUDY: It has been shown that the prognosis of patients with stroke can be improved by specialized stroke units. Whether any additional benefit can be achieved by use of intensive care resources is unknown. Therefore, it was the purpose of this study to analyze our first experience of management of patients with acute ischaemic stroke in an intensive care unit, as part of a newly implemented coordinated stroke concept. METHODS: A consecutive series of 88 patients with acute ischemic stroke (age 64.4 +/- 14.2 years, 28% females) hospitalized in a medical intensive care unit according to predefined criteria formed the study population. The goals were to monitor vital functions, to complete diagnostic studies in timely fashion and to prevent and treat complications. RESULTS: The patients were hospitalized in the intensive care unit for a mean period of 34.4 +/- 19.5 hours. Relevant pathologic findings included systolic hypertension > 220 mm Hg in 5% and permanent or intermittent relative systolic hypotension < 150 mm Hg in 25% and 98% of patients respectively. One patient (1%) died during the stay. Additional diagnostic studies were performed more often in patients with progressive or fluctuating symptoms (100% of patients in each group) than in those with improving or stable symptoms (50% of patients in each group). Fourteen percent of patients were treated for hypertension and 30% for hypotension. Antithrombotic therapy with aspirin was started in 34%, prophylaxis for venous thrombosis with low dose heparin in 39% and systemic anticoagulation in 40% of patients respectively. No cardiac or pulmonary complications requiring treatment were observed and no specific therapies for neurologic complications were utilized. At the time of discharge from the intensive care unit, 88% of patients showed improved or stable neurologic findings. CONCLUSIONS: In the present analysis, an unexpectedly high incidence of relative arterial hypotension was observed in patients hospitalized in an intensive care unit for acute ischaemic stroke. Therapeutic measures were restricted mainly to blood pressure control and anticoagulation/antithrombotic treatment. Specific therapies for neurologic complications or interventions requiring the resources of an intensive care unit were not used. Whether defined patient groups with ischaemic stroke will benefit from specific treatment in an intensive care unit needs to be tested by controlled, randomized studies.
Acute Disease↗
MR angiography in internal carotid artery dissection: improvement of diagnosis by selective demonstration of the intramural haematoma.
We studied eight consecutive patients with clinical and intra-arterial angiographic (DSA) diagnosis of internal carotid artery (ICA) dissection to analyse the accuracy of MRA in dissections, using a new technique with presaturation pulses. Spin-echo images of the head were followed by three-dimensional time-of-flight (TOF) MRA at the site of the dissection, with and without a special caudal saturation pulse in addition to the cranial one. The accuracy of MRA was assessed in 64 segments of 16 ICA, all examined with DSA and MRA. High-signal intramural haematoma in the ICA at the level of the dissection was observed in all patients either on the maximal-intensity projection (MIP) reconstructions or on the partitions with this presaturation pulse technique. MRA had a sensitivity to detect dissected vessels of 100%. Specificity for vessels correctly identified as not having a lesion was also 100%. There was good correlation between DSA and MRA in demonstrating the site of the dissected ICA segment and the degree of stenosis. In only two cases was there overestimation of the degree of stenosis on the MIP reconstructions of the 3-D MRA.
Adult↗
Prostate-specific antigen in the cerebrospinal fluid leads to diagnosis of solitary cauda equina metastasis: a unique case report and review of the literature.
A 79-year-old male patient presented with a subacute cauda syndrome caused by an intradural metastasis of the lumbosacral caudate fibres from an adenocarcinoma of the prostate, which had been treated 5 years earlier with external beam radiation therapy. Diagnosis could not be established by repeated magnetic resonance images (MRIs) during a 2-year period of increasingly severe radicular pain. Eventually, a small tumour mass could be visualized on the fourth MRI. Repeated normal serum prostate-specific antigen (PSA) did not hint at a prostate cancer metastasis (range 2.4-5.1 ng ml(-1)); however, PSA in the cerebrospinal fluid was found to be elevated (29.1 ng ml(-1)). Empirical radiation therapy of the caudate region did not improve radicular pain. Therefore, an exploratory surgical procedure was conducted, which confirmed the suspicion of an intradural prostate cancer metastasis. In conclusion, PSA in the cerebrospinal fluid provides a useful diagnostic tool for detecting intradural prostate cancer metastasis.
Adenocarcinoma↗
[Amnesia. Transient global amnesia].
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Aged↗
Acute infectious disorders of the spinal cord and its roots with gadolinium-DTPA enhancement in magnetic resonance imaging.
We studied three patients with myelomeningoradiculitis caused by Borrelia burgdorferi, herpes zoster virus or cytomegalovirus infection. All patients underwent MRI of the spinal cord with gadolinium-DTPA and showed enhancing lesions of the spinal cord or nerve roots that correlated with clinical signs. Gadolinium-DTPA enhancement may visualize lesions that suggest an inflammation associated with blood-brain-barrier alteration and indicate the diagnosis before serological results are available.
Adult↗
[Prognosis of and basis for decision making in transient ischemic attacks].
Transient ischemic attacks are frequently seen in physicians' daily clinical practice. TIA's are often a warning sign of a following stroke. It is important to diagnose the underlying etiology in order to prevent subsequent stroke. With knowledge of the exact etiologic diagnosis correct secondary preventive therapy may be given. Most patients have atherosclerotic cerebrovascular disease. The aim of this procedure is to save patients from disabling strokes. There is no need to hospitalize patients in the absence of severe comorbidity.
Aged↗
Doppler monitoring of middle cerebral artery emboli from carotid stenoses.
The aim of this study was to prove the existence of clinically silent embolization arising from carotid stenoses. Simultaneous bilateral transcranial Doppler sonography of the middle cerebral artery was carried out during 10 minutes in 30 patients having ultrasonically demonstrated unilateral (n = 12) or bilateral internal carotid stenoses (n = 18). Twenty-four of the stenoses were clinically considered to be symptomatic and 24 were asymptomatic. Emboli signals were detected in 5 of the 30 patients. All occurred unilaterally on the side of a high-grade carotid stenosis. Four of the 5 lesions were symptomatic, and 1 was asymptomatic.
Aged↗
[Current concepts in the acute treatment of cerebrovascular insults].
Up to the present, treatment strategies for acute cerebral ischemia have not shown scientifically proven efficacy. Based upon new knowledge on stroke pathogenesis and experimental data, new concepts of cerebral ischemia treatment are being clinically tested. The main therapeutic instrument is clot lysis by systemic or local application of thrombolytic drugs or the use of cytoprotective agents. For both treatment strategies clinical trials to show efficacy are ongoing or planned. Early reperfusion can be obtained by fibrinolysis, but its clinical usefulness has yet to be proven.
Acute Disease↗
[Is early diagnosis possible in cerebral aneurysm? Symptoms of saccular cerebral aneurysms before the occurrence of massive subarachnoid hemorrhage. Literature review and discussion].
Cerebral aneurysms may manifest as subarachnoid hemorrhage. Approximately two fifth of the patients with subarachnoidal hemorrhage complained of early symptoms prior to the major hemorrhage. The complaints may be headache as the most likely, cranial nerve palsies, different vegetative symptoms, transient neurologic deficits, etc. Considering the good outcome of surgical repair of cerebral aneurysms before a major hemorrhage occurs makes it evident that early diagnosis of intracerebral aneurysm is crucial. In the following we will discuss early signals and warning symptoms with respect to literature and personal experiences.
Adult↗
[Severe herpes simplex encephalitis: course 15 years following decompressive craniotomy].
Decompressive craniotomy with brain biopsy was carried out in two patients with herpes simplex virus encephalitis (HSE). In both cases the indication for surgery was based on the clinical picture of coma with rapidly progressive hemiparesis and on the computer tomographic finding of a large space-occupying lesion of in the temporal lobe accompanied by brain stem compression not controllable by medication. Both patients were treated with a standard dosage of vidarabine (Ara-A 15 mg/kg/24 h) and corticosteroids after the operation. The improvement attained by surgery was very impressive in both cases. The massive neurological deficits (which also included subtotal aphasia in one case) regressed to a minimum in the following weeks. Both patients were followed up at yearly intervals for 15 years. They are now 36 and 76 years of age, both in a very satisfactory condition. Our observations show that decompressive craniotomy with duraplasty may be the crucial therapeutic measure in HSE with brainstem compression not controllable by medication.
Adrenal Cortex Hormones↗
Levels of low molecular weight scavengers in the rat brain during focal ischemia.
Ascorbic acid, cysteine, glutathione, uric acid, tyrosine and tryptophan were quantified in samples of frontoparietal cortex, striatum, hippocampus and cerebellum from both sides of rat brain 0.5 h, 4 h and 24 h after focal ischemia. Cysteine, tyrosine and tryptophan were increased in cortex and striatum at 0.5 h, returning afterwards to normal. Uric acid was increased, whereas ascorbic acid and glutathione were correspondingly decreased. Although changes can be explained primarily by energy failure they are also consistent with free radical activity during early stages of ischemia.
Amino Acids↗
[MRI and the diagnosis of multiple sclerosis].
88 patients aged 22-70 (mean 44) years, presenting with symptoms and/or signs of multiple sclerosis, were investigated by MRI for the purpose of revealing MS-like lesions. 54% of all patients had MRI scans suggestive of MS. Patients with clinically definite MS had MS-suggestive lesions in 85% of cases, and none was normal. In patients with possible signs or symptoms of MS the rate of MS-suggestive MRI scans was 34%. MS lesions can be detected, in decreasing order, in the white matter of the hemispheres (centra semiovalia), the periventricular system, the basal ganglia and the posterior fossa. MRI confirms the diagnosis of clinically definite MS and diagnoses MS in cases with questionable MS symptoms or signs.
Adult↗
[Multiple sclerosis: correlation between clinically suspected locations and ascertained lesions in MRI].
The neurological symptoms of patients with multiple sclerosis are located to four brain areas and are compared with the demonstrated Magnetic Resonance Imaging (MRI) lesions. Areas mostly involved are the centrum semiovale, the periventricular space, the cerebellum and the brain stem. There is a good correlation of the different clinical locations and the MRI lesions in general. Only in the cerebrum lesions are more frequent than expected. In individual patients correlations are difficult to achieve especially in the cerebellum and the spinal cord. Repeated, complete studies of the brain and the spinal cord with contrast medium are necessary to improve the results.
Brain↗
[Current assessment of radioimmunological determination (RIA) of prostate acid phosphatase in the diagnosis of prostatic cancer].
Sera of patients without any tumors of the prostate and sera of patients with benign and malignant tumors of the prostate were tested with the enzyme assay using thymolphthalein monophosphate as substrate. The results were compared with the RIA of Clinical Assay (Travenol) and found to yield an approximately 50% better recognition of malignant growth. However, false-positive rates were rather high (approximately 20%), which lowers the overall success rate to approximately 30%.
Acid Phosphatase↗
Prominent activation of the putamen during essential palatal tremor: a functional MR imaging case study.
Palatal tremor (PT), also known as palatal myoclonus, is defined by short rhythmic contractions of the palatal musculature. Functional MR imaging (fMRI) revealed prominent bilateral neuronal activation in the putamen associated with essential palatal tremor (EPT) in a 41-year-old man. This implies a central role of the putamen in EPT, most likely as a consequence of diminished inhibition in an afferent pathway. Because fMRI primarily detects activations, dysfunctional areas remain obscure. The present functional study complements previous pathologic studies, which associated PT with lesions to dentate nucleus, red nucleus, and the inferior olive (Guillain-Mollaret triangle).
Adult↗