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Biomedical subjects

P Wessely

Publications and source records attributed to P Wessely.

At least 55 records · Page 3Linked to original sources
PubMed1987

[On the problem of post-traumatic headache].

Posttraumatic headache is a general term for pain localized in the head or neck, occurring after head trauma and of varied aetiology and pathogenesis. In many cases one only finds a time-dependent relation to trauma, but no causal one. There is no uniform, typical "posttraumatic headache". The headaches are commonly caused by injury to scalp, cervical spine and intracranial structures. A reciprocal influence exists between these functionally disturbed structures and a relation to psychogenic factors, which are essential co-factors. Usually it is difficult to decide whether posttraumatic headaches are exclusively caused by organic or psychogenic factors. Probably both factors are involved to an individually different degree.

Brain Concussion↗
PubMed1987

[Creutzfeldt-Jakob disease. Clinical aspects and diagnosis based on 2 cases].

The case histories are presented of two patients with Creutzfeldt-Jakob disease. The clinical diagnosis was confirmed on autopsy. A 51-year-old man and a 63-year-old woman developed--after a period of non-specific prodromal symptoms--a rapidly progressive dementia accompanied by cerebellar, pyramidal and extrapyramidal signs. The clinical features, the course of the disease and the results of investigations are discussed, as well as the differential diagnosis.

Astrocytes↗
PubMed1987

[Possibilities of early diagnosis of intracranial meningioma based on clinical symptoms].

In a retrospective study, 56 patients with intracranial meningiomas were investigated. The diagnosis was verified by computer tomography with subsequent selective cerebral angiography in all cases. At the time of admission, 62.5% of the patients had functional losses affecting the cranial nerves, 44% functional losses involving the long nerve tracts and 23.2% had cerebellar symptoms. Nonspecific clinical symptoms found comprised headaches in 61% of the patients; these were already present almost three and a half years before the final diagnosis. There was a marked organic psychological disorder in 50% of the patients which had already been present retrospectively for an average of 10 months. Cerebral convulsive attacks were present in 27% of the patients with partial convulsions (mainly of the "temporal lobe type") which had already been present for an average of 40 months before diagnosis; in the general tonic-clonic convulsions, the diagnosis was already made an average of six weeks after the first attack. These data show that nonspecific symptoms such as headaches, organic psychological disorders and cerebral convulsions may be early indicators for the presence of an intracranial space occupation and should be investigated further without delay.

Adult↗
PubMed1987

[Prevention of migraine using flunarizine (results of a pilot study using Amalium)].

A short episode of focal cortical hypoxia seems to be the turning-point in the genesis of the migraine attack. This pathophysiological situation induces vascular changes according to the hypothesis of Wolff. Under such conditions some Ca-antagonists develop antihypoxic and antivasoconstrictive properties. The efficiency of Flunarizine as potent prophylactic drug in migraine therapy is well documented in many double-blind randomized studies versus placebo or other antimigrainous drugs. Based on the positive results of these studies, we liked to investigate the efficiency and tolerability of Flunarizine also in a sample on n = 44 adults Austrian patients recruited from the Headache-Ambulance of the Neurological Department, University of Vienna. After a 3 months treatment with Flunarizine, 10 mg daily, there was a drug free follow-up period of 4 to 12 months. After this time in 29 patients (66.6%) there was a decrease of attack frequency of more than 50%. 12 (27.3%) of them were completed free of attacks. Beside this, the intake of attack ameliorating drugs (ergotamine, analgetics) was markedly reduced. Treatment was well tolerated. Weight gain was observed in 20.3% of patients likely correlating with the therapeutic efficiency. Due to its efficiency, safety and its long-lasting therapeutic effect, Flunarizine appears to be a very suitable agent in the prophylaxis of migraine.

Adult↗
PubMed1987

Unilateral stenosis of the vertebral artery--secondary finding with no prognostic relevance?

The outcome of 142 patients suffering from ischemic cerebral circulation disorders was followed up over a period of 33 months on average. The spontaneous course of 25 patients with unilateral, hemodynamically ineffective stenoses of the vertebral artery was compared with that of 107 patients without vertebral artery stenoses. Within the first 12 months, novel clinically manifest cerebrovascular events were observed in 16.0% of patients without vertebral artery stenosis (deaths 5.0%), but in only 4.3% of the patients with vertebral artery stenosis (no deaths). Within 30 months, only 2 of the 13 patients with vertebral artery stenosis had suffered a new cerebrovascular attack. At the end of the observation period, 39.3% of the patients without vertebral artery stenosis and 48.0% of the patients with vertebral artery stenosis were significantly disabled in their social life or had died. An additional unilateral hemodynamically irrelevant vertebral artery stenosis did not influence the rate of reinfarction or the remission of neurological deficits, independently of age, the degree of the circulatory disorder, the vascular territory involved, the presence of an organic psychosyndrome, or of additional stenoses in the carotid arteries. Consequently, a vertebral artery stenosis narrowing the vessel diameter to less than 1/3 is without prognostic relevance.

Carotid Artery Diseases↗
PubMed1986

[Rare pathomorphologic findings in complicated migraine].

137 patients suffering from classical or complicated migraine were investigated in the Neurology Department of the University of Vienna between 1971 and 1984. 13 of these patients were found to have pathological alterations and their case histories are presented. Clinically, 11 patients suffered from migraine accompagnée (in 2 cases accompanied by epileptic seizures), 1 patient had ophthalmoplegic migraine and 1 had a subarachnoid haemorrhage imitating migraine. The underlying pathological findings were: 1 tumour, 4 arteriovenous malformations, 4 aneurysms, 1 arterio-venous shunt, 1 pathological vascular network, 1 Moya-Moya syndrome and 1 intracerebral haemorrhage without detectable source of bleeding. 8 of the patients underwent successful surgery and most of them showed subsequent clinical improvement. The family history was positive in only 2 patients. The time interval between the occurrence of the first symptoms and the establishment of the final diagnosis was up to 25 years. The neurologist should undertake extensive investigation of the patient, including cerebral angiography, if the following criteria apply: hemicrania consistently on the same side; change in type of headache after a number of years; uniform complicating neurological symptoms; additional occurrence of epileptic seizures; manifestation of neurological symptoms after the prodromal phase; persistent neurological signs without remission; negative family history; persisting diffuse or locally accentuated EEG changes; pathological CAT results.

Adult↗
PubMed1985

[Further therapeutic possibilities with valproic acid (Convulex)].

Valproic acid is used in first case as an antiepileptic; own clinical observance and references from the literature show other indication-fields outside of the group of cerebral fits; so Convulex was employed successfully also in the therapy of perioral dyskinesia of variable etiology and in the medical treatment of therapy-resistant pains within the bounds of Polyneuropathy-Polyneuritis Syndrome. Our own experience is presented by the description of the 10 case histories.

Aged↗
PubMed1985

[The cerebral angiogram in patients with complicated migraine].

38 patients (mean age: 29 years) were investigated by means of complete 4-vessel angiography: all of them were suffering from complicated migraine without detectable vascular malformation. Stenoses of the great craniocervical vessels were found in 11 patients (28.9%), but there was not a single case of vascular occlusion. A correlation between the localization of the stenosis, the localization of the headache and the presumed region of the transient cerebral function disturbance was found only in a few patients. Concerning the morphological changes of the small intracranial arterial branches, there was hardly any difference between clinically affected and non-affected territories of the middle cerebral artery. The angiograms of the 38 cases of complicated migraine were compared with the angiograms of 40 patients suffering from strokes in the young and those of 49 patients with transient ischaemic attacks. There were remarkably fewer stenoses or occlusions in the great craniocervical arteries of patients suffering from complicated migraine (28.9%) than in the vessels of cases of stroke in the young (52.5%). However, the incidence was comparable with the results in patients with transient ischaemic attacks (34.7%). The degree of morphological changes in the small intracranial arterial branches is likely to depend primarily on the patient's age and less on the diagnosis. The results suggest that in almost 30% of patients with complicated migraine-even at juvenile age-stenoses of the great craniocervical vessels might be found.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Cerebral angiography in complicated migraine--reactions, incidents].

Seventy-one patients (ages: 15-58 years) suffering from complicated migraine were investigated by means of cerebral angiography which was not performed during an attack. Angiography was carried out to exclude stenoses or occlusions of the cranio-cervical vessels and above all vascular malformations (arterial aneurysms, arteriovenous angiomas). In 18 cases (25.4%) organic lesions were found, including three vessel malformations (4.2%). Thirty-one patients (43.7%) suffered from headache reactions or other complications during or within 24 h following angiography. In 15 cases (21.1%) attacks of complicated migraine were observed, three patients (4.2%) suffered from headache and bilateral flickering visual disturbances, another 11 patients (15.5%) developed headache and vegetative symptoms requiring therapeutic management. One patient (1.4%) got an epileptic seizure, another patient (1.4%) developed a generalized urticaria exanthema. There were more headache reactions in women than in men. However, the highest percentage of reactions was observed in patients in whom migraine headache had occurred clearly set off from the transient cerebral functional disturbances. Neurological complications (transient functional disturbances) occurred in 16 of 71 patients (22.5%). The neurological complication rate was significantly (P less than 0.001) higher than that in an unselected group of patients (3.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Apraxia of the left limbs in a case of callosal disconnection: the contribution of medial frontal lobe damage.

A 40 year old right-handed woman suffered hemorrhage from an anterior cerebral artery aneurysm. CT scan showed destruction of the anterior two thirds of the corpus callosum, both cingulate gyri, and the white matter underlying the medial frontal lobes. The left limbs displayed apraxia on verbal command, in imitation, and in actual object use. There were antagonistic actions of both hands, and the patient accused her left hand of disobeying her. We interpret the leftsided apraxia as resulting from a lack of interhemispheric transfer combined with a deficit in ipsilateral motor control stemming from damage to the left supplementary motor area. Right frontal lobe damage may have impaired the motor learning capacity of the right hemisphere and thus its ability to compensate for the lack of left hemisphere motor control.

Adult↗
PubMed1985

[EEG findings in complicated migraine].

In the past 11 years 115 patients with complicated migraine were examined at the Neurological University Clinic of Vienna (34 male, 81 female, age range 15-65 years, mean age 32 years). About 80% suffered not only from complicated but also from uncomplicated migraine. 6 cases had ophthalmoplegic migraine, 3 cases typical basilaris migraine and the rest (n = 106) migraine accompagnée. The complicated neurological symptoms consisted in most cases of transient sensory and/or motor deficits (n = 37), 15 of these cases had additional visual field deficits. 36 cases had combination of marked aphasia with sensory and/or motor deficits, 16 were monosymptomatic with severe hemihypaesthesia, 10 cases had only motor deficits. The complicating symptoms (i.e. neurological deficits) occurred before attacks of headache and autonomic symptoms in 85 cases. The man frequency of complicated migraine showed a maximum of 1-2 attacks per year (n = 28), the mean duration of single attacks were 15-45 minutes in most cases (n = 31). Only 3 cases had presistent deficits. All patients were examined with EEG, 24.3% of standard EEG done at an any timepoint within the first 3 month after the last attacke revealed no abnormality, 8.7% cases had diffuse slowing, 14.8% bilateral dyshythmia over tempro-frontal areas, other 19.2% asymmetries of this activity and surprisingly 33.1% foci. The maximum of abnormal activities was over frontal and temporal areas. Marked spikes and sharp waves etc. was observed only in 8%. This is the distribution of abnormal EEGs with regard to the severity of abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Paroxysmal brain stem ischemia in a combination of thoracic outlet syndrome with contralateral subclavian steal syndrome].

Mechanical irritation of the right subclavian artery in the scalenus region and stenosis of the contralateral subclavian artery in combination with hypoplasia of the vertebral artery led to recurrent neurological symptoms in a 41 year-old female patient. Sudden loss of consciousness, episodes of dizziness, vomiting and paraesthesiae occurred as a result of manoeuvres involving turning the head and lifting the right arm. A significant blood pressure difference between both arms and a stenotic bruit were found. Angiography revealed the "subclavian steal syndrome" with stenosis of the left subclavian artery and hypoplasia of the left vertebral artery. On operation of the right scalenus region an atypically angled origin of the right vertebral artery was detected. After dissection of the scalenus anticus muscle and-in a second step-transaxillary resection of the first rib the patient has remained symptom-free for the past 24 months.

Adult↗
PubMed1984

[Sarcoidosis of the nervous system. Clinical and diagnostic synopsis based on two cases].

This paper reports two cases of neurosarcoidosis . Initially the clinical picture involved only the nervous system. Later on manifestations pertaining to other systems were detected by interdisciplinary investigations. The resulting diagnostic problems, the value of additional investigations and the therapeutic management are discussed on the basis of the two presented cases.

Adult↗
PubMed1983

[Polygraphic registration of spontaneous syncope].

A 29 year-old female patient suffered from a syncopal attack in the early morning hours. During polygraphic registration (ECG, EEG, pulse, breathing, blood pressure) on a tilt table she developed another spontaneous orthostatic syncopal attack, which was triggered off by a lengthy period of standing and was preceded by a drop in the recorded blood pressure. She was asystolic over 21 sec., the EEG did not show any bioelectric activity (with standard attenuation) over 22 sec. Within a short time she recovered fully from the clinical, as well as from the polygraphic point of view. The syncopal attack in this patient is discussed as being of the vagocardial type in connection with vagotonia. The original polygraphic data of the relevant period are presented.

Adult↗
PubMed1983

[A chemically induced polyneuropathy in chronic polyarthritis treated with D-penicillamine?].

Polyneuropathy occurring during therapy with D-penicillamine is reported in a 63 year-old women with chronic rheumatoid arthritis. 6 weeks after recommending therapy with 500 mg D-penicillamine/day the patient developed bilateral oculomotor palsy and axonal peripheral neuropathy. The development of clinical symptoms was accompanied by the observation of high levels of antinuclear antibodies and antibodies against native DNA. The appearance of polyneuropathy after repeated administration of penicillamine, the regression of symptoms and the rapid decrease in antinuclear antibodies after discontinuation of the drug plus the absence of signs of a malignant form of rheumatoid arthritis show a remarkable correlation.

Antibodies, Antinuclear↗