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Biomedical subjects

R Biniek

Publications and source records attributed to R Biniek.

At least 19 recordsLinked to original sources
PubMed1992

Non-traumatic subarachnoid hemorrhage with normal angiogram. Long-term follow-up and CT predictors of complications.

We investigated 91 patients with non-traumatic subarachnoid hemorrhage (SAH) in whom no aneurysm was found on initial angiography. In 31 of these patients CT did not show subarachnoid blood. A typical feature was a localized blood clot in the prepontine or interpeduncular cistern. Follow-up was obtained 6 months to 11.8 years after SAH by personal re-examination (n = 49) or questionnaire sent to patients or their doctors. 79 patients were free of neurological signs, 3 had a mild and one a severe neurological deficit. Five patients had died from SAH. Those patients who died or had complications often had blood in the frontal basal interhemispheric fissure. None of the 3 therapeutic regimens applied proved to be superior. We conclude that prognosis is good, but an unidentified aneurysm must be considered and repeat angiogram is warranted if blood is found in the anterior part of the basal cisterns. When the hemorrhage is in the prepontine cistern, repeat angiogram is not necessary.

Adult↗
PubMed1992

Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalization.

We evaluated the influence of time of recanalization or degree of initial leptomeningeal collateral blood flow in cardioembolic or arterio-arterial middle cerebral artery (MCA) occlusion on infarct size and clinical outcome in a series of 34 consecutive acute stroke patients with main stem (N = 31) or major branch (N = 3) occlusions using CT, initial cerebral arteriography (N = 21), repetitive close-meshed transcranial Doppler ultrasonography, and a neurologic stroke scale. We treated 15 patients with tissue plasminogen activator intravenously within the first 6 hours. The type and size of infarction depended on the location of the occluding lesions within the MCA trunk. Proximal MCA occlusion always led to infarction involving the striatum and internal capsule. Sixty-five percent of patients showed recanalization of the occluded MCA within 1 week. Following MCA recanalization, hyperperfusion was present in 38 to 44% of cases. There was a marginally significant relation between size of infarction on CT and recanalization time within the first 24 hours. The more rapidly recanalization occurred, the smaller the size of the infarct. When recanalization time was greater than 8 hours, the lesions always extended to the cortex. An additional good leptomeningeal collateral blood flow significantly reduced the size of the infarct and improved clinical outcome after 17 days and after 10 months. Early recanalization of embolic MCA occlusions within up to 8 hours, in conjunction with good transcortical collateralization, has a favorable impact on infarct size and outcome and may constitute the therapeutic window of opportunity.

Aged↗
PubMed1992

[The Aachen Aphasia Bedside Test--criteria for validity of psychologic tests].

The Aachen Aphasia Bedside Test (AABT) has been developed in order to examine aphasic patients within the first 4 to 6 weeks after onset of illness. The psychometric properties of the AABT were established by repeated examination of 82 acute stroke patients, ratings by 20 raters on the basis of 10 videotapes, repeated examination of 28 chronic aphasics three times with an interval of 2 days, and parallel examination of 47 chronic aphasic patients with the AABT and the Aachen Aphasia Test (AAT), administered on the same day. Objectivity, reliability and validity of the AABT were highly rated, indicating its usefulness in acute stroke cases. Data on the 82 acute stroke patients showed that an initial prognosis can be made as early as the fourth day after the stroke.

Adult↗
PubMed1992

High frequency vibration induced gating of subcortical and cortical median nerve somatosensory evoked potentials: different effects on the cervical N13 and on the P13 and P14 far-field SEP components.

Subcortical and cortical somatosensory evoked potentials (SEP) to median nerve stimulation were recorded before, during and after high frequency (270 Hz) vibration of the fingers 1-3 in 8 healthy subjects. A marked decrease of the amplitude of all potentials was observed. The attenuation of the sensory nerve action potential (SNAP) of the median nerve and the attenuation of SEP components N9, N11 and N13 showed no differences, while the attenuation of the subcortical P14 component was significantly higher. This is in accordance with a generator of the cervical N13 in the interneurons beside the lemniscal pathway. The cortical N20 (post-rolandic) was significantly more decreased in amplitude than P14 while P22 (pre-rolandic) remained reduced in amplitude like P14. An increased latency of the far-field subcortical P14 was observed, while P13 recorded in the same montage remained unchanged in latency. These findings suggest different generators of these peaks. A generator of P14 above the nucleus cuneatus is confirmed. A presynaptic generator of P13 is suspected.

Action Potentials↗
PubMed1991

Infarctions and non-invasive diagnosis in moyamoya disease: two case reports.

An 31-year-old female and a 32-year-old male had clinical signs and angiographical confirmation of adult Moyamoya disease (MMD). Bilateral carotid siphon (C1), middle cerebral artery (M1), and anterior cerebral artery (A1) stenoses were diagnosed by means of transcranial Doppler sonography (TCD) and visualized during angio Magnetic Resonance Imaging (angio-MRI). In the woman, a 'rete mirabile' of dilated and tortuous lenticulostriate arteries could be visualized during proton weighted and T1-weighted MRI sequences. CO2-dependent vasomotor reactivity was bilaterally reduced and completely exhausted in the territory of right middle cerebral artery in both patients. Cerebral perfusion reserve, defined as the ratio of cerebral blood flow (CBF) to cerebral blood volume (CBV) was assessed by SPECT, and was found to be dramatically reduced in the anterior region of the male patient. Both patients had bilateral small subcortical infarctions in the corona radiata. TCD and MRI are important noninvasive techniques for a preliminary diagnosis of Moyamoya disease. Infarctions in Moyamoya disease may be hemodynamically produced low-flow infarctions.

Adult↗
PubMed1991

[Clinical aspects of acute lesions of the brain stem of inflammatory origin].

The diagnostic considerations of an inflammatory brainstem disease and its symptoms are shown in 22 cases. The diagnosis based on a topodiagnostic decision and the demonstration of an inflammatory genesis. The topodiagnosis has to take into consideration that a symptom can be caused by both a central lesion as well as a peripheral nerve lesion. Electrophysiological methods (EEG, Nerve conduction velocity, reflex studies and evoked potentials) were of only minor use in these decisions. The somatosensory evoked potentials demonstrated 5 central lesions and were far more useful than the other methods. The CCT demonstrated a brainstem lesion in one case. In fifty percent of the cases, symptoms caused by both peripheral and central nerve lesions were demonstrated. Thus, there is no clear border between a brainstem encephalitis and a peripheral neuropathy (Fisher-Syndrome or Guillain-Barré-Syndrome). The inflammatory genesis was proven by CSF in 12 cases. An inflammatory disease was supported in the other cases through the exclusion of another genesis by means of CCT, NMR, Doppler sonography, angiography and an observation of the course of the illness.

Adolescent↗
PubMed1991

[Immunotherapy of chronic Guillain-Barré syndrome with high dose IgG and cyclosporin A. Case report, review of the literature and perspectives].

We report about the three-year treatment of a patient with chronic relapsing Guillain-Barré syndrome (GBS), who, simultaneously, suffered from benign gammopathy. A casual relationship between the two diseases could not be proven, since specific antimyeline antibodies could not be found. Five severe bouts of the disease occurred during the observation period, only the first two relapses, however, showed improvement with cortisone treatment, while the latter did not so. High dosages of 7S-immunoglobuline, by contrast, led to a rapid improvement during each of the subsequent relapses. The additional therapy with ciclosporine A kept the patient free from neurological deficits for more than six months now. The mechanisms of various immunological therapeutic approaches are discussed, particularly as an alternative to plasmapheresis. Our observation, as well as theoretical considerations, suggest the aforementioned immunological treatment being promising in chronic GBS.

Aged↗
PubMed1991

[A test for the detection of speech and language disorders in the acute phase after stroke. Development and clinical application].

No standardized assessment of aphasic symptoms for stroke patients in the acute phase has as yet been published in the German language. Current test batteries such as the AAT are too time-consuming and cannot be performed on severely impaired patients. A short test for the examination of aphasic and dysarthric symptoms has been developed which contains 7 subtests in three main areas: spontaneous speech, comprehension and planning of movements, speech and language abilities. Since abilities in acute cases may only be functionally impaired and often only detectable after stimulation, standardized stimulation is applied in most of the subtests. In this way it is possible to test acute stroke patients for aphasic and dysarthric symptoms. The course of recovery in a typical case is described.

Aged↗
PubMed1990

Complex hyperkinesia during recovery from left temporoparietal cortical infarction.

A 51-year-old man with preexistent lacunar infarctions in the basal ganglia and pons developed complex involuntary movements of his right arm 1 day after a purely cortical-subcortical ischemic infarction in the territory of the left middle cerebral artery sparing the basal ganglia. The movements were stereotyped and repetitive, affecting hand and fingers or proximal arm muscles alternatively or together. Although hyperkinesia after basal ganglia lesion has been described many times in the literature, it has not yet been reported after cortical-subcortical ischemic infarctions sparing the basal ganglia.

Cerebral Infarction↗
PubMed1990

Loss of brainstem acoustic evoked potentials with spontaneous breathing in a patient with supratentorial lesion.

The loss of brainstem acoustic evoked potentials (BAEP) is considered as a confirmatory test for the diagnosis of brain death in patients with supratentorial lesions. We report a patient with ischemia in the territory of the left middle and anterior cerebral artery, who showed a loss of BAEP waves III-V as a sign of brainstem compression, but maintained spontaneous breathing and EEG activities. We conclude that occasionally BAEP may provide misleading results in the diagnosis of brain death.

Aged↗
PubMed1989

The complete apallic syndrome--a case report.

In six patients with apallic syndrome the EEG was isoelectric, although the patients were breathing spontaneously and vegetative functions remained stable for a long period of time. No cortical somatosensory evoked potentials could be recorded in four of the patients examined. Cranial CT performed in three patients revealed extensive hypodensity of the cortex, whereas the brain stem showed no major damage. This syndrome is labelled a "complete apallic syndrome". None of our patients, and none of the 23 patients described in the literature, recovered.

Adult↗
PubMed1988

Intrathecal production of HIV antibodies in suspected AIDS encephalopathy.

Thirty-one serum and CSF samples from 21 HIV-antibody-positive patients with neurological deficits were examined to prove or exclude intrathecal production of HIV antibodies. By dilution, sera were adjusted to the IgG concentration of the corresponding CSF samples. Both samples were then serially diluted in log2 steps down to the detection limit and were tested in an anti-HIV ELISA. From the dilution obtained at the cut-off level, a quotient QHIV was derived as an indicator of intrathecal production of HIV antibodies. Six of a total of eight samples with a QHIV value of greater than or equal to 2 were correlated which the clinical diagnosis of AIDS-related dementia complex (ARDC). However, a QHIV less than 1 did not exclude the development of ARDC, as was shown during follow-up in one case. Different methods are compared for the determination of intrathecal production of IgG and anti-HIV. A quotient QHIV greater than or equal to 2 is suggested to be highly indicative of intrathecal production of anti-HIV as well as of the development of ARDC.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Human immunodeficiency virus antibodies in cerebrospinal fluid.

The relative concentrations of human immunodeficiency virus (HIV) antibodies in relation to equal IgG contents of 46 serum cerebrospinal fluid (CSF) samples from 32 patients were determined by serial dilution in an anti-HIV enzyme-linked immunosorbent assay (ELISA). The ratio of CSF and the serum HIV antibody concentration was expressed as QHIV = CSF dilution/serum dilution. QHIV is regarded as a parameter for specific intrathecal HIV antibody production. The QHIV ranged from 0.7 to 16. Six of seven patients with clinical signs of acquired immunodeficiency syndrome (AIDS)-related dementia (ARD), but only seven of 25 patients without clinical diagnosis of ARD showed a QHIV greater than 2.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[EEG changes in HIV infections].

A standardized examination, including EEG, was performed in 54 cases of HIV infection. The EEGs were analyzed and compared to 30 EEGs of HIV-negative test persons. The visual analyses with respect to basic activity, dysrhythmias, general slowing, foci and alteration of vigilance were performed without any information on HIV infection. Significant differences in the median frequency were found between both groups, HIV-positive patients presenting with a slower basic activity. Moderate or severe dysrhythmias (2 patients) or foci (2 patients) were found exclusively in HIV-positive patients. The findings described above could not be replicated when only HIV-patients without secondary CNS infections were compared to HIV-negative test persons.

Acquired Immunodeficiency Syndrome↗