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Biomedical subjects

R Biniek

Publications and source records attributed to R Biniek.

35 records · Page 2Linked to original sources
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↗
PubMed1986

[Cryptococcal meningitis].

Cryptococcal meningitis is a life-threatening disease. Headache, vomiting, cranial nerve symptoms and mental changes are the most common symptoms, but as many as 15% may have no symptoms referable to the CNS. For chemotherapy four drugs are available: namely amphotericin B, 5-fluorocytosine, miconazole and ketoconazole. Most cases have been treated by combination of amphotericin B and 5-fluorocytosine. The intrathecal administration of amphotericin B should be considered for patients who fail to respond to the usual intravenous therapy. The case is reported of a patient who died due to hydrocephalus, and the CSF-levels of the administered drugs are presented. Some pitfalls of therapy are discussed.

Adult↗
PubMed1984

[Limitations of neurologic intensive care].

The indication for intensive care in incurable neurological diseases is discussed. An attempt is made to analyse the problem by presenting two cases of multiple sclerosis and two other cases of amyotrophic lateral sclerosis. There is a clear indication for intensive-care treatment in all cases with life-threatening symptoms and complications, provided there seems to be a chance of reversibility in spite of an eventually poor prognosis. If there is no chance of improvement, and the illness has reached its terminal stage, we do not think, that intensive care is of any benefit for the patient. However, we are not able to make a decision should he insist on such a treatment. When the patient is doomed to die in any case, there is no obligation to inform him about a life-prolonging treatment which is not indicated.

Adult↗
PubMedDate not supplied

[Infarct of the basal ganglia in childhood--clinico-neuroradiologic findings and differential diagnosis].

Basal ganglionic infarctions during childhood are comparable in size and favourable prognosis with lacunary infarctions in adults. Considering their etiology they are comparable with capsular infarctions in adults. In four children with basal ganglionic infarctions and acute motoric hemiparesis, a quick and complete regression of clinical signs and CT-findings was observed. With regard to the differential diagnosis of basal ganglionic infarction we additionally report of a female patient with initially unilateral lesion who had silently developed the hemiparesis. In this case the clinical course and the neuroradiological follow-up findings suggested Leigh disease.

Adolescent↗