Search PubMed⌕ Search

Biomedical subjects

R Klingebiel

Publications and source records attributed to R Klingebiel.

At least 19 recordsLinked to original sources
PubMed2006

[Multislice computed tomographic myelography].

While magnetic resonance imaging (MRI) is the first line modality in depicting intramedullary spinal lesions, computed tomographic (CT) myelography has gained renewed attention due to the introduction of multislice scanning (MS-CT). Compared with conventional CT, MS-CT permits rapid, high-resolution imaging of various spinal pathologies with extended scan length. Although soft tissue contrast is inferior to that with MRI, MS-CT myelography performs best in detailed assessment of osseous pathologies, 3D imaging of orthopedic and anesthesiologic implants, and showing dural leakage and causes of CSF circulation impairment. Whenever MRI is not available or contraindicated, MS-CT myelography is the method of choice for evaluating spinal lesions.

Anatomy, Cross-Sectional↗
PubMed2005

Opening of the blood-brain barrier preceding cortical edema in a severe attack of FHM type II.

The authors report a patient with familial hemiplegic migraine type II who developed a long-lasting attack including fever, right-sided hemiplegia, aphasia, and coma. Quantitative analysis of early gadolinium-enhanced MRI revealed a mild but significant left-hemispheric blood-brain barrier (BBB) opening limited to the cortex and preceding cortical edema. The findings suggest that the delayed cortical edema was vasogenic in the severe migraine aura variant of this ATP1A2 mutation carrier.

Adult↗
PubMed2005

[Adenocarcinoma-associated nonbacterial thrombotic endocarditis as the cause of recurrent strokes].

We describe a 60-year-old female patient without vascular risk factors diagnosed with cardioembolic ischemic stroke due to an atrial septal aneurysm with a right-to-left shunt. However, further investigation after recurrent strokes revealed a nonbacterial thrombotic endocarditis (NBTE) caused by a metastatic adenocarcinoma. The presented case illustrates the difficulties in establishing the diagnosis of NBTE premortally and points out the importance of repeated echocardiographic evaluations of cardiac valves and serological examination of tumor markers in patients with recurrent strokes of unknown origin.

Adenocarcinoma↗
PubMed2005

[Sporadic cerebral amyloid angiopathy with ischemic leukoencephalopathy and microbleeds. Cause for a rapidly progressive dementia syndrome].

We describe a 72-year-old patient with rapidly progressive dementia and a complex focal seizure. Magnetic resonance (MR) imaging revealed leukoencephalopathy with the involvement of the U-fibers as well as cortical and subcortical microbleeds. Brain biopsy confirmed the diagnosis of cerebral Abeta amyloid angiopathy (CAA). The presented case illustrates the significance of CAA as a cause of rapidly progressive dementia and leukoencephalopathy and points out the importance of T2-weighted MR imaging in the evaluation of dementia.

Aged↗
PubMed2005

Internal jugular vein valve incompetence and intracranial venous anatomy in transient global amnesia.

BACKGROUND: Recently a causal relation between internal jugular vein valve incompetence (IJVVI) and transient global amnesia (TGA) has been suggested. IJVVI is postulated to provoke a transient mesiotemporal ischaemia by venous congestion. This mechanism requires a patent venous pathway from the affected IJV through the transverse sinus, confluens, straight sinus (SS), vein of Galen into the basal vein of Rosenthal and the internal cerebral veins. OBJECTIVE: To study IJVVI in TGA patients in relation to the intracranial venous anatomy. METHODS: IJVVI was defined if a repeated Valsalva manoeuvre (VM) led to a retrograde jugular flow detected by extracranial duplex ultrasound. Non-contrast venous MR angiography (MRA) was performed to analyse intracranial drainage patterns of the SS in relation to the side of the IJVVI. SS drainage was differentiated into three groups: predominantly right, left, and bilateral drainage. Ultrasound studies were performed in 25 TGA patients and 85 age matched controls. Twenty patients underwent venous MRA. RESULTS: Sixty eight per cent of patients and 33% of controls showed unilateral or bilateral IJVVI (p = 0.0025). In 36% of patients a TGA preceding VM was reported. Drainage pattern of SS and side of IJVVI corresponded in five of eight patients (63%) with VM and four of 12 patients without VM (33%, p = 0.0994). CONCLUSION: Our study confirms the significantly higher prevalence of IJVVI in TGA patients. However, no specific IJVVI related intracranial venous drainage patterns could be found to further support the hypothesis of a direct causal relation between IJVVI and TGA.

Adult↗
PubMed2003

[Langerhans cell histiocytosis: petrosal remodelling after chemotherapy--case report and review of the literature].

We report the case of a child presented by her parents to the ENT outpatient service for swelling of the right temporal bone. The child had a history of recurrent bilateral inflammation of the middle ear. Tympanometry revealed a reduced compliance. Due to conductive hearing loss it was impossible to measure otoacustic emissions. Otherwise a normal ENT status was found. Imaging (MRI/CT) demonstrated bitemporal soft-tissue changes with extensive osseous destruction, but no typical imaging signs of an inflammatory, dysplastic or expansive process. The tentative diagnosis of Langerhans' cell histiocytosis (LCH) made on the basis of the clinical and imaging findings was confirmed by biopsy. After exclusion of disseminated LCH, chemotherapy was initiated, and the child underwent follow-up imaging after 3 months. CT showed clear signs of bitemporal reossification. The case reported here illustrates the problems encountered in diagnosing LCH which may present with unspecific clinical symptoms despite advanced osseous destruction. ENT specialists should be familiar with this very heterogeneous entity and think of LCH especially in children presenting with therapy-refractory otitis media, otitis externa, or mastoiditis in order to ensure a timely diagnosis and to thus improve the chances of successful therapy. Imaging modalities (CT, MRI) have a role in the early diagnosis and follow-up of this disorder.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

[Bilateral spontaneous development of a frontal sinus pyocele--a rare diagnosis].

Due to the length and the narrowing of the sinus draining passage, mucoceles are typically located within the frontal sinus. This case report describes the pathology of a patient with bilateral formation of pyoceles of the frontal sinus without the history of trauma, sinus operation or nasal pathology. The patient visited an ophthalmologist and reported a slowly increasing visual loss and protrusion of the left bulbus in the course of one year. Coronal CT scan showed bilateral soft tissue densities within the frontal sinus with arrosion of the floor on the left side. Extranasal frontal sinus surgery with ethmoidectomy (Ritter-Jansen and Uffenorde mucosal plasty) was performed. Intraoperative view demonstrated bony defects of the floor and the posterior wall of the frontal sinus.

Aged↗
PubMed2003

[Quantitative perfusion imaging by multi-slice CT in stroke patients].

OBJECTIVES: Evaluation of a parametric deconvolution algorithm (DA) in the diagnostic assessment of stroke patients by multi- slice spiral computed tomography (MS-CT). MATERIAL AND METHODS: 52 patients (age range 34 - 89 years) with clinically suspected acute ischemia of one hemisphere and no infarct demarcation on plain cerebral CT underwent CT perfusion (CTP), performed on average 3.4 hours after the onset of symptoms by using MS-CT (4 x 8 mm scan volume). Using a DA-based software module, perfusion images of the cerebral blood perfusion (CBP), cerebral blood volume (CBV) and mean transit time (MTT) were calculated and assessed by two readers for visually apparent perfusion abnormalities. Amount and extension of perfusion disturbances were measured and correlated with the outcome. RESULTS: Of 44 patients, in whom perfusion maps could be generated, territorial infarction was confirmed by follow-up in 22 subjects. With a sensitivity of 95 % ischemia could be detected on MTT-maps (CBP 91 %, CBV 77 %). Specificity was highest (100 %) for CBV-maps. Patients with infarction showed significant (p < 0.001) reduction of CBP (10.7 vs. 38.3 ml/100 ml/min), CBV (1.3 vs. 2.3 ml/100 ml) and prolongation of MTT (12.3 vs. 4.3 s) compared to the contralateral hemisphere, whereas in patients without infarction no significant changes were found. Extension of CBV reduction showed the best correlation (r = 0.82) with final infarct volume. CONCLUSION: The DA-based CTP protocol evaluated in this study is a suitable tool for the early identification and quantification of acute cerebral ischemia.

Adult↗
PubMed2003

Visualization of the pulmonary valve using cine MR imaging.

PURPOSE: To evaluate the capability of bright-blood cine MR to directly visualize the leaflets of the valve replacement in pulmonary position following Ross operation. MATERIAL AND METHODS: Long and short axis views of the pulmonary valve were obtained in 10 normal subjects and 14 patients after Ross operation. Valve morphology and function were analyzed and signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were calculated. Flow measurements were performed in the pulmonary trunk to assess pulmonary regurgitation. RESULTS: In all subjects, tricuspid morphology of the pulmonary valve was visualized. SNR of the leaflets in normal subjects (9.8 +/- 3.0) and in patients after Ross operation (7.5 +/- 2.2) differed significantly from blood (12.6 +/- 3.2 and 11.3 +/- 2.5, respectively, p < 0.05). Valvular regurgitation was seen in 5 patients as an insufficient closure of the valve which was confirmed by flow measurements. CONCLUSION: Cine MR enables in-plane visualization of the pulmonary valve and allows for functional and morphological evaluation in patients after pulmonary valve surgery.

Adult↗
PubMed2002

[Using multislice spiral CT in neuroradiologic imaging].

Multislice computed tomography (MS-CT) was introduced into clinical radiology in 1999 and has shown a significant effect on various indications for computed tomography (CT) imaging in neuroradiology. Technical highlights of this new scanner type are the simultaneous data acquisition by up to four detector rows at present, an accelerated rotation time, and a reduction of the slice thickness to as low as 0.5 mm. These features account for an extended scan area, such as head and neck imaging in polytraumatized patients, detailed contrast-enhanced studies of the cervicocerebral vascular system from the carotid bifurcation to the vertex, as well as cerebral perfusion studies of a larger brain volume with an improved time resolution compared to established CT procedures. In addition, the diagnostic yield of the CT is increased with respect to several applications by reducing common image artefacts at the level of the cervicothoracic junction as well as those caused by metallic implants. Apart from improving the image quality of the primary cross-sectional slices, MS-CT significantly enhances two- and three-dimensional image reconstructions. Radiation protection is an important issue with MS-CT, especially when skull base imaging is considered.

Artifacts↗
PubMed2002

Large cerebral vessel occlusive disease in Lyme neuroborreliosis.

We report on a 12-year-old, previously healthy girl with an acute hemiparesis as the predominant clinical manifestation of Lyme neuroborreliosis (LNB). The diagnosis of LNB was based on cerebrospinal fluid (CSF) studies, laboratory findings and the clinical course whereas the patient's history and the lack of characteristic skin lesions obscured the diagnosis in the beginning. After four weeks of antibiotic and physiotherapeutic treatment, the hemiparetic symptoms had completely resolved. Although evidence of vasculitic and perivascular inflammation in LNB has been described in the literature, large cerebral vessel occlusive disease represents a rare finding. Appropriate treatment strategies can lead to good clinical rehabilitation, as shown in this case, making the timely diagnosis a crucial issue. We conclude that LNB should be considered in every stroke-like episode of unknown origin in children, even in the absence of a history of a tick bite or typical skin lesions.

Arterial Occlusive Diseases↗