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Biomedical subjects

T Brandt

Publications and source records attributed to T Brandt.

At least 217 records · Page 12Linked to original sources
PubMed1991

[Cluster headache and chronic paroxysmal hemicrania: current therapy].

In acute attacks of cluster headache (CH), the mainstays of treatment are inhalation of pure oxygen (due to lack of any side effects), ergotamine aerosol, and intranasal application of local anaesthetics. The following treatments have hitherto been recommended for the prevention of attacks: young patient with first manifestation-methysergide; middle aged patient with episodic or chronic CH-steroids; older patient with history of resistance to therapy-lithium. These guidelines have been superceded as a result of the demonstration of the efficacy of several other drugs which have reduced side effects. This increased variety of treatments also reduces the importance of clinical differentiation between episodic and chronic cluster headache. Today, the drugs of first choice for treatment of episodic cluster headache are steroids or calcium channel blockers like verapamil, replacing methysergide which is now drug of second choice. In chronic CH, verapamil and lithium are normally prescribed, steroids-possibly in combination with one of the other drugs-are regarded as drugs of second choice. Another possibility, used with increasing frequency, is valproate acid, and the experimental drug budipine may be a further alternative in therapy resistant patients. There is no convincing role for invasive surgical procedures, particularly in the light of the increased number of effective drugs. The treatment of choice for chronic paroxysmal hemicrania is indometacin, although individual patients may respond to salicylates, naproxene, prednisone and ergotamine.

Cluster Headache↗
PubMed1990

Influence of visual blur on object-motion detection, self-motion detection and postural balance.

We have compared the influence of visual blurring (either by use of plastic foils or by plus lenses) on detection of object-motion and self-motion, and on visual control of postural balance. Three experiments were performed--in all of which object-motion and self-motion detection latencies (response times) and postural sway (sway path) increased with increasing visual blurring. We conclude that visual blurring either by foils or by glasses affects object- and self-motion perception and postural sway in a similar way.

Attention↗
PubMed1990

Positional and positioning vertigo and nystagmus.

Positional and positioning vertigo and nystagmus syndromes can be attributed to either peripheral or central vestibular dysfunction. The most common form is benign paroxysmal positioning vertigo which is caused by cupulolithiasis into the posterior semicircular canal. Other labyrinthine manifestations such as positional alcohol nystagmus, positional nystagmus with macroglobulinaemia and "heavy water" or glycerol ingestion occur because of a specific gravity differential between the cupula and the endolymph (buoyancy mechanism). Neurovascular compression of the vestibular nerve may be a causative factor for "disabling positional vertigo" which is an insufficiently described entity. Hesitation is highly justifiable since retromastoid craniectomy for microvascular decompression is the recommended management. Central positional vertigo is either induced by head movements which result in a transient ischaemia of the ponto-medullary brainstem, or by a change in head position relative to the gravitational vector. The latter is comprised of at least three forms: positional downbeat nystagmus (nodulus), positional nystagmus without concurrent vertigo, and positional vertigo with nystagmus. The site of the lesion is always near the fourth ventricle and the vestibular nuclei. The most probable explanation for the positional response is a vestibular tone imbalance caused by disinhibition of the vestibular reflexes on perception, eye, head and body position.

Humans↗
PubMed1990

Nonsurgical treatment of a viable cervical pregnancy with intra-amniotic methotrexate.

Although a rare complication of gestation, the possibility of fertility loss is no more serious than with a cervical pregnancy. A case of a viable cervical pregnancy treated with ultrasound guided transabdominal aspiration and intra-amniotic methotrexate administration is presented. When the diagnosis is made early in gestation this method should be considered for the treatment of a cervical pregnancy when future fertility potential is desirable.

Adult↗
PubMed1990

Psychogenic disorders in neurology: frequency and clinical spectrum.

Among 4470 consecutive neurological inpatients presenting "with typical neurological symptoms" 405 (9%) were found to have psychogenic rather than neurological dysfunction of the nervous system as the primary cause of admission. This probably represents a conservative figure, since secondary and minor pseudoneurological symptoms were not included. Retrospective analysis of these cases showed that pain was the most common psychogenic symptom, followed by motor symptoms (in particular stance and gait disturbances), dizziness, psychogenic seizures, sensory symptoms, and visual dysfunction. Unilateral motor and sensory symptoms were equally distributed to the left and right side of the body. Psychiatric abnormalities in these patients were heterogenous. Depressive syndromes were most common (38%), whereas hysterical features were less frequent than expected (9%). On discharge, improvement was significantly better for patients with recent onset of symptoms (2 weeks or less) than for those with longstanding disturbances. Short-term outcome was best for motor symptoms and worst for pain. Improvement was independent of psychiatric findings, coexistence of a neurological disease, age, and sex.

Adult↗
PubMed1990

Tonic contraversive ocular tilt reaction due to unilateral meso-diencephalic lesion.

We studied 4 patients with tonic contraversive ocular tilt reactions due to unilateral, paramedian, mesodiencephalic lesions. This is in contrast to the only 2 previously reported patients with ocular tilt reactions due to unilateral mesodiencephalic lesions, each of whom had a paroxysmal ipsiversive ocular tilt reaction. This new finding is considered in the context of previous clinical and experimental data on the various types of ocular tilt reactions that follow stimulation or destruction of the peripheral and central vestibular system. Otolithic inputs to the interstitial nucleus of Cajal from the contralateral vestibular nucleus and motor outputs from the interstitial nucleus of Cajal to cervical and ocular motoneurons could be involved in the ocular tilt reaction. We propose that in patients with unilateral meso-diencephalic lesions, a tonic contraversive ocular tilt reaction could be due to persistently decreased resting activity of ipsilateral interstitial nucleus neurons, whereas a paroxysmal ipsiversive ocular tilt reaction could be due to transiently increased activity of the same interstitial nucleus neurons. Cases of ocular tilt reaction due to unilateral meso-diencephalic lesion point to the existence of a crossed graviceptive pathway between the vestibular nucleus and the contralateral interstitial nucleus of Cajal.

Adult↗
PubMed1989

Differential effects of retinal target displacement, changing size and changing disparity in the control of anterior/posterior and lateral body sway.

When visual information is provided in addition to input from other sensory systems, normal body sway can be attenuated by about 50%. The essential visual cue is retinal target displacement, which increases as eye-target distance is reduced. As a result, both lateral and anterior/posterior (A-P) sway decrease as eye/target distance decreases. We have investigated the geometrical basis of lateral and fore-aft sway detection by vision, the latter provided by detection of change in disparity of the visual axis of both eyes and change in target size. Using known movement detection thresholds the largest possible distance for visual stabilization of posture can be calculated to be 34 m for lateral sway, and for fore-aft sway 1.50 m for change in disparity and 3.20 m for change in size. Visual stimuli were designed to selectively stabilize fore-aft sway either by change in size or by change in disparity. The experiments revealed that the theoretical prediction overestimates the efficacy of visual stabilization of lateral sway and underestimates the efficacy of fore-aft sway stabilization. It is proposed that microoscillations of the eye increase the threshold for detection of retinal target displacements, leading to less efficient lateral sway stabilization than expected, and that the threshold for detection of self motion in the A-P direction is lower than the threshold for object motion detection used in the calculations, leading to more efficient stabilization of A-P sway.

Form Perception↗
PubMed1989

Supralevator abscess: evaluation with transrectal sonography.

Transrectal ultrasound was used in 2 patients with supralevator perirectal fluid collections. In one instance, this technique was used to diagnose and plan surgical drainage of a perirectal abscess. In another patient needle aspiration under sonographic guidance was performed for removal of a septated fluid collection.

Abscess↗
PubMed1989

Otolith function in man. Results from a case of otolith Tullio phenomenon.

An otolith disorder is described in a patient with a subluxed stapes footplate. Otoneurological examination, including tympanoscopy, showed that nonphysiological mechanical stimulation of the otoliths by a (pathologically) hypermobile stapes footplate typically manifests with a pattern of sound-induced paroxysms of ocular tilt reaction (OTR), oscillopsia and postural imbalance (otolith Tullio phenomenon). The rare condition of sound-induced otolithic stimulation in an otherwise healthy young man offered a unique opportunity to investigate otolith reflex control of the eye, head and posture in man. Electro-oculographic recordings and special video analysis (time resolution: 1000 images/s) revealed an initial rapid and phasic counterclockwise rotatory upward deviation with a latency of 22 ms, followed by a smaller tonic effect which lasted as long as sound stimulation (480 +/- 20 Hz, 95 dB A). Latencies of the otolithic vestibulospinal reflex, recorded using surface EMG during upright stance with the eyes closed, were surprisingly short with activation of the ipsilateral tibialis anterior muscle 47 ms after the stimulus, and of the ipsilateral gastrocnemius muscle after 52 ms. A considerable postural pertubation was measured by means of a Kistler platform, with the shortest latency for displacement of the centre of pressure of 80 ms and a preferred body sway direction from right-backward to left-forward. When the Valsalva manoeuvre was performed, tonic eye movements and oscillopsia were induced opposite in direction to those produced by the sound reflecting a push-and-pull deviation of the otoliths.

Adult↗
PubMed1989

Postural sway during retinal image stabilisation.

Posturographic measurements using a piezoelectric platform were made in normal subjects while wearing a combination of spectacle and contact lens providing partial stabilisation of the retinal image (RIS). The amount of postural sway seen while wearing the device at rest is intermediate between the "normal vision" and "eyes closed" conditions, and increases with increasing amounts of RIS. However, when large active head-and-eye movements are performed, postural sway is dramatically increased when using RIS, and is then worse than while performing the same task in the "eyes closed" condition. It is concluded that patients who use the partial-RIS device for the treatment of severe oscillopsia may benefit only when performing tasks in which the head is relatively still, such as reading, writing or watching TV. It is also proposed that the partial-RIS device can serve as a model in normal free-standing subjects for the postural effects of oculomotor disorders.

Adult↗
PubMed1989

Visual postural performance in ametropia and with optical distortion produced by bifocals and multifocals.

Visual stabilization of posture depends strongly on the performance of the visual system and declines with experimentally induced reduction of visual image quality. We studied postural performance in subjects with median and high grade hyperopia or myopia. While body sway of median grade ametropic subjects increased slightly when measured without glasses, high grade ametropia showed no significant differences between postural performance with glasses on and off. We concluded that the increase in visual acuity when wearing glasses is outweighted by concurrent dioptric distortions such as size change and prismatic effects. In addition we could not find any difference between bifocal and multifocal lenses in their effect on sway when investigated in normals with either steady fixation or saccades or foveal pursuit.

Adult↗
PubMed1989

Successful treatment of a live cervical pregnancy with methotrexate and folinic acid. A case report.

A case of cervical pregnancy with a fetal pole, fetal cardiac activity and a serum beta-human chorionic gonadotropin level reaching a peak of 60,000 mIU/mL was treated successfully with methotrexate and folinic acid. These criteria have been considered a contraindication to conservative medical management. Serial beta-human chorionic gonadotropin levels and sonography were used to diagnose the pregnancy and monitor therapy. Complications were limited to transient conjunctivitis and blood loss anemia. The patient's fertility potential was preserved.

Adult↗
PubMed1988

Incidence of post-lumbar puncture headache is independent of daily fluid intake.

The clinical practice of advising patients to increase their daily fluid intake after lumbar puncture in order to increase CSF production by re-hydration and thus try to prevent post-lumbar puncture headache (PLPH) has not yet been shown to be effective. In 100 patients the different effects of re-hydration on the incidence of PLPH (1.51 compared with 3.01 oral fluid per day over a period of 5 days) were tested prospectively. The incidence of PLPH was independent of the amount of fluid intake in both groups (18, 36%), as was the duration of PLPH. The physiology of CSF production and resorption suggests that PLPH is not a problem of CSF dynamics but a simple mechanical problem of how to close the dural rent and thereby stop the continuous leakage. It is no longer justifiable to advise patients to drink more than usual since there is no physiological or empirical basis for this and it does not seem to have even a placebo effect.

Adolescent↗