Cerebral venous thrombosis: correlation between recanalization and clinical outcome--a long-term follow-up of 40 patients.
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Adult↗
Biomedical subjects
T Brandt
Publications and source records attributed to T Brandt.
Motion perception in the ipsilateral visual field of a hemispherectomized patient.
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Adult↗
A method to obtain reference images for evaluation of ultrasonic tissue characterization techniques.
A general problem when evaluating ultrasonic methods for tissue characterization is that "a golden standard" is seldom known. This paper describes a manual method to obtain a reference image, with the same geometry as the ultrasound image, indicating spatial location of the different tissue types present in the biological tissue scanned in vitro. A 30 x 10 x 2 mm3 piece of formalin fixed porcine tissue was molded into an agar block, which on the top surface, contained a set of fiducial markers, spaced 2.5 mm. The block was submerged into 20 degrees C water and a set of parallel 7.5 MHz spatial compound ultrasound images of tissue and fiducial markers were recorded each 0.5 mm. Guided by the fiducial markers, the agar block was subsequently cut into slices 2.5 mm thick, photographed and finally analyzed histologically identifying these tissues: collagen rich, collagen poor, micro vessels and muscle fibres. Due to: (1) the cutting procedure, (2) the finite size of the ultrasound beam and (3) the spatial variation in propagation velocity, the macroscopic photographs did not align completely with the ultrasound images. Likewise, the histological image is a geometrically distorted version of the macroscopic photograph, due to the histological preparation process. The histological information was "mapped back" into the format of the ultrasound images the following way: On the macroscopic images, outlines were drawn manually which defined the border of the tissue. These outlines were superimposed on the corresponding ultrasound images (identified via the fiducial markers) and modified to encompass what appeared to be tissue regions on the ultrasound images and subsequently re-applied to the macroscopic image. This modified macroscopic outline was used as guideline when drawing outlines identifying regions of the various tissue types. Specifically, the macroscopic image revealed the borders between the different tissues, while the histological image identified the four tissue types. A set of 12 reference images based on modified macroscopic outlines was created. The overlap between the ultrasound images and the macroscopic images--which are the geometrical basis for the final reference images--was between 77% and 93%. A set of 12 reference images spaced 2.5 mm, identifying spatial location of four different tissue types in porcine muscle has been created. With the reference images, it is possible to quantitatively compare different ultrasound based tissue classification techniques.
Animals↗
"Atraumatic" Sprotte needle reduces the incidence of post-lumbar puncture headaches.
Post-lumbar puncture headache (PLPH) is best explained by spinal fluid leakage due to delayed closure of a dural defect. In a prospective, randomized, double-blind study, taking into consideration all known methodological problems, the authors compared the incidence of PLPH using the "atraumatic" Sprotte needle vs the "traumatic" Quincke needle. Of the 230 patients included in the final analysis, 24.4% of patients in the "traumatic" group developed PLPH, whereas only 12.2% of patients in the "atraumatic" group did (p < 0.05). Therefore, use of the "atraumatic" Sprotte needle for lumbar puncture is recommended.
Adult↗
Pathogenesis of cervical artery dissections: association with connective tissue abnormalities.
BACKGROUND: The etiology of spontaneous cervical artery dissection (CAD) is largely unknown. An underlying connective tissue disorder has often been postulated. OBJECTIVE: To further assess the association of CAD with ultrastructural abnormalities of the dermal connective tissue. METHODS: In a multicenter study, skin biopsies of 65 patients with proven nontraumatic CAD and 10 control subjects were evaluated. The ultrastructural morphology of the dermal connective tissue components was assessed by transmission electron microscopy. RESULTS: Only three patients (5%) had clinical manifestations of skin, joint, or skeletal abnormalities. Ultrastructural aberrations were seen in 36 of 65 patients (55%), consisting of the regular occurrence of composite fibrils within collagen bundles that in some cases resembled the aberrations found in Ehlers-Danlos syndrome type II or III and elastic fiber abnormalities with minicalcifications and fragmentation. A grading scale according to the severity of the findings is introduced. Intraindividual variability over time was excluded by a second biopsy of the skin in eight patients with pronounced aberrations. Recurrent CAD correlated with connective tissue aberrations. In addition, similar connective tissue abnormalities were detected in four first-degree relatives with familial CAD. CONCLUSION: CAD is associated with ultrastructural connective tissue abnormalities, mostly without other clinical manifestations of a connective tissue disease. A structural defect in the extracellular matrix of the arterial wall leading to a genetic predisposition is suggested. The dermal connective tissue abnormalities detected can serve as a phenotypic marker for further genetic studies in patients with CAD and large families to possibly identify the underlying basic molecular defect(s).
Adult↗
Smoking and balance: correlation of nicotine-induced nystagmus and postural body sway.
Unaccustomed smoking may elicit transient nystagmus, dizziness, unsteadiness, and nausea. Infrared videonystagmography and posturography were performed simultaneously to study the differential effects of nicotine on the association of ocular motor and postural disturbances in 25 non- or occasional smokers. Sixteen showed nicotine-induced nystagmus (NIN) of various directions (mainly horizontal or upbeat) which was associated with a significant increase in postural sway after smoking a cigarette (total sway path (SP) before smoking 2.22 +/- 0.82 m/min (mean +/- s.d.), 1 min after smoking 3.83 +/- 1.41 m/min; p < 0.0004, ANOVA); nine showed neither effect. There was a high correlation between the intensity of the nystagmus (measured as peak slow phase velocity) and the increase in total SP (correlation coefficient 0.78) as well as the time courses of both. Visual fixation of an LED integrated in the mask not only caused a suppression of NIN but also a decrease in body sway. Transient ocular motor and postural effects are compatible with simultaneous nicotine-induced effects on the vestibulo-ocular and vestibulo-spinal functions.
Adult↗
Helicobacter pylori infection as an independent risk factor for cerebral ischemia of atherothrombotic origin.
Chronic infection may increase the risk for ischemic stroke. Presently, it is insufficiently established whether Helicobacter pylori infection represents a risk factor for ischemic stroke. We analyzed IgG antibodies against H. pylori in 109 patients with acute cerebral ischemia and 82 age- and sex-matched control patients with non-vascular and non-inflammatory neurological diseases. Antibody titers were significantly higher in patients than in control subjects (p=0.007). H. pylori seropositivity tended to be more common in patients (odds ratio (OR) 1.55, 95% confidence interval (ci) 0.87-2.76), but this trend was further attenuated in multivariate analysis (OR 1.42; 95% 0.75-2.67) with hypertension, diabetes mellitus, current or previous smoking, previous cerebral ischemia and low socioeconomic status. H. pylori seropositivity increased the odds for cerebral ischemia of atherothrombotic origin in univariate (OR 3.63; 95% ci 1.37-9.65) and multivariate analysis (OR 3.53; 95% ci 1.09-11.4). H. pylori seropositivity may be an independent risk factor for stroke of atherothrombotic origin.
Aged↗
Intracranial hypotension syndrome due to duropleural fistula after thoracic diskectomy.
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Adult↗
Postural reflexes evoked by tapping forehead and chest.
We investigated whether a tap with a reflex hammer to the forehead can elicit responses in the leg muscles and whether vestibular stimulation is the crucial prerequisite for eliciting these responses. We also measured the postural changes caused by the tap and by the compensatory, presumably reflex-like reactions of the subject. Tap-evoked activity of leg muscles was easily elicited during upright stance in normal subjects and was also seen in two subjects without vestibular function. The pattern of muscle activation clearly showed a counteraction to the tap-evoked perturbation of stance. Taps applied to the chest elicited similar reflexes. Since these two conditions imply a different activation of the vestibular apparatus, the vestibular input alone cannot account for the observed leg muscle reflexes. We suggest that multisensory reflex pathways that integrate vestibular and proprioceptive inputs account for these reflexes.
Adult↗
Visually induced gait deviations during different locomotion speeds.
Optic flow is essential for the perception of self motion and the control of path integration during locomotion. Inverting prisms oriented 15 degrees off vertical in the roll plane were used to experimentally distort optic flow during locomotion. Depending on the direction in which the prisms were rotated, optic flow was diagonally upward to the right or upward to the left. A reproducible deviation of gait toward the direction of perceived optic flow was found in ten healthy subjects. This deviation is explained to be a gait deviation that compensates for misleading perceived self motion induced by optic flow. The amount of deviation was dependent on locomotion speed. When walking slowly (about 1 m/s), mean deviation was 0.22+/-0.08 m/s to the right and -0.18+/-0.08 m/s to the left for right and left, respectively, diagonal prism orientation. Deviation was significantly less when running (about 3 m/s) with mean deviations of 0.05+/-0.03 m/s and -0.06+/-0.03 m/s, respectively (ANOVA, P<0.01). It is assumed that path integration during running is largely achieved by highly automated spinal programs operating independently of sensory control. In contrast, walking is more dependent on afferent and reafferent visual control. Thus, the experiments show that visual control of locomotion is direction specific and dependent on optic-flow-induced vection. It becomes less influential with increasing speed of locomotion, e.g., when walking in contrast to running.
Adult↗
Increased cytokine release by leucocytes in survivors of stroke at young age.
BACKGROUND: Enhanced stimulus-induced release of pro-inflammatory cytokines by leucocytes may contribute to the pathogenesis of ischaemic stroke. DESIGN: We investigated the lipopolysaccharide-induced release of interleukin-1beta (IL-1beta), IL-6, IL-8, and tumour necrosis factor-alpha (TNF-alpha) in whole blood from 20 patients with a history of ischaemic stroke under the age of 50, 20 patients with a history of cervical artery dissection (CAD) and 21 age- and sex-matched healthy control subjects. RESULTS: Release of IL-8 was higher (P = 0.006) and release of TNF-alpha and IL-6 tended to be higher (P < 0.1) in young stroke patients than in control subjects. No increased release existed in CAD patients. Vascular risk factors or history of infection before stroke did not modify IL-8 production. A common T(250) --> A polymorphism in the IL-8 gene promotor was newly identified but did not correlate with the variability of IL-8 release. The C(260) --> T polymorphism in the gene of the monocytic LPS-receptor CD14--a risk factor for myocardial infarction--was not associated with increased cytokine release. CONCLUSIONS: We conclude that high inducible release of IL-8--and possibly of TNF-alpha and IL-6--may contribute to the odds of ischaemic stroke in young adults.
Adult↗
Modeling the role of the interstitial nucleus of Cajal in otolithic control of static eye position.
Previous models of ocular counterroll assumed that static eye position was controlled by direct brainstem pathways from the vestibular nuclei via the ocular motor nuclei to the extraocular eye muscles. However, recent experimental evidence has shown that the interstitial nucleus of Cajal (INC), known as the vertical-torsional velocity-to-position integrator, plays a crucial role in torsional otolith-dependent eye position, i.e. for the modification of Listing's plane by static head tilts. To evaluate possible mechanisms by which otolithic input may influence eye position via the INC, we constructed a 3D mathematical model of saccade and nystagmus generation. The model includes the burst generators located in the rostral interstitial nucleus of the medial longitudinal fasciculus (MLF) and paramedian pontine reticular formation and the velocity-to-position integrators located in the INC and prepositus hypoglossi. The model simulations suggest that otolith pathways to the neural integrator that adjust Listing's plane may involve the cerebellum.
Humans↗
Modelling brain function: the vestibulo-ocular reflex.
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Animals↗
Exercise and drug therapy alter recovery from labyrinth lesion in humans.
Acute unilateral vestibular failure is characterized by rotatory vertigo, horizontal-rotatory nystagmus, and postural imbalance, all of which last from days to weeks. These signs and symptoms are caused by a vestibular tone imbalance between the two labyrinths. Recovery results from a combination of peripheral restoration of labyrinthine function (usually incomplete) and central vestibular compensation (CVC) of the vestibular tone imbalance. Acute unilateral failure is most often caused by vestibular neuritis, which is most likely due to the reactivation of a latent HSV-1 infection. Therefore, therapeutic strategies to improve the outcome of VN are theoretically based on two principles: (a) vestibular exercises and drugs to improve CVC and (b) drug treatment of the assumed viral inflammation. The following conclusions can be drawn from studies in animals and/or humans: (1) There is strong evidence that vestibular exercises may improve vestibulo-spinal compensation. These exercises should begin as early as possible after symptom onset. Moreover, slower exercises are likely to be more effective than faster exercises because slower ones seem to depend more on the vestibular system. (2) Despite extensive data from animal experiments indicating that drugs have a favorable effect on CVC, this has not been clinically proven and thus cannot be recommended yet. (3) Preliminary results of an interim analysis from an ongoing randomized, prospective study showed that methylprednisolone (plus an antiviral agent?) may be useful for improving peripheral vestibular function in vestibular neuritis.
Acyclovir↗
Prevalence of HSV-1 LAT in human trigeminal, geniculate, and vestibular ganglia and its implication for cranial nerve syndromes.
Herpes simplex virus type 1 (HSV-1) enters sensory neurons and can remain latent there until reactivation. During latency restricted HSV-1 gene expression takes place in the form of latency-associated transcripts (LAT). LAT has been demonstrated to be important not only for latency but also for reactivation, which may cause cranial nerve disorders. Tissue sections of the trigeminal ganglia (TG), geniculate ganglia (GG), and the vestibular ganglia (VG) from seven subjects were examined for the presence of LAT using the in situ hybridization technique. LAT was found on both sides in allTG (100%), on both sides of five subjects (70%) in the GG, and in none of the VG. Using a second more sensitive detection method (RT-PCR), we found LAT in the VG of seven of ten other persons (70%). This is the first study to demonstrate viral latency in the VG, a finding that supports the hypothesis that vestibular neuritis is caused by HSV-1 reactivation. The distribution of LAT in the cranial nerve ganglia indicates that primary infection occurs in the TG and GG and subsequently spreads along the faciovestibular anastomosis to the VG.
Adult↗
Cervical vertigo.
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Diagnosis, Differential↗
Absence of nystagmus during REM sleep in patients with vestibular neuritis.
Saccades, including fast phases of nystagmus, disappear during drowsiness and non-rapid eye movement (NREM) sleep, but are present during the alert state and REM sleep. The purpose of this study was to determine whether spontaneous nystagmus is present in patients with vestibular neuritis during REM sleep. Eight patients with spontaneous nystagmus due to vestibular neuritis and eight control patients without any nystagmus underwent at least one night of polysomnography. Fast phases of nystagmus were analyzed. The number of right and left horizontal saccades were counted, first during 3-5 minute samples of the awake state before sleep onset, then during the first REM episode and the last REM episode of nocturnal sleep, and finally during the alert state in the morning after nocturnal sleep. All patients with vestibular neuritis showed significantly more saccades (fast phases) towards the side contralateral to their vestibular lesion in the awake state before and after the polysomnography. This reflects their spontaneous nystagmus. By contrast, during REM sleep the patients with vestibular neuritis showed no preponderance in saccade direction. The eye movement pattern in REM was the same for patients and controls. In conclusion, peripheral vestibular imbalance producing nystagmus in vestibular neuritis in the awake state is not active at the brain stem level during REM sleep.
Aged↗
Multisensory cortical signal increases and decreases during vestibular galvanic stimulation (fMRI).
Functional magnetic resonance imaging blood-oxygenation-level-dependent (BOLD) signal increases (activations) and BOLD signal decreases ("deactivations") were compared in six healthy volunteers during galvanic vestibular (mastoid) and galvanic cutaneous (neck) stimulation in order to differentiate vestibular from ocular motor and nociceptive functions. By calculating the contrast for vestibular activation minus cutaneous activation for the group, we found activations in the anterior parts of the insula, the paramedian and dorsolateral thalamus, the putamen, the inferior parietal lobule [Brodmann area (BA) 40], the precentral gyrus (frontal eye field, BA 6), the middle frontal gyrus (prefrontal cortex, BA 46/9), the middle temporal gyrus (BA 37), the superior temporal gyrus (BA 22), and the anterior cingulate gyrus (BA 32) as well as in both cerebellar hemispheres. These activations can be attributed to multisensory vestibular and ocular motor functions. Single-subject analysis in addition showed distinctly nonoverlapping activations in the posterior insula, which corresponds to the parieto-insular vestibular cortex in the monkey. During vestibular stimulation, there was also a significant signal decrease in the visual cortex (BA 18, 19), which spared BA 17. A different "deactivation" was found during cutaneous stimulation; it included upper parieto-occipital areas in the middle temporal and occipital gyri (BA 19/39/18). Under both stimulation conditions, there were signal decreases in the somatosensory cortex (BA 2/3/4). Stimulus-dependent, inhibitory vestibular-visual, and nociceptive-somatosensory interactions may be functionally significant for processing perception and sensorimotor control.
Acoustic Stimulation↗