Search PubMed⌕ Search

Biomedical subjects

W Hacke

Publications and source records attributed to W Hacke.

At least 253 records · Page 14Linked to original sources
PubMed1985

Neuromonitoring.

Neuromonitoring--the continuous or intermittent observation of nervous system functions--has become a field of interdisciplinary interest. Basically there are two major applications of neuromonitoring: in the operating theatre and the neurological or neurosurgical intensive care unit. Evoked potential recording, intracranial pressure measurement, serial EEG recording, cerebral blood flow measurement and ultrasound techniques have all been used as monitoring methods. The application of these techniques for operations, intensive care and the evaluation of brain death will be described.

Brain Death↗
PubMed1985

Balloon embolization in the treatment of basilar aneurysms.

Some vertebro-basilar aneurysm may not be treatable at a reasonable risk by direct clipping. A possible alternative is transvascular obliteration, using the means of modern interventional neuroradiology in combination with neurophysiological monitoring. These possibilities and related difficulties are outlined and discussed and the example of two cases with different types of vertebrobasilar aneurysms (top of the basilar artery and basilar trunk aneurysm) which have been treated by balloon embolization.

Adult↗
PubMed1985

Transcranial Doppler sonography as a non-invasive guide for the transvascular treatment of an inoperable basilar-artery aneurysm.

This report deals with the successful treatment of a giant aneurysm located at the caudal basilar trunk in a 19-yr old boy. The aneurysm had been declared to be inoperable by several authorities in the field of neurosurgery. A series of neuroradiological interventions was performed in order to block the aneurysm with the help of a detachable balloon or, at least, to induce spontaneous thrombosis of the aneurysm sac by reducing blood flow within the caudal basilar artery. Transcranial Doppler sonography proved to be a helpful guide for therapeutic decision-making from one interventional step to the next in this adventurous field of treatment. The changing sonographic findings of the vertebrobasilar system during the course of the treatment and during the functional tests, as well as the favourable outcome, have made this case worth reporting.

Adult↗
PubMed1985

Neuromonitoring during interventional neuroradiology.

The neurophysiologic monitoring of interventional neuroradiologic procedures is a new field of intraoperative monitoring. Interventional neuroradiology makes use of different diagnostic or therapeutic catheterization techniques in both cerebral and spinal cord arteries. Both procedures can be made more secure by monitoring of EEG or evoked potentials. Using the advantages of the different catheter techniques, such as series of balloon occlusions or injections of drugs or contrast dye, the neuroradiologist and the neurophysiologist are able to plan and test the next steps of an interventional maneuver. The results and implications of neuromonitoring during occluding maneuvers of the internal carotid artery, during local fibrinolytic therapy, during embolization procedures of cerebral or spinal arteries, malformations, or tumors, and during drug application are discussed and illustrated.

Angioplasty, Balloon↗
PubMed1985

[Monitoring of therapeutic neuroradiologic examination and therapeutic procedures using evoked potentials].

Interventional neuroradiology makes use of different diagnostic and therapeutic catheterization techniques. Treatments performed are local intraarterial thrombolytic therapy, embolization and occlusion of brain supplying arteries, percutaneous transluminal angioplasty and intraarterial application of drugs. These treatments make it most important to check the patients neurological state during the procedure. Intraoperative monitoring of evoked potentials offers the opportunity to get objective information about changes in certain central nervous system functions even in anaesthesized patients. Usually intraoperative monitoring is performed to obtain information whether the function of structures at risk remains stable or is altered by the operation. This represents a more passive, observing way of monitoring. During interventional neuroradiology one is enabled to take additionally a more active and experimental way of monitoring by using the advantages of special catheter techniques like series of reversible balloon occlusion or intraarterial drug application. This leads to a dialogue between the radiologist and the neurophysiologist about the safety or the risk of the next step during a procedure. There are mainly two types of new information that can be achieved by active monitoring: the identification of functional territories of single or multiple feeding vessels and new insights into hemodynamics and the establishing of new sufficient collaterals. We have used intraoperative neuromonitoring in 35 patients during interventional neuroradiology. Our findings will be summarized and the usefulness of the different monitoring methods will be discussed.

Amobarbital↗
PubMed1985

[Ectopic internal carotid artery in the tympanic cavity. Intraoperative complications and their treatment. A case report].

Ectopy of the internal carotid artery involving the middle ear occurs only rarely. In this case, middle ear surgery will almost always result in severe haemorrhage. After package of the external auditory canal and the epipharynx, immediate closure or ligation of the internal carotid artery is mandatory. The authors describe the interventional neuroradiological treatment as an alternative way to the known neurosurgical methods like cervical and intracranial ligation of the artery. Intravasal blocking of the leakage was done by using a detachable balloon filled with contrast medium. During this procedure cortical evoked potentials were measured showing no decrease of the homolateral haemispheric blood flow. Although this procedure cannot maintain the continuity of the internal carotid artery, it preserves a maximum of collateral vessels. The cortical evoked potentials simultaneously show the brain function during blockage of the artery.

Carotid Artery, Internal↗
PubMed1985

[Visual evoked potentials from the viewpoint of test theory].

Retest reliability and objectivity (i.e. interrater agreement) are very important aspects of diagnostic tests. We report on studies concerning the retest reliability and objectivity (interrater agreement) of visual evoked potentials. The reliability and different facets of objectivity had been calculated. The confidence interval of single measurement can be identified, when the retest reliability is known. The confidence interval has to be taken into account for interpretation of measurement. The interrater agreement of measurement and interpretation of visual evoked potentials is high, but special attention has to be paid to the fact, that the interpretation of identical VEP-plots can be influenced by different preinformation.

Adolescent↗
PubMed1984

[Polyradiculomeningoencephalitis caused by Epstein-Barr virus infection--description of a case with fatal outcome].

A 21 years old high school student, who, since early childhood, suffered from complete spinal paraplegia of unknown cause at D 10, suddenly, after a three week period with influenca -like prodromal symptoms, presented with acute polyradiculomeningoencephalitis . Positive reactions following Paul-Bunnell- Davidsohn -test and tests for specific antivirus IgG as well as specific IgM revealed acute Epstein-Barr-Virus infection, although no glandular signs could be found. The clinical findings consisted of peripheral sensory-motor tetraparesis, ataxia, nystagmus and disturbances of the caudal cranial nerves. Initially, the diagnosis of Fisher's syndrome was made. The orbicularis oculi reflex, however, indicated a circumscribed brainstem lesion in the medial reticular formation. This finding lead to the additional clinical diagnosis of encephalitis. Shortly after admission, a heart-arrest occurred, and, after successful reanimation, the patient presented with a "locked-in syndrome". On the 12th day after admission, he succumbed during a sudden drop of blood-pressure. Necropsy revealed septic shock as the cause of death, due to perforation of a duodenal ulcer. In the lower thoracic spinal cord a neurocytoma was found, which once lead to the paraplegia. Additionally, moderate inflammatory infiltrations were found in the basal leptomeninges, in the walls of several subcortical vessels and in the hypoglossal nerve. The infiltrations, at some sites, contained a large number of atypical lymphoid cells in the inflammatory meningeal exsudate . Microglial proliferation with satellitosis was found in the inferior olives, thus confirming the clinical diagnosis of polyradiculomeningoencephalitis . This case report should emphasize special features of EBV-infection with neurological complications: (1) in inflammatory diseases of the peripheral and central nervous system, infectious mononucleosis should always be drawn into the diagnostic considerations, even if heterophil antibodies and glandular symptoms are lacking. (2) In Guillain-Barré-syndrome, a transient external heart stimulator should be administered, in order to prevent heart arrest from acute autonomic neuropathy.

Adult↗
PubMed1984

Predominant sensory Guillain-Barré syndrome in hereditary sensory neuropathy--case report of a three-year-old boy.

We observed a three-year-old boy with increasing ataxia over a period of two weeks, which cleared up completely within four months. The electroneurographic features and their course in the child and the father allow us to suspect the additional existence of a hereditary sensory neuropathy. The authors put forward the hypothesis that the genetic disturbance of the sensory nerves is responsible for this clinical variant of Guillain-Barré syndrome.

Child, Preschool↗
PubMed1984

[Methodologic aspects of the intraoperative monitoring of evoked potentials].

The aim of intraoperative monitoring methods is to obtain early information about central nervous function during critical phases of the operation. To this end it can be useful to accept modifications of the method or the technical parameters such as changes of the electrode positions, of the system's bandpass, the analysis time or the number of sweeps used for averaging. Additionally emphasis is laid upon the fact that there is no knowledge concerning the critical changes of potential which might indicate functional disturbances or impending postoperative neurological deficits. At the present time intraoperative EP-Monitoring is not an established method for clinical use. Evidence is lacking that supervision of the operation by these means results in a reduced operation risk.

Electrodes↗
PubMed1983

Anterior interosseous nerve syndrome following supracondylar lesions of the median nerve: clinical findings and electrophysiological investigations.

Lesions at the volar aspect of the forearm may lead to isolated paralysis of the anterior interosseous nerve, which is a purely motor branch of the median nerve. The same syndrome may result from circumscribed damage at the level of the upper arm. Two patients are reported with the typical anterior interosseous nerve syndrome following supracondylar lesions of the median nerve and the literature is reviewed. In most cases this syndrome is a complication of supracondylar fractures of the humerus in children. A simple clinical test for the diagnosis, the pinch test, and the typical electromyographic findings are described. Whereas electroneurography has been considered to provide little help in diagnosis, a significantly lower nerve conduction velocity was found in the median nerve between the medial intermuscular spatium and the cubital fossa compared to the normal arm, and a prolonged response latency of the pronator quadratus of the injured arm following stimulation of the median nerve in the intermuscular medial spatium and the cubital fossa.

Adult↗
PubMed1983

Evoked potential monitoring during acute occlusion of the basilar artery and selective local thrombolytic therapy.

Neurophysiological examinations of brainstem functions before, during and after selective interventional neuroradiology i.e. selective intraarterial thrombolytic therapy of an acute occlusion of the basilar artery are reported. The success of the therapy was demonstrated by the reappearance of normal somatosensory potentials and of the blink reflex immediately after the thrombolysis. The BAEPs were continuously recorded during the thrombolysis. Normalization of the latencies and of the interpeak latencies at a very early stage of the therapy indicated the improvement of brainstem functions.

Adult↗
PubMed1983

[Orbicularis oculi reflex in computerized tomography verified lesions of the posterior cranial fossa].

The blink reflex elicited by electrical stimulation was studied in 60 patients with lesions of the brainstem and cerebellum (ischemic lesions, non-traumatic bleedings or tumors), which were diagnosed by computertomography. The relationship between localized morphological changes in computertomography and changes in blink reflex has been studied. 46 patients (77%) had a pathologic blink reflex. Usually the blink reflex was normal in patients with a tumor of cerebellum. In bleedings or tumors of the brainstem a good relationship existed between localization and extension of the lesion and the pathological pattern of the blink reflex. In patients with thrombosis of the basilar artery no responses or single delayed responses to the electrical stimulation were found. A less good relationship was observed in ischemic lesions of the brainstem. This is interpreted as indicating possible multilocalization of vascular lesions in the brainstem. Nearly half of the patients with ischemic lesions also had supratentorial lesions. The influence of these lesions on the pattern of the blink reflex will be discussed.

Adolescent↗
PubMed1983

[Vascular recanalization procedure in interventional neuroradiology].

Thirty-two patients are described. Sixteen patients were treated by local intra-arterial fibrinolysis (LIF) for lesions of the intracranial vessels. In nine patients there was a vertebrobasilar thrombosis, in four patients an occlusion of the middle cerebral artery and in three patients a sinus thrombosis. The results of percutaneous transluminal angioplasty (PTA) in fourteen patients are reported; they included dilatation of the subclavian artery in 12 and the vertebral artery in two of them. Dilatation of post-operative fibrous stenosis of the internal carotid artery in two patients is described. The technique for local intra-arterial fibrinolysis and recommended doses for streptokinase are given. The use of Doppler sonographic monitoring during PTA is recommended, particularly as for delayed return to normal flow in the vertebral artery.

Angioplasty, Balloon↗