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Biomedical subjects

W Hacke

Publications and source records attributed to W Hacke.

283 records · Page 16Linked to original sources
PubMed1978

[Theory and practice of finding a therapeutic vacancy for addicts--demonstrated in the case of a female patient habituated to heroin (author's transl)].

This article tries to describe the problems, difficulties and setbacks experienced by patients, doctors, psychologists or social workers when looking for a public health insurance body competent to bear the cost, as well as for a vacancy in a suitable hospital or institution where appropriate therapy can be effected. The case history of a female heroin addict was chosen as a model example to show that the simultaneous activities by a variety of offices or bodies is rarely crowned with succes. The author surveys several other cases where similar protacted mechanisms of decision to be arrive at by bodies who might be requested to bear the cost interfered with the therapy in patients addicted to alcohol and/or drugs. A suggestion is presented aiming at arriving at a decision in minimum time and according to a compact pattern.

Alcoholism↗
PubMed1978

[Audiovisual recordings of electromyographic examinations (author's transl)].

The presented method is to be an aid in the recording and documentation of single EMG examination results by the possibility of adding acoustic and clinical details to the previous method which was purely an optical method. This recording method is especially good for continuing education courses and for detailed storing of certain results, because the method may be reprodused indefinately. The method is not suitable for conventional documentation because 1) it is too costly and 2) it does not fulfill the qualitative requirements of a documentation.

Audiovisual Aids↗
PubMedDate not supplied

Monitoring therapeutic efficacy of decompressive craniotomy in space occupying cerebellar infarcts using brain-stem auditory evoked potentials.

Brain-stem auditory evoked potentials (BAEPs) have been used to gauge effects of brain-stem dysfunction in humans and animal models. The purpose of this study was to evaluate the usefulness of BAEP in monitoring patients undergoing decompressive surgery of the posterior fossa for space occupying cerebellar infarcts. We report on serial BAEP recordings in 11 comatose patients with space occupying cerebellar infarcts undergoing decompressive craniotomy. BAEP studies were performed within 12 h after admission, 24 h following surgery and prior to extubation. BAEP signals were analyzed using latency determination and cross-correlation. Following surgery, 9 patients regained consciousness; 2 patients persisted in a comatose state and died subsequently. BAEP interpeak latency (IPL) I-V assessed prior to surgery exceeded normal values in all patients in whom it could be reliably measured (N = 9). Following decompressive surgery BAEP wave I-V IPL normalized in 5 patients, but remained prolonged despite dramatic clinical improvement in 4 patients. We prospectively computed the coefficient of cross-correlation (MCC) of combined ipsilateral BAEP trials after right and left ear stimulation. In all patients increasing MCC was associated with clinical improvement. Unchanging or decreasing MCC indicated poor outcome. We conclude that serial BAEP studies are an appropriate perioperative monitoring modality in patients with space occupying cerebellar infarcts undergoing decompressive surgery of the posterior fossa. Our study suggests advantages of cross-correlation analysis as an objective signal processing strategy; relevant information can be extracted even if BAEP wave discrimination is impossible due to severe brain-stem dysfunction.

Acoustic Stimulation↗
PubMedDate not supplied

The ECASS 3-hour cohort. Secondary analysis of ECASS data by time stratification. ECASS Study Group. European Cooperative Acute Stroke Study.

OBJECTIVES: (1) To determine whether and how outcome measurements in the ECASS trial are influenced by a shorter time window (0-3 vs. 3-6 h) between onset of symptoms and start of thrombolytic therapy using recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke. (2) To discuss the results of the ECASS 0- to 3-hour cohort with the results of the National Institute of Neurological Disorders and Stroke Study (NINDSS). DESIGN AND ANALYSIS: Analysis of the 0- to 3-hour and the 3- to 6-hour cohort in accordance with the ECASS protocol. Comparative analysis of the ECASS and NINDSS results following the NINDSS protocol using dichotomized endpoints. MAIN OUTCOME MEASURES: Primary endpoints: modified Rankin Scale, Barthel Index; secondary endpoints: combined Barthel/Rankin, long-term Scandinavian Stroke Scale, National Institutes of Health Stroke Scale, mortality at 30 and 90 days, occurrence of intracranial hemorrhage. NINDS trial endpoint: favorable outcome as defined in the NINDS trial. RESULTS: In ECASS, 87 patients were randomized within 3 h of stroke onset. Differences in favor of rt-PA treatment can be found for all primary and secondary outcome measures in the ECASS 0- to 3-hour cohort, except for mortality at day 30, which is somewhat higher in the rt-pA-treated group. However, due to the small sample size, the differences do not reach statistical significance. Early infarct signs (as defined by the ECASS protocol) are found as early as 2 h after stroke onset. Parenchymal hemorrhages are found significantly more often among rt-PA-treated patients. The results in the ECASS 0- to 3-hour cohort fit well with the results in NINDSS. CONCLUSION: Data from the 3-hour ECASS cohort support the efficacy of early thrombolytic therapy in acute hemispheric stroke patients. Comparing bleeding complications between the ECASS and NINDSS is difficult because of differences in the definition and occurrence of hemorrhagic events.

Aged↗
PubMedDate not supplied

Cardiovascular safety of lubeluzole (Prosynap(R)) in patients with ischemic stroke.

The cardiovascular safety of lubeluzole was evaluated in patients with ischemic stroke in a double-blind, placebo-controlled trial. Forty-six patients were randomized to receive a continuous daily infusion of lubeluzole 5 mg (loading dose 3.75 mg over 1 h), lubeluzole 10 mg (loading dose 7.5 mg over 1 h), or placebo for 5 days within 24 h of stroke onset. The primary measure of cardiovascular safety was the QTc interval, derived from the continuous electrocardiogram (ECG) and measured during treatment and a 2-day follow-up. Compared with placebo. Neither dosage of lubeluzole had any statistically or clinically relevant effects on the QTc. Neither were there any significant differences among the three treatment groups in the area under the curve for heart rate, QT interval, QT dispersion, or QTlc. Lubeluzole did not increase the frequency of ECG abnormalities. No ventricular fibrillation, ventricular tachycardia, or torsades de pointes were observed in any of the treatment groups. During this trial, 3 patients in the placebo group and 2 patients in the lubeluzole 5-mg group died. There were no deaths in the lubeluzole 10-mg group. Adverse experiences were similar in all three treatment groups except that superficial thrombophlebitis was more frequent in the lubeluzole 10-mg group. In doses to 10 mg/day, lubeluzole has a favorable cardiovascular safety profile, as demonstrated by the lack of clinically relevant effects on heart rate, QT, QTc, and QTlc, and it was well tolerated by patients with ischemic stroke.

Acute Disease↗
PubMedDate not supplied

Indomethacin for brain edema following stroke.

Conventional therapies for raised intracranial pressure (ICP) frequently are not effective. We report a patient with raised ICP following a large hemispheric stroke. After conventional therapies had failed, indomethacin was repeatedly administered. After bolus infusion (50 mg), the ICP fell by a mean of 8.1 mm Hg, and the mean arterial blood pressure increased by a mean of 7.1 mm Hg, leading to a mean increase in the cerebral perfusion pressure by 15.3 mm Hg. After 1 h, the ICP had returned to baseline values after most infusions. Continuous infusion of indomethacin was not effective. We conclude that indomethacin may reduce elevated ICP over a short time in patients with ischemic brain edema even after conventional therapy has failed.

Adult↗
PubMedDate not supplied

[How did the results of ECASS II influence clinical practice of treatment of acute stroke].

INTRODUCTION AND DEVELOPMENT: There appears to be a rationale for the use of thrombolysis in ischemic stroke. Streptokinase should no longer be used to treat acute ischemic stroke. However, thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA) may have an important role in the management of acute stroke. The studies to-date highlight the importance of early intervention and careful patient selection. In the National Institute of Neurological Disorders and Stroke (NINDS) trial, treatment within three hours was associated with an improved functional outcome without an increase in mortality. In the European Cooperative Acute Stroke Study (ECASS), treatment of eligible patients resulted in improved neurologic and functional out come. In the Multicentre Acute Stroke Trial Europe (MAST-E) and Australian Streptokinase Trial (ASK) trials, later intervention was associated with an increased risk of cerebral hemorrhage and poor outcome. CONCLUSIONS: Successful use of thrombolytic therapy with rt-PA, therefore, depends on rapid assessment to exclude patients with hemorrhagic stroke or those at risk of hemorrhagic complications. It has been shown to be beneficial in patients treated within three hours who conform to the strict inclusion and exclusion criteria of the NINDS trial. Moreover, after the results of ECASS II, and the recent metaanalyses of all three major rt-PA trials, it seems that with strict selection criteria, expert CT-reading, adherence to the protocols and a stroke unit type approach, the time window for thrombolysis may be as long as six hours in selected patients.

Acute Disease↗
PubMedDate not supplied

Monitoring of hemispheric or brainstem functions with neurophysiologic methods during interventional neuroradiology.

Interventional neuroradiology, sometimes requiring full anesthesia, is now performed in high-risk patients. The neurologic state of an anesthetized patient cannot always be sufficiently evaluated during the neuroradiologic examination. In such cases neurophysiological methods provide information about some aspects of the patient's cerebral condition. Three useful neurophysiological methods for monitoring hemispheric or brainstem functions during the neuroradiologic procedure are on-line or Fourier-transformed electroencephalographic (EEG) analysis; the monitoring of somatosensory-evoked potentials; and the monitoring of brainstem acoustic-evoked potentials. All methods can be done in the operating room with small, mobile equipment.

Afferent Pathways↗
PubMedDate not supplied

Local intraarterial thrombolysis in vertebrobasilar thromboembolic disease.

The poor prognosis of basilar artery occlusion is well known. Systemic anticoagulation rarely prevents a lethal outcome. A new therapeutic approach involves selective perfusion of streptokinase through the vertebrobasilar artery via a coaxial catheter system. Three of five reported cases demonstrated successful vascular recanalization with clinical improvement.

Adult↗
PubMedDate not supplied

Thrombolytic therapy in acute occlusion of the intracranial internal carotid artery bifurcation.

PURPOSE: To evaluate efficacy and clinical benefit of early thrombolytic therapy in intracranial internal carotid artery occlusion. METHODS: Thirty-two patients (mean age, 56 years) with acute intracranial internal carotid artery occlusion were studied clinically and with CT and angiography before and after thrombolytic therapy with intravenous alteplase (n = 16), superselective intraarterial alteplase (n = 8), and superselective intraarterial urokinase (n = 8). RESULTS: Initial CT showed a large parenchymal hypodensity in 11 (34%) patients, a small hypodensity in 15 (47%) patients, and no hypodensity in 6 (19%) patients. Recanalization after thrombolytic therapy was observed in 4 patients (12.5% in each treatment group). Follow-up CT showed six hemorrhagic infarcts and four parenchymal hematomas unrelated to recanalization, alteplase, or urokinase administration, but commonly associated with intraarterial treatment. Clinical outcome was fatal in 53%, poor in 31%, and moderate or good in 16% of the patients. Outcome was equal in different treatment groups and closely linked to both the quality of leptomeningeal collaterals and the extent of parenchymal hypodensity on the first CT. CONCLUSION: Because intravenous or intraarterial treatment with alteplase or urokinase fails to recanalize the vascular obstruction, it does not improve the prognosis of intracranial internal carotid artery occlusion over that of the natural course. Improved results may be possible with novel recanalization techniques.

Adult↗
PubMedDate not supplied

A mouse model of herpes simplex virus encephalitis: diagnostic brain imaging by magnetic resonance imaging.

Herpes simplex virus encephalitis is a severe sporadic encephalitis in man with high mortality and morbidity. A critical step in the establishment of therapy is early diagnosis. Magnetic resonance imaging is a noninvasive, accurate diagnostic test for the detection of central nervous system disease. In an effort to monitor morphological changes in vivo we present a new diagnostic neuroimaging model of experimental herpes simplex virus encephalitis. A mouse model of herpes simplex virus encephalitis was used. 40 SJL mice were intranasally inoculated with an infectious dose of wild-type strain HSV-I F. Morphological abnormalities were studied by cranial magnetic resonance imaging (MRI). These findings were correlated with sequential neuropathological studies. 95% of animals developed cerebral abnormalities on MRI. resembling human HSVE. Areas of increased signal intensity on T2-weighted sequences and focal pathological contrast enhancement were mostly found in the frontal and temporal lobes and thalamic and cerebellar regions. All animals with MRI abnormalities had neuropathological signs of neuronal degeneration and reactive astrocytosis in corresponding regions. The described monitoring system offers a new approach for studies on neurovirulence and therapeutic strategies.

Animals↗
PubMedDate not supplied

Hypothermia induced by atypical neuroleptics.

Hypothermia is a potentially life-threatening emergency. This article examines the case of a 34-year-old, mentally retarded man who experienced three episodes of hypothermia during recurrent exposure to pipamperone. After the pipamperone dose was largely reduced, no further hypothermic episodes occurred. Nine other cases of hypothermia with neuroleptic treatment were reported to the German Federal Institute of Drugs and Medical Devices from 1988 to 1997. A review of the cases revealed that nine of ten patients were treated with drugs that are potent antagonists of 5-HT2 receptors. In conjunction with experimental data, this suggests that antipsychotics with a strong 5-HT2 antagonistic component might be associated with hypothermia. Most of the newly developed "atypical" neuroleptic drugs belong to this group. Therefore, special attention for hypothermia is warranted during the use of "atypical" neuroleptics.

Adult↗