0000000000194999
AUTHOR
Barbara Tettenborn
Third nerve palsy as the sole manifestation of midbrain ischemia
Thirty-seven patients with risk factors for the development of cerebrovascular diseases had sudden onset isolated third nerve palsy and abnormal masseter reflex and/or electro-oculographic findings indicating a causative midbrain lesion. Improvement or recovery of the third nerve palsies was accompanied by improvement or recovery of the abnormal electrophysiologic findings pointing to their functional significance. Magnetic resonance imaging (MRI) in 29 of these patients demonstrated corresponding ischemic midbrain lesions in eight, ipsilateral in five patients, bilateral in three. In another three patients with MRI proven midbrain lesions (ipsilateral in two, bilateral in one) electrophysi…
Exophthalmos and basilar impression. A contribution to differential diagnosis of endocrine orbitopathy.
We report on a male patient with exophthalmos of unclear etiology, basilar impression, syringohydromyelia and type II Arnold-Chiari malformation. Two diseases involving the orbital region were to be considered in differential diagnostic terms: endocrine orbitopathy and osseous orbit dysplasia. The typical physical appearance associated with basilar impression as well as suppurative keratitis in Lagophthalmos was striking. Tetraspasticity with pareses, bulbar symptoms, proximally pronounced muscular atrophy as well as a left hemihypesthesia was shown neurologically. Although the orbit CT was normal, sonography revealed thickened ocular muscles. There was euthyroidism in diffuse goiter with n…
Color-coded duplex ultrasonography of the origin of the vertebral artery: normal values of flow velocities.
The introduction of color-coded duplex ultrasonography has improved the ease of performing ultrasound investigations of the vertebral arteries. So far, normal values of flow velocities have been reported only for the intertransverse region of the vertebral artery (V2 segments). Atherosclerotic disease at the origin of the vertebral arteries (V0 segment) is frequent and is one of the risk factors for vertebrobasilar ischemic disease. Normal values of flow velocities of the vertebral artery origin are needed to assess pathologic findings, such as vertebral artery origin stenosis or dissection. The aim of this study was to describe the normal flow velocities of vertebral artery origin (V0 segm…
Therapy of Early Poststroke Depression With Venlafaxine: Safety, Tolerability, and Efficacy as Determined in an Open, Uncontrolled Clinical Trial
To the Editor: The development of persistent depressive symptoms is a severe and frequent complication of ischemic or hemorrhagic stroke.1 The etiology of poststroke depression is not well understood. Only few placebo-controlled, double-blind studies have been carried out, all reporting various degrees of superiority of standard antidepressants over placebos.1 2 On the other hand, serious side effects have been reported.3 4 In most of these studies, patients were examined whose stroke had occurred several weeks to several months before the antidepressive therapy was started. Antidepressive therapy in the first weeks after stroke has not yet been attempted in studies. Drug-induced improvemen…
Polytopiekriterien in der Diagnostik von Hirnstammläsionen
Bei Patienten mit akuten klinischen Zeichen einer Hirnstammlasion, versuchen wir fur gewohnlich, die Symptome und klinischen Befunde einer einzigen Lokalisation zuzuordnen. Aber selbst in dem anatomisch sehr komplex aufgebauten Hirnstamm kann eine unifokale Lasion nicht in jedem Fall alle neurologischen Ausfalle erklaren. Es mus dann von mehreren kleinen Lasionen innerhalb des Hirnstamms ausgegangen werden.
Mutation analysis in myophosphorylase deficiency (McArdle's disease).
Inherited deficiency of myophosphorylase leads to glycogen storage disease type V (McArdle's disease). We performed mutation analysis in 9 patients of eight unrelated families from Germany with typical cliniclal presentation of myophos-phorylase deficiency. Beside previously described mutations we identified four novel mutations in the myophorsphorylase gene. Four patients were homozygous for a nonsense mutation Arg49Stop that has been reported to be the most common mutation in white patients. Two affected siblings were compound heterozygotes for a novel missense mutation Gly685Arg and the nonsense mutation Arg49Stop. One patient carried a novel nonsense mutation Arg575Stop and a previously…
Photoreactive flow changes in the posterior cerebral artery in control subjects and patients with occipital lobe infarction.
Background and Purpose Photoreactive flow changes of the posterior cerebral artery (PCA) in control subjects and patients with unilateral occipital lobe infarction were investigated to study the hypothesis that occipital lobe infarction of varying extent leads to a reduced visually activated flow increase in the ipsilateral PCA. Methods Maximum mean flow velocity (MFV) of the PCA was investigated by transcranial Doppler sonography after photic stimulation of the retina. Results In 25 control subjects MFV was increased by 30.6±9.7%. In 13 patients with unilateral occipital lobe infarction the ipsilateral MFV increase was significantly lower than in control subjects. Nine patients with homon…