Biomedical subjects

C Wöber

Publications and source records attributed to C Wöber.

52 records · Page 3Linked to original sources

PubMed1995

Chronic relapsing polyradiculoneuropathy in IgG lambda monoclonal gammopathy of undetermined significance (MGUS)--complete remission following carmustine treatment.

A previously healthy 43 year-old female developed IgG lambda monoclonal gammopathy of undetermined significance (MGUS) and ascending sensorimotor polyradiculoneuropathy which relapsed 11 times within 2 years. Marked improvement was noted repeatedly after plasmapheresis. However, on each occasion symptoms and signs of polyradiculoneuropathy recurred almost exactly 3 weeks after plasma-pheresis. Following 6 weeks of treatment with carmustine (70 mg/week), nearly complete recovery was established, which has persisted up to now (82 months after the end of therapy). The close temporal correlation between clinical relapse and recurrence of the IgG paraprotein and its permanent absence in stable clinical remission after carmustine treatment suggest a causal relationship between the paraprotein and the polyradiculoneuropathy. However, further studies are required to confirm this observation, as well as the efficacy of carmustine therapy.

Adult↗

PubMed1994

Dopamine D2 receptor blockade and antimigraine action of flunarizine.

We studied in vivo the influence of flunarizine on dopamine D2 receptors and investigated whether dopamine D2 receptor blockade is involved in its antimigraine action. Eleven migraine patients, treated with flunarizine, 10 mg per day, underwent single photon emission computer tomography (SPECT) using [123I] labeled iodobenzamide, a ligand with high affinity and high specificity for D2 receptors. There was a reduction of the dopamine D2 receptor binding potential in all patients compared to age-matched controls. The efficacy of flunarizine in migraine prophylaxis failed to correlate with the degree of the dopamine D2 receptor blockade. The antimigraine action of flunarizine may not involve antidopaminergic mechanisms.

Adult↗

PubMed1993

[SUNCT syndrome--case report and review of the literature].

The SUNCT syndrome is a recently described headache disorder characterised by shortlasting, unilateral headache attacks with conjunctival injection and tearing. Our report presents a further case and compares the findings in our patient with those in the cases described earlier. In addition, we review the literature and discuss possible aetiological and pathogenetic factors as well as the differential diagnosis of SUNCT syndrome, trigeminal neuralgia and cluster headache syndromes.

Adult↗

PubMed1993

[Idiopathic headache in childhood and adolescence].

This review of the literature covers classification, epidemiology and clinical aspects of idiopathic headache in childhood and adolescence. In addition, pathogenetic models taking into account the complex involvement of organic, psychological and psychosocial factors are critically reviewed. A general pathogenetic model of migraine may be characterized by a given predisposition, various co-factors which enhance the tendency, and finally, trigger mechanisms which induce an attack. No generally accepted model exists for tension-type headache. In assessing the importance of various factors thought to be related to idiopathic headache, it is necessary to differentiate between causal relation, unspecific association, and coincidence. The aim of this review is to present potential factors influencing headache in childhood and adolescence and to discuss these factors critically with regard to their etiopathogenetic importance. Organic factors seem to be most important in migraine, whereas psychological and (psycho)social factors may influence any type of headache. Briefly, migraine in childhood and adolescence seems to be definitively associated with vegetative dysfunction, abdominal symptoms and hormonal factors and possibly with allergic reactions, whereas a relation to epilepsy can be excluded. There is absolutely no evidence for a typical personality of migraine patients. Various psychic reactions, however, are important in all types of headache. Depression and anxiety in young headache patients seem to be related generally to pain, but not specifically to headache. However, school problems, learning disabilities and stress coping behaviour seem to be related directly to recurrent headache. Additionally, there is evidence that the prevalence of headache is associated with low economic status.

Adolescent↗

PubMed1993

Posturographic measurement of body sway in survivors of severe closed head injury.

Postural imbalance was measured in 39 survivors of severe closed head injury 7 to 66 months after head injury using a posturographic platform. The results were compared with those derived from age-matched healthy control subjects. Severe postural imbalance, particularly in an anteroposterior direction, was found in 16 patients, whereas 9 patients showed moderate imbalance and 14 patients showed normal results in the posturographic investigation. Low initial Glasgow Coma Scale scores and deep parenchymal brain lesions demonstrated by magnetic resonance imaging were shown to be significant indicators of subsequent severe postural imbalance. The duration of posttraumatic amnesia, the localization and size of cortical contusions and subcortical white matter lesions, on the contrary, were not associated with postural imbalance in the long-term outcome.

Adolescent↗

PubMed1992

Tension headache and the cervical spine--plain X-ray findings.

The aim of the present study was to investigate if there is any causal connection between plain X-ray findings of the cervical spine and tension headache. We evaluated the X-rays of the cervical spine of 243 patients, in 91 of which the diagnosis was "tension headache", in 102 "headache not fulfilling the criteria of tension headache" and in 50 "spondylogenic complaints without headache". We compared these three groups with regard to frequency and severity of radiologically assessable changes of the cervical spine and found that patients with tension headache had normal findings significantly more often and significantly less often functional or organic changes or both than patients of the other two groups. The radiologically assessable changes of the cervical spine are unlikely to have an essential role in the cause or mechanism of tension headache.

Adult↗

PubMed1992

Spontaneous body sway as a function of sex, age, and vision: posturographic study in 30 healthy adults.

Detailed neurological examinations and body sway measurements with a stable force measuring platform were carried out on 30 healthy adults between 21 and 63 years of age. The results were analyzed for sex- and age-associated changes with regard to three different sway components (total sway, anterio-posterior sway, lateral sway) and two different conditions (eyes open, eyes closed). Sex-associated differences were highly significant for all sway components in the oldest age group (51-65 years) in which men exhibited more spontaneous postural sway than women in the condition eyes open. With eyes closed these differences increased. Middle-aged men (36-50 years) also exhibited significantly more postural sway than women of the same age. In the condition eyes open especially total sway and anterioposterior sway were increased, whereas in the condition eyes closed total sway and lateral sway were predominantly higher in men than in women. In the youngest age group (21-35 years) no sex-related differences in postural sway were found. Age-associated differences were significant for anterioposterior sway (eyes open) in men, increasing continuously from the young to the middle-aged, and again from the middle-aged to the older age group. Anterioposterior sway in women, on the contrary, did not change with age. Age-associated differences in women were found for total sway (eyes open) and lateral sway (eyes closed). However, the highest values for total sway and lateral sway within the female group were obtained from young women in both conditions eyes open and eyes closed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Speech arrest as first symptom of a tumour in the supplementary motor area.

There are only few reports in the literature on isolated episodes of speech arrest as first symptom of a tumour in the supplementary motor area. These episodes of speech arrest are due to seizure activity and must be distinguished from speech arrest due to transient ischaemic attacks. The diagnosis may be difficult because the tumour may erroneously be suspected in the lower portion of the sensorimotor strip and may, hence, be missed on CT if apical sections of the regions are not performed. Clinical and experimental aspects of this problem are discussed on the basis of a case report and a review of the literature.

Aged↗

PubMed1992

[Etiology of Alzheimer's disease].

The major factor that causes problems in studies on the aetiology of Alzheimer's disease (AD) is the clinical heterogeneity of the condition. Familial early-onset AD and familial late-onset AD are differentiated from sporadic AD. Aetiologically a genetic defect on chromosome 21 is the most important factor, at least in some cases of AD. In familial AD and autosomal dominant inheritance with complete penetrance in old age is thought to be possible. In sporadic AD the role of genetic and exogenous factors (infectious agents, aluminium) is unknown. The current status of knowledge about the aetiology of Alzheimer's disease is reviewed with reference to the literature.

Aged↗

PubMed1991

Early diagnosis of Alzheimer dementia?

The main problems in early diagnosis of Alzheimer dementia (AD) are: 1. The differentiation between normal aging and AD i.e. difficulties in the assessment of cognitive disturbances in the healthy elderly and in early demented subjects. 2. Interference with other dementia syndromes. 3. Lack of information in the population and among physicians about the different causes and courses of dementia syndromes. The first two aspects are discussed in this paper.

Aging↗

PubMed1991

Long-term results of migraine prophylaxis with flunarizine and beta-blockers.

We followed-up 64 migraine patients after discontinuation of successful interval prophylaxis with flunarizine, propranolol or metoprolol, to investigate how long the therapeutic success would last, if further prophylaxis would be successful again, and what factors would influence the prognosis. We found that 16 out of 64 patients experienced a lasting reduction of migraine frequency, whereas 48 patients did improve initially, but later experienced a relapse. Further prophylaxis was effective in 29, poorly effective in 11, and ineffective in 8 of these patients; in 7 of the 8 non-responders prophylaxis was not changed. Negative prognostic factors were frequent attacks, a history of analgesic abuse and/or analgesic withdrawal therapy and ineffective previous prophylaxis. In conclusion, the therapeutic success decreases dramatically in the majority of patients several months after discontinuation of prophylaxis; further prophylaxis is more effective if the substance class is changed; increased analgesic intake is the most important prognostic factor. As a strategy for migraine prophylaxis we propose sequential changing of interval prophylaxis or--in patients with negative prognostic factors--long-term prophylaxis.

Adult↗

PubMed1991

[Therapeutic possibilities in spasmodic torticollis].

Spasmodic torticollis is classified as a focal dystonia. It is characterized by involuntary contractions of the muscles of the neck, with consequent deviation of the head from the correct posture. Psychological factors are recognized as important trigger and aggravating mechanisms. The various possibilities of therapeutic management (medical and surgical treatment, psychological methods and psychotherapy) are reviewed. Therapy of spasmodic torticollis should be started with methods such as biofeedback, behaviour therapy, and anticholinergic drugs. If these procedures not successful, local application of botulinum toxin offers a new and highly effective technique. Surgical treatment such as neurotomy, rhizotomy, or stereotaxic operations should be restricted to otherwise intractable cases.

Accessory Nerve↗

PubMed1989

Stabilizing and destabilizing effects of vision and foot position on body sway of healthy young subjects: a posturographic study.

A total of 800 posturographic measurements--each characterized by four values (sway path, sway area, anteroposterior sway and lateral sway)--was carried out for this study. Eight different conditions (interfoot distances of 0, 4, 10 and 20 cm, each with eyes open and eyes closed) were compared by statistical means. All sway values were diminished by vision in small interfoot distances. At large interfoot distances, however, the presence of visual control resulted in an increase of lateral sway. Comparing the different foot positions, an increase of anteroposterior sway and a decrease of all other components were found at large interfoot distances no matter whether the eyes were open or closed.

Adult↗

PubMedDate not supplied

Ataxia of stance in different types of alcohol dependence--a posturographic study.

The aim of this study was to assess the prevalence of ataxia of stance in different types of alcohol-dependent patients. Posturographic measurements were performed in 82 abstinent alcohol-dependent patients and 54 healthy controls in order to analyse postural control. According to Lesch and co-workers, alcohol dependence was classified as total abstinence (Type I), drinking without loss of control (Type II), fluctuating course (Type III), and persistent severe drinking (Type IV). The mechanisms of alcohol dependence in these subtypes can be summarized as follows: Type I patients drink alcohol to counteract symptoms of alcohol withdrawal; Type II patients use alcohol as an agent for solving conflicts; Type III patients drink alcohol to 'treat' an affective disorder; and Type IV patients have a history of pre-alcoholic neurological and/or psychiatric disorders. The neurological examination showed pathological findings in 39%, whereas posturographic measurements uncovered impaired postural control in 61% (chi2 = 8.8, P = 0.003). Comparing the different study groups revealed that ataxia of stance was most common in alcohol-dependent patients classified as Type IV (tau = 0.24, P = 0.005). In conclusion, posturographic measurements are superior to the clinical examination in detecting postural imbalance in alcohol-dependent patients. The prevalence of postural imbalance is highest in patients classified by Lesch as Type IV. Consequently, this type of alcohol dependence -- characterized by pre-alcoholic neurological and/or psychiatric disorders, bears the highest risk of developing ataxia of stance.

Adult↗

PubMedDate not supplied

Functional impact of unvarying exercise program in women after menopause.

Low bone mass, functional impairment, low muscle strength, and postural instability are predictors of the risk of fracture in an elderly person. The purpose of this study was to investigate the functional impact of an unvarying long-term exercise program to be carried out at home. The exercises had been shown to delay bone loss in an elderly population. At the Department of Physical Medicine and Rehabilitation, University of Vienna, postmenopausal women who had been stratified into exercise or control groups 5 to 10 yr ago were called in for a follow-up examination. Frequency of training, habits, and pain causing disability in activities of daily living were recorded. Walking velocity, muscle strength, and postural stability were measured. Functional assessment, blood analysis, and x-rays of the spine were performed additionally. One hundred twenty-four women aged 68.3 +/- 6.8 yr (mean +/- SD) underwent a follow-up investigation at the outpatient clinic. After 7.7 +/- 1.1 yr the compliance of the training group was still 36%. Self-chosen gait velocity was slightly higher in the regular exercisers than in the controls. No intergroup differences were found for pain induced disability, muscle strength, body sway, and fracture rate. The pain disability index was significantly associated with corrected self-chosen gait velocity. The results suggest that an unvarying home-based exercise program may support general agility but does not yield enough force to improve muscle strength and postural stability in healthy, nondisabled, postmenopausal women who start exercising at the age of 60 yr. Further studies are needed to define more appropriate exercise programs for a comprehensive improvement of functional outcome in a population at high risk for osteoporosis.

Accidental Falls↗

PubMedDate not supplied

Establishing principles for migraine management in primary care.

Published guidelines for the management of migraine in primary care were evaluated by an international advisory board of headache specialists, to establish evidence-based principles of migraine management that could be recommended for international use. Twelve principles of migraine management were identified, covering screening, diagnosis, management and treatments: Almost all headaches are benign/primary and can be managed by all practising clinicians. Use questions/a questionnaire to assess the impact on daily living and everyday activities, for diagnostic screening and to aid management decisions. Share migraine management between the clinician and the patient. Provide individualised care for migraine and encourage patients to manage their migraine. Follow up patients, preferably with migraine calendars or diaries. Regularly re-evaluate the success of therapy using specific outcome measures and monitor the use of acute and prophylactic medications regularly. Adapt migraine management to changes that occur in the illness and its presentation over the years. Provide acute medication to all migraine patients and recommend it is taken at the appropriate time, during the attack. Provide rescue medication/symptomatic treatment for when the initial therapy fails. Offer to prescribe prophylactic medications, as well as lifestyle changes, to patients who have four or more migraine attacks per month or who are resistant to acute medications. Consider concurrent co-morbidities in the choice of appropriate prophylactic medication. Work with the patient to achieve comfort with mutually agreed upon treatment and ensure that it is practical for their lifestyle and headache presentation. Using these principles, practising clinicians can screen and diagnose their headache patients effectively and manage their migraine patients over the long-term natural history of the migraine process. In this way, the majority of migraine patients can be well treated in primary care, ensuring a structured and individualised approach to headache management, and conserving valuable healthcare resources.

Humans↗