Failure of physostigmine in treatment of acute severe intrathecal baclofen intoxication.
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Biomedical subjects
Publications and source records attributed to F Aichner.
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Of the population of a small Tyrolean village, 185 (56%) of the 329 inhabitants over 40 years were investigated by means of Doppler and duplex sonography, electroencephalography (EEG), electrocardiography (ECG), and neurological examination. Four subjects (2%) previously had a transitory ischemic attack (TIA) or stroke in the carotid territory. Sonographically detectable abnormalities in one or more extracranial arteries were present in 42 (23%) persons. Of the 14 subjects with more than slight abnormalities in the common or internal carotid artery two were symptomatic. Two additional cases with TIA or stroke did not show relevant lesions on sonographic examination. The presence of narrowing in the extracranial artery was not related to risk factors (hypertension, smoking, obesity) or abnormalities on ECG and EEG. This study shows 1) that the clinical relevance of ultrasound screening of the carotid arteries in an average population is 15%; 2) that significantly more patients with TIAs or strokes are found in the group with more severe sonographic findings (p = 0.001) than in the group with normal ultrasound results.
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Modern diagnostic management of diseases of the spinal cord is discussed, illustrated by some exemplary cases and reviewed by the literature. Special attention is directed to high resolution tomography, magnetic resonance imaging, analysis of the cerebrospinal fluid and electrophysiological methods. It seems conceivable that a shift from invasive methods to noninvasive procedures (e.g. magnetic resonance imaging) may occur.
Nervous system involvement in progressive systemic sclerosis (PSS) has been considered rare compared to other collagen diseases. We present 14 additional cases of PSS with neurological manifestations. Primary involvement of the peripheral nerves could be detected in 4 of 14 patients and is documented by electromyo- and electroneurographical examinations. Central nervous system (CNS) manifestations directly related to PSS are a rarity, which may reflect the lack of collagen in the brain, histological differences between cerebral and other arteries and the immunological particularity of the brain. There may have been a direct relationship between CNS involvement and PSS in only one patient presenting with an overlap-syndrome.
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An attempt was made to measure quantitatively the total cerebral blood flow by means of Duplex sonography. In a group of healthy young subjects a median value for total cerebral blood flow was obtained amounting to 469 ml/min +/- 30%; repeat measurements yielded a maximum deviation of +/- 11%. In three patients the values obtained after severe apoplectic insult due to occlusion of the internal carotid artery were definitely below the value of the group of healthy subjects, whereas the value for the total blood flow was in the upper range of normal values in a patient with occlusion of the a. cerebri media. Comparative measurements of the regional cerebral blood flow with xenon 133 yielded in those patients with occlusion of the internal carotid artery a markedly reduced mean flow and in the patient with occlusion of the a, cerebri media a less markedly reduced mean flow. Regionally reduced perfusion was seen in all the four patients in the range of the clinically and computer tomographically well-known ischaemia zone. Thanks to the simplicity of this sonographic examination method it could be a useful decision parameter in determining the indication for a reconstruction of the carotid artery, especially in asymptomatic patients.
The histories of two patients with spinal epidural abscess are reported. Attention is drawn to the route of infection by means of direct inoculation of pathogens in the wake of paravertebral infiltration of local anaesthetics for relieving lower backpain, furthermore we emphasize the rare occurrence of a relapsing acute spinal epidural abscess. Additionally the diagnostic superiority of nuclear magnetic resonance tomography is described in a patient known to be allergic to commonly used contrast material.
The computer-tomography appearances of the Chiari I-III malformations are reviewed. The study is based on a series of 35 cases of Chiari I malformation, 116 cases of Chiari II malformation, and one case of Chiari III malformation. In our experience, a reliable diagnosis of all three types of malformation is possible on computer tomography. However, nuclear magnetic resonance imaging does reveal more detail and may become more important in the diagnosis of malformations of the posterior fossa structures.
The results of Doppler sonographic and Duplex sonographic examinations of the extracranial carotid artery carried out in 100 patients by two sonographers were compared with angiographic findings. The accuracy and quality of the ultrasonic examinations did not differ from those of documented examinations performed by physicians. The percentage of error due to mistakes on the part of sonographer vas 1.3%. We conclude that sonographers are qualified for performing carotid Doppler and duplex sonography, provided that they are well-trained, experienced and supervised.
A new imaging method for computerized tomography is presented and some examples are demonstrated. The method is based on the collection of all image data of a chosen block of tissue and enables the examiner to perform multiplanar reconstructions of high quality in any direction, even in oblique planes. In order to achieve a better orientation, the block of tissue can also be visualized at the same time on the reconstruction.