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Biomedical subjects

F Mundinger

Publications and source records attributed to F Mundinger.

At least 19 recordsLinked to original sources
PubMed1992

Dystonia following head trauma: a report of nine patients and review of the literature.

We report nine patients who developed dystonia following head trauma. The most frequent form was hemidystonia only (six patients). One patient presented with hemidystonia plus torticollis, one with bilateral hemidystonia and one with torticollis only. Seven patients sustained a severe head injury, and two had a mild head injury. At the time of injury, six were younger than 10 years, two were adolescents, and the patient with torticollis only was an adult. Except in the patient with torticollis only, the onset of dystonia varied considerably from months to years. All patients with hemidystonia had posthemiplegic dystonia of delayed onset. Seven out of 8 patients with hemidystonia had lesions involving the contralateral caudate or putamen, as demonstrated by CT and MR. The patient with hemidystonia plus torticollis had no lesion to the basal ganglia, but a contralateral pontomesencephalic lesion. Response to medical treatment was generally poor. Functional stereotactic operations were performed in seven patients. A variety of factors may be responsible for the vascular or nonvascular posttraumatic basal ganglia lesions, which may lead to dystonia. The pathophysiology seems to be more complex than thought previously. We believe that dystonia following head injury is not as rare as is assumed. Awareness of its characteristics and optimized diagnostic procedures will lead to wider recognition of this entity.

Adult↗
PubMed1992

Primary cerebral malignant non-Hodgkin's lymphomas: a retrospective clinical study.

In this retrospective study a series of 54 patients (seen from 1982 to 1989) with sporadic primary cerebral malignant lymphomas (PCML), which were uniformly classified with the support of immunocytochemical data, is presented. The analysis shows that on CT PCML are shown as cirumscribed, homogeneous, contrast-enhanced multifocal (70%) or solitary (30%) mass lesions within the subcortical white matter; they were found mainly close to the ventricular system or the subarachnoid space. To prove the histological diagnosis and for the purposes of differential diagnosis, low-risk CT-stereotactic biopsy is necessary and is the method of choice. Immunomorphological techniques are valuable adjuncts to confirm the histological diagnosis of PCML. In the series presented these tumours have been predominantly classified as high-grade blastic B-cell lymphomas. For this reason, this type should be regarded as the prevalent variant of malignant brain lymphomas. The evaluation of possible prognostic factors suggests that age at admission and morphological features of regression are relevant determinants of survival time. A correlation between neuroradiological evidence of a decrease in tumour size, morphological signs of regression and glucocorticoid administration has been found. Thus, patients suspected of having PCML require rapid diagnosis prior to corticosteroid administration. PCML have been shown to be radioresponsive, but not curable. Because of the lack of uniformity in management of this rate brain neoplasm, the different treatment protocols are not comparable, and hence the optimum therapy has not been satisfactorily determined.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1992

Movement disorders in astrocytomas of the basal ganglia and the thalamus.

In a series of 225 patients with astrocytomas (grades I-IV) of the basal ganglia and the thalamus, 20 had a movement disorder. In all patients the histological diagnosis was verified by stereotactic biopsy. Tremor was observed in twelve patients, dystonia in eight, chorea in three, and chorea/ballismus and myoclonus in one. The tumour involved the thalamus in 16 patients. Corticospinal tract dysfunction was evident in 70% of the patients with movement disorders and in 73% of those without. Demographic, clinical, histological and neuroradiological data of the patients with a movement disorder were compared with the data of patients without. CT data yielded no differences with respect to the involvement of anatomical structures. Movement disorders were significantly associated with low-grade astrocytomas.

Adolescent↗
PubMed1991

Dystonia and akinesia due to pallidoputaminal lesions after disulfiram intoxication.

A case with segmental cranial plus crural dystonia of delayed onset and akinesia after acute intoxication with disulfiram is presented. Computed tomography showed bilateral pallidal lesions, whereas on magnetic resonance imaging additional small lesions of the putamen could be detected. Long-term observation with progression and a change of symptoms over a period of 10 years after the intoxication is demonstrated on videotape. Although other central side effects after intoxication with disulfiram are well known, movement disorders are uncommon. Carbon disulfide, a disulfiram metabolite, may be important in the etiopathogenesis.

Adult↗
PubMed1991

Bilateral ballismus in children.

Bilateral ballismus is extremely rare. We found 23 reported cases, and only 2 of these were in children. In older patients the movement disorder is usually due to cerebrovascular disease, but in younger patients a variety of aetiopathological causes may be found. There are few data regarding medical treatment. There have been no previous reports on stereotactic operations. We report on two severely disabled children who underwent stereotactic surgery. A 9-year-old boy suffering from bilateral ballismus after meningoencephalitis was operated on bilaterally (two operations 1 year apart). Another 9-year-old boy, who was suffering from progressive, presumably degenerative, basal ganglia disease, was operated on unilaterally. The nosological and conceptual controversies differentiating bilateral ballismus as a phenomenological entity are reviewed. The therapeutic options, indications, and special problems of stereotactic surgery in these rare cases are discussed.

Child↗
PubMed1991

Ventricular fluid neuropeptides in Parkinson's disease. II. Levels of substance P-like immunoreactivity.

Substance P-like immunoreactivity (SPLI) was determined in cerebrovascular fluid of patients with extrapyramidal motor diseases. Patients with Parkinson's disease (PD) showed a SPLI concentration decreased by 30% compared with patients without extrapyramidal disease. No differences were apparent for patients with dystonia. Fluid obtained from the foramen Monro showed higher SPLI concentrations than fluid from a lateral ventricle, indicating that hypothalamic sources are important for ventricular substance P. Lateral ventricular SPLI was particularly low in parkinsonian patients which raises the possibility of a decreased SPergic activity in basal ganglia occurring in PD.

Adult↗
PubMed1991

Image-directed stereotactic drainage of the symptomatic cavum septi pellucidi et vergae.

Two rare cases of symptomatic non-communicating cava septi pellucidi et Vergae (CSPV) with successful treatment via image-directed stereotactic internal drainage are reported. Because the management of these benign space-occupying structures by the transcallosal approach bears certain risks, safer methods should be applied. The clinical significance, results, and advantages of the CT-stereotactic procedure are represented. If patients with symptomatic CSPV are scheduled for an operation, stereotactic intervention is proposed as the therapy of choice.

Adult↗
PubMed1991

Chiasmatic optic glioma.

Optic nerve glioma is a rare tumor usually occurring in small children. How these tumors should be treated, is a matter of controversy. Recommended treatment ranges from a wait-and-see policy to radical excision with or without subsequent radio- or chemotherapy. Comparative data on these lesion are limited, as there are no randomized investigations and long-term studies reported in the literature. In 11 patients interstitial radiotherapy was carried out, by the implantation of J-125 seeds following confirmation of the histological diagnosis. The results are compared with those of 10 patients who underwent only biopsy for histological confirmation. CT-stereotactic biopsy to verify the diagnosis with subsequent interstitial irradiation is presented as an alternative therapy for optic gliomas.

Adolescent↗
PubMed1991

Long-term outcome of 89 low-grade brain-stem gliomas after interstitial radiation therapy.

Between 1974 and 1985, 89 patients suffering from histologically confirmed, nonresectable low-grade astrocytomas located in the brain stem were entered into a retrospective study. Iodine-125 (125I) was implanted in 29 patients and iridium-192 (192Ir) in 26 patients. Computerized tomography revealed that 78% of the tumors in these patients were located chiefly in the mesencephalic region, 70% were circumscribed, and 78% were contrast-enhanced. Thirty-four patients underwent biopsy without prior aggressive tumor-specific therapy such as chemotherapy or external beam irradiation. Among these, 70% of the tumors were located predominantly in the pons, 74% were diffuse, and 59% were hypodense or isodense after contrast enhancement. Long-term follow-up investigations indicated that life expectancy after interstitial radiation therapy with 125I implanted directly by catheter either permanently or temporarily showed a more favorable trend than that after treatment with 192Ir. Interstitial radiation therapy with 125I appears to be an effective treatment for slowly proliferating, differentiated, well-delineated, nonresectable brain-stem gliomas. This technique makes it possible to achieve radiosurgical tumor control and, when carefully applied, represents the least traumatic treatment. Reduction of the tumor mass brings about improvement of the clinical symptoms. Further investigations on the biological behavior of brain-stem gliomas and prospective randomized long-term follow-up studies are necessary to evaluate the different kinds of treatment available for these patients.

Adolescent↗
PubMed1990

Ventricular fluid neuropeptides in Parkinson's disease. I. Levels and distribution of somatostatin-like immunoreactivity.

We have measured somatostatin-like immunoreactivity SLI in cerebroventricular fluid of patients with Parkinson's disease (PD) and other extrapyramidal disorders with hyperkinesia. Patients with PD showed a significantly lower concentration of SLI when compared with levels in control patients with chronic stable multiple sclerosis or temporal lobe epilepsy. Less markedly decreased levels of SLI were also noted in patients with torsion dystonia. Of two patients with Huntington's disease one showed a high and one a medium concentration of SLI. According to the site of the stereotactic cannula, verified by ventriculopathy, SLI concentrations in CSF specimen obtained from the foramen Monro tended to be higher than in specimen from a supraforaminal level. Of 5 other patients with lateral and third ventricle being accessible during the passage of the stereotactic cannula, 4 showed higher SLI concentrations in the third ventricle compared to the lateral ventricle. High performance liquid chromatographic analysis combined with radioimmunoassay showed molecular heterogeneity of SLI in CSF. The ratio of SST-14 to SST-28 was higher in the third ventricle than in the lateral ventricle.

Adult↗
PubMed1990

Long-term results of stereotaxy in the treatment of essential tremor.

In patients with severe tremor that is resistant to drug therapy, stereotactic coagulation can achieve a satisfactory and lasting reduction of the movement disorders. Very few long-term studies have been conducted following stereotactic operations. From 1964 to 1984, 104 patients with a diagnosis of essential tremor were operated on in the Division of Stereotaxy and Neuronuclear Medicine. After an average follow-up period of 8.6 years, 65 patients were examined. In 80%, the success of the stereotactic operation was still evident. Complete disappearance or substantial reduction of the tremor was determined in 69% and moderate improvement in 11.9% of the patients.

Aged↗
PubMed1990

Stereotactic evacuation and fibrinolysis of cerebellar hematomas.

Despite modern diagnostic and operative methods, the mortality and morbidity rates of spontaneous cerebellar hematomas remain very high, i.e., according to a review of the literature as high as 45%. By stereotactic puncture, partial evacuation and fibrinolysis of the remaining hematoma with urokinase, much more favorable results can be achieved. As we could observe in long-term follow-up, only 1 patient out of 15 died within 2 months after operation. The method is effective, easy, exact, without risk and applicable at every age, so that actually there is no comparable alternative way of treatment.

Adult↗
PubMed1989

Stereotactic interstitial irradiation of diencephalic tumors with iridium 192 and iodine 125: 10 years follow-up and comparison with other treatments.

The only possible treatment of non-removable tumors of the diencephalon or recurring tumors invading the diencephalon after partial resection or percutaneous radiotherapy is interstitial irradiation (Curie therapy). With the CT/MRI stereotactic method, biopsy for histological tumor classification can be performed and 125I or 192Ir implanted, provided the neuroimaging methods show the delimitation of the tumor, its diameter does not exceed 3 cm and, given the patient's condition, focal irradiation seems advisable. As of 31 August 1987, a total of 1883 cases had been stereotactically biopsied and interstitially irradiated. The indications and results are reported in 204 patients under 18 years of age with diencephalic and deep-seated astrocytomas, after a follow-up period of up to 10 years; the data were compared for tumor resection, percutaneous irradiation, and for interstitial irradiation. The latter proved to be the most effective treatment.

Adolescent↗
PubMed1989

[The significance of stereotaxic brain biopsy in atypical multiple sclerosis].

Multiple sclerosis (MS) is one of the most common diseases of the central nervous system. Up to now, there is no pathognomonic test to ascertain the diagnosis and in 10 to 15% of MS cases there are problems in differential diagnosis. We report 15 bioptically diagnosed MS cases with atypical clinical, C.S.F. and neuroradiological findings. In each case the diagnosis of MS was made by CT/MRI-stereotactic brain biopsy. Neoplastic and other non-tumorous lesions could be excluded. Indications for and significance of stereotactic brain biopsy in atypical cases of MS are discussed.

Adult↗
PubMed1988

Computed tomography in cases of multiple sclerosis: problems of differential diagnosis in cases with atypical findings.

The value of computed tomography in the diagnosis of multiple sclerosis is undisputed. The examination is usually carried out as a routine part of the examination program. We report on the CT results of 112 patients with confirmed or suspected MS. Seventy-three patients were examined without, 39 with intravenous administration of a contrast medium. In 41% of the patients, isolated or multiple hypodense foci were found as a manifestation of a multilocular demyelinization process. In 17.8%, only cerebro-atrophic changes were encountered. In 30.3% of the cases the CT showed normal results. In the group of patients examined with a contrast medium, a pathological contrast medium concentration was found in 30.7%. The differential diagnostic demarcation against other diseases of the CNS with similar CT findings and problems of differential diagnosis with MRI are discussed.

Adult↗