Biomedical subjects
Publications and source records attributed to G Ladurner.
We describe the case of a 40-year-old male patient who had presented clinically as primary lateral sclerosis for the past 10 years and neuropathologically as diffuse Lewy body disease (DLBD). Neuropathology demonstrated DLBD as an almost ubiquitous disorder of the neuronal cytoskeleton.
Sixteen patients with acute occlusion of the basilar artery were treated with systemic fibrinolysis. Recanalisation was achieved in 10 patients; five patients survived and 11 patients died. Survival was associated with vascular recanalisation in every case. Most of the survivors were younger than 50. An age above 50 and a comatose state on admission seem to indicate a poor clinical outcome. The problem of multimorbidity in the older age group also affects outcome adversely. Haemorrhagic complications were found in two cases (12.5%), with clinical deterioration in one.
12 patients were diagnosed as suffering from spondylodiscitis by means of clinical and laboratory investigations. Magnetic resonance tomography (MRT) and bone scintigraphy (with Tc 99m-diphosphonate) were performed and 6 patients had further MRT follow up investigations. In the initial state of disease the comparison of MRT and bone scan both revealed a sensitivity of 92%. The specificity was 83% for MRT and 50% for bone scintigraphy, respectively. Therefore we conclude MRT is a more specific diagnostic tool in patients with spondylodiscitis. 6 patients were followed up with additional 13 MRT scans. During the first two months of treatment period in most of the patients more distinct pathological findings were seen in MRT in comparison with MRT at the start. No signs of any improvement despite effective treatment were found in the first three months of therapy.
In a retrospective study we analysed two groups each consisting of 100 consecutive patients of similar age and sex distribution who underwent surgery for carotid disease with an intervening period of 5 years (group A 1980/82, group B 1986/87) between the collectives. Against a background of changing indications, tactics and techniques the aim of the study was to detect any differences between the two groups. Group A had a higher proportion of coronary and peripheral vascular disease. The states of cerebral ischemia I, II and III were distributed equally, but state IV was seen more frequently in group B (p less than 0.05). The number of shunt/without shunt operations in group A was 97/2, in group B 10/84 (p less than 0.005). The external carotid artery was deobliterated in 58/81 cases group A versus group B (p less than 0.005). We closed the artery by direct suture in 8/31 (p less than 0.005), by autologous venous patch in 53/26 (p less than 0.005) and by Dacron patches in 39/41 patients. In group A the operative mortality was zero and in group B 1 patient died; one patient in group B developed sudden occlusion (with TIA) postoperatively. Transient intra-/postoperative neurological deficits occurred in 1/2, permanent in 4/2 patients (n.s.). 54/25 patients have died up to 31/08/91. Coronary heart disease was the main cause of late complications and deaths in group A (p less than 0.025). Statistically, there was no dependence of neurological deficits on group, sex, age or intraoperative management. Only patients with preoperative PRINDS hat a higher postoperative neurological deficit rate than the others.
Recent research on the relationship between ERP-latencies and reduced information process capabilities with demented subjects has yielded divergent results. In the present study P300-latencies and RT are used in an attempt to differentiate between demented and nondemented subjects. Based on the "feature-integration-theory" of Treisman an experiment was designed in order to investigate more complex cognitive processes. The results showed that both P300-latency and RT may be used as additional diagnostic indices for cognitive capability.
In a double-blind, active-controlled study 30 patients with mild to moderate multiinfarct dementia diagnosed according to DSM III definition were treated by either 20 mg nicergoline or 4.5 mg co-dergocrine mesilate once daily during eight weeks. Therapeutic effects on symptoms of the organic brain syndrome were quantitatively measured by standardized psychological and psychometric methods evaluating cognitive and thymopsychic functions. Main criteria, which were tested by inferential analysis, were SCAG total score (Sandoz Clinical Assessment Geriatric Scale), SCAG overall impression and the AD Test (alphabetischer Durchstreichtest). Other results were assessed by descriptive statistics. Both treatments resulted in a statistically significant improvement in most of the tested functions. The effects of 4.5 mg co-dergocrine mesilate s.i.d. were in accordance with published results. Although differing slightly with respect to individual results 20 mg of nicergoline once daily showed the same efficacy on the whole.
The prevalence of clinical and electrophysiological signs of peripheral nerve disease was evaluated in 151 patients with chronic obstructive pulmonary disease. Patients with concomitant disorders affecting the peripheral nervous system were excluded. Thirty patients had clinical signs of a mild sensorimotor and distal neuropathy and 13 additional patients had only electrophysiological abnormalities. The rate and the severity of the neuropathy correlated with the severity of chronic hypoxaemia. Three out of 20 patients with mild hypoxaemia (PaO2 less than 15 mm Hg below normal) had polyneuropathy as compared with 15 out of 36 with severe hypoxaemia (PaO2 more than 30 mm Hg below normal (rates different at the 10% level)). PaO2 and age were the only variables discriminating between patients with and without peripheral neuropathy.
64 ischemic stroke patients with angiographically verified occlusion of the internal carotid artery were studied. 32 patients underwent surgical revascularization in the acute stage within a few hours of acute onset of stroke. 32 patients had conservative management of treatment. Both groups were compared in regard to mortality rate, functional recovery and clinical findings or neurological deficits and psychiatric disturbances on admission and 4 weeks later. Correlations of functional recovery between the two groups showed no significant differences. Mortality rate in the conservatively managed group however was significantly lower than in the operative group.
Visual evoked potentials, including the P300 response, and reaction time were recorded from 20 patients with multi-infarct dementia, 20 nondemented patients with brain-infarct diseases, and 20 age-matched control subjects. Additionally the patients were assessed using the WAIS-index. Prolonged P300 latency and reaction time occurred in both of the patient-groups, correlated significantly with the WAIS-index. However, effects regarding to P300 latency and reaction time were not strong enough to allow individual classifications.
The expectations towards rehabilitation held by 45 stroke patients and their relatives were investigated. It was found that the expectations held by the relatives are more realistic and not quite as optimistic as those held by the patients. The patients above all hoped for physical-vocational restoration, the relatives on the other hand more for emotional-social recovery. Also dealt with are the expectations and notions of patients and relatives in respect of duration, location and material rank of rehabilitation. Pointed out are the difficulties to be reckoned with on account of the divergent expectancies of patients and relatives toward rehabilitation.
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This study investigated the clinical usefulness of the contingent negative variation (CNV) as a neurophysiological index of cognitive dysfunction associated with cerebrovascular disease. A total of 31 patients ranging in age from 45 to 88 years with the diagnosis of a stroke were included. Nineteen patients were classified as demented according to clinical assessment and the Mental Deterioration Index (MDI) based on the WAIS, the other 12 patients as non-demented. In a discriminative CNV-paradigm two different tones served as warning stimuli for a flash of light presented 1.5 s later that could be turned off by a press on a button only after the relevant tone. According to our hypothesis, CNV amplitudes of demented patients were significantly smaller than those of the non-demented group. Moreover, a significant relationship was observed between severity of dementia (MDI) and degree of amplitude reduction. Thus, it was concluded that the CNV method could make an important clinical contribution to the assessment and course of dementia.
In 167 patients with cerebrovascular disorders 323 carotid bifurcations were investigated by Duplex ultrasound. In 100 of these patients, additionally intravenous digital subtraction angiography (DSA) was performed and in 35 patients, also intra-arterial DSA was carried out. In 32 patients all three procedures were performed. Comparing the results of Duplex scan and intravenous DSA with intra-arterial DSA it can be concluded that Duplex scan and intravenous DSA are comparable as screening methods for the evaluation of haemodynamically relevant stenoses and occlusions in extracranial artery disease. However, for the evaluation of stenotic vessels of less than 50% lumen reduction the Duplex scan showed a higher agreement rate with a contingency coefficient of 0.957 in comparison to intravenous DSA with a contingency coefficient of 0.903.
40 patients with multiple sclerosis were investigated by magnetic resonance imaging (MRI) and computer tomography (CT). Additionally, cerebrospinal fluid (CSF) findings and evoked potentials (EPs; visual, brainstem) were evaluated. MRI findings were abnormal in 85% of the patients, whilst CT scan showed pathological changes in only 23%. The sensitivity for detecting lesions was significantly higher for MRI than CT. 86% of 23 patients with a duration of disease of more than 1 year had pathological MRI findings, and MRI was abnormal in 82% of 17 patients with a duration of symptoms up to 1 year. All patients with abnormal MRI had at least one other pathological laboratory finding. CT revealed only large lesions, and in patients with abnormal CT MRI visualized lesions more extensively. Additionally, brainstem lesions could be verified in 6 patients and spinal cord lesions in 3 cases. CSF was abnormal in 86%, and positive MRI findings occurred in 26 of 31 patients with abnormal CSF. Abnormalities of EPs were found in 76%, and MRI was positive in 24 of 33 patients with abnormal EPs.
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79 patients with ischaemic stroke were investigated, with 31 patients showing a pure hemiparesis, 22 an additional depressive syndrome and 26 a dementia. After an average time intervall of 28 months, a follow-up investigation was performed on these 3 groups relative to their course and rehabilitation outcome. No significant differences were present between the 3 groups as regards age and sex distribution as well as hemisyndrome severity. The neurological and psychiatric findings at follow-up differed significantly from the primary findings. Also, significant differences were found in the degree of disability, and in the self- and family ratings of rehabilitation outcome, with a poorer long-term course, i.e. a higher degree of disability, significantly more frequent in the dementia group. Comparison of self- and family-ratings showed that self-ratings given were significantly worse in the dementia and depressive groups, whereas patients with purely neurological symptoms rated themselves better than their relatives did.
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To estimate the frequency of stroke patients in the county of Salzburg (Austria), which has a population of 434,000 inhabitants, 211 doctors (in general practice), and staff of 58 homes for the elderly and 9 hospitals were interviewed. Altogether 1,871 stroke patients were found, which represents a prevalence of 4.3 patients per 1,000 inhabitants; 1.5% had to be considered as patients requiring constant care. 78% of the patients were living at home; 13% were in homes for the elderly and only 9% were found in the hospitals. 35% of the hospital patients were in general medical units, 26% on neurological and 22% on geriatric wards. 13% of the patients were in a rehabilitation centre and 3.5% in the local neurosurgical unit.