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H D Langohr

Publications and source records attributed to H D Langohr.

At least 19 recordsLinked to original sources
PubMed2004

[Recurrent cerebral ischemias due to cerebral vasculitis within the framework of incomplete POEMS syndrome with Castleman disease].

The POEMS syndrome is a multisystem disorder characterised by polyneuropathy, organomegaly, endocrinopathy, plasma cell dyscrasia and skin changes. A coincidence with angiofollicular lymphoid hyperplasia (Castleman's disease) exists in about 60% of all cases. The POEMS syndrome may be associated with macroangiopathy and acute vascular obliterations. Most case reports refer to involvement of the coronary and lower limb arteries. There are only few reports dealing with cerebral strokes and POEMS syndrome. We report on a 32-year-old female with an incomplete form of POEMS syndrome with Castleman's disease and associated cerebral vasculitis. After sufficient treatment of the plasma cell dyscrasia, recurrent cerebral ischemias occurred. A stable state was finally reached after primary treatment of the vasculitis with cyclophosphamide.

Adult↗
PubMed2001

Treatment of acute ischemic stroke with the low-molecular-weight heparin certoparin: results of the TOPAS trial. Therapy of Patients With Acute Stroke (TOPAS) Investigators.

BACKGROUND AND PURPOSE: To study the safety and efficacy of the low-molecular-weight heparin certoparin, we performed a randomized, double-blind, dose-finding multicenter trial in patients with acute ischemic stroke (Therapy of Patients With Acute Stroke [TOPAS]). METHODS: We randomized 404 patients to 4 treatment groups within 12 hours of stroke onset: 3000 U anti-factor Xa (aXa) certoparin once daily (treatment group 1); 3000 U aXa twice daily (group 2); 5000 U aXa twice daily (group 3); and 8000 U aXa twice daily (group 4). The primary efficacy variable was the proportion of patients reaching a favorable functional outcome (Barthel Index >/=90 points) at 3 months. CT was performed at trial entry, after 7 days, and on clinical deterioration. RESULTS: The proportion of patients with Barthel Index >/=90 was not different between treatment arms (61.5%, 60.8%, 63.3%, and 56.3% in the 4 groups, respectively; intent-to-treat population). European Stroke Scale scores improved in all treatment groups within the first 14 days to a similar extent. During the follow-up of 6 months, percentages of patients with recurrent stroke/transient ischemic attack were 11.0%, 5.9%, 9.7%, and 13.0% in the 4 groups, respectively. Overall mortality was only 7.4%. Two parenchymal cerebral hematomas and 1 extracranial bleeding episode occurred in treatment group 1 versus 1 and 0 in group 2, 2 and 0 in group 3, and 4 and 5 in group 4, respectively. During certoparin treatment, 1 deep vein thrombosis but no pulmonary embolism was observed. CONCLUSIONS: Dose increase of certoparin up to 8000 U aXa twice daily did not improve the functional outcome of patients with ischemic stroke. Severe bleeding tended to be more frequent in the highest dose group only.

Adolescent↗
PubMed1999

[Headache caused by polycythemia vera. Classification of a headache under the heading of metabolic disturbances].

UNLABELLED: As polycythemia vera is a myeloproliferative syndrome, it is based on an autonomic increase in the proliferation of all hematopoetic cells--mostly of erythropoesis. An increase in blood viscosity induces disturbed microcirculation, resulting in headaches with clinical symptoms. So far, the headache in polycythemia vera has not been classified. METHODS: We would like to demonstrate a case of a female patient aged 58 years who had been complaining of persistent hemicranial right-sided headaches for the last 16 days, alternating between throbbing and stabbing pain as well as a retrobulbar feeling of pressure. Blood chemistry demonstrated pronounced changes: hemoglobin, 20,1 g/dl; hematocrit, 58%; erythrocytes, 6,8 T/l (6,800,000/microl) leucocytes, 14,400/microl; thrombocytes, 543,000/microl A punch biopsy from the pelvic rim showed cell-rich bone marrow, demonstrating a myeloproliferative syndrome suggestive of polycytemia vera. RESULTS: Following hemodilution, the headache disappeared within 3 days following normalization of blood chemistry: hemoglobin, 14.9 g/dl; hematocrit, 44%; erythrocytes, 5.2 T/l (5,200,000/microl; leucocytes, 13,100/microl. Further diagnosis of the headache by means of MRI of the head, extra and transcranial doppler sonography as well as MRI of the cervical spine did not produce findings with the exception of retrospondylophyth at C5-6. The patient was therefore managed on aspirin 300 mg daily and was given weekly isovolemic bleeding. The headaches did not recur. CONCLUSION: We diagnosed a headache caused by polycythemia vera and recommend classification of this headache under the heading of metabolic disturbances, because this classification meets the diagnostic criteria of the international headache classification.

English Abstract↗
PubMed1999

[Virus encephalitis with symptomatic Parkinson syndrome, diabetes insipidus and panhypopituitarism].

Virusencephalitis is characterised by clinical symptoms of a parenchymatous inflammation. In addition, early mental status changes often occur as a result of virusencephalitis, beside focal neurological deficiencies, epileptic seizures, cerebral compression, even coma. Other pathological manifestations of virusencephalitis are disturbances of the neurohumoral and the endocrine system, which are often recognised and treated too late. This case report describes symptoms, treatment, and complications of a 76 year old female in-patient, who was diagnosed with virusencephalitis. The number of lymphocytes in the cerebrospinal fluid was increased to 30 cells per microliter, liquor albumin was 1705 mg/l, liquor sugar was 53 mg/dl and liquor lactat was 1.9 mmol/l. IgM antibodies against herpes viruses were found in the cerebrospinal fluid and distinct contrasting foci were found near the mammillary bodies, hypothalamus, tractus opticus, hypophyseal stalk and right parahippocampal in the magnetic resonance imaging of the head, indicating a focal herpes simplex encephalitis. Within seven days, the following symptoms developed: akinetic parkinsonian syndrome, central diabetes insipidus with hypernatremia and polyuria (6 l/die), hypothyreosis, adrenal insufficiency with adynamia, sopor, hypotension and even hypophyseal coma. Panhypopituitarism was diagnosed after measuring the basal hormone levels (ACTH, TSH, FT3, FT4, Cortisol, Prolactin, LH, FSH, ADH) and conducting the pituitary stimulation test. The severeness of all symptoms was slightly improved after substitution with antidiuretic hormone at 0.4 microgram/die and administration of hydrocortisone at 50 mg/die. Administration of amantadine sulphate at 0.6 g/die and L-dopa at 187.5 mg/die for 14 days resulted in a complete regression of the parkinsonism. After administration of aciclovir at 2.25 g/die for 21 days a complete regression of the clinical symptoms could be reached in connection with a decrease of 90% in number and size of cerebral contrasting foci in the magnetic resonance imaging of the head. Three month after therapy, clinical examination and blood serum analysis revealed persistent panhypopituitarism. The present case report is the first description of a viral infection on of the central nervous system (CNS) in combination with parkinsonism, diabetes insipidus, persistent panhypopituitarism and hyperprolactinemia. Early treatment of viral infections of the brain can improve a patient's prognosis dramatically. Early determination and early treatment of a patient's neurohumoral parameters is therefore critical to prevent or reverse early mental status changes like attention disturbances, alterations of personality and behavior, apathy, and slowed cognition.

Aged↗
PubMed1995

[The value of clinical and chemical laboratory follow-up parameters in neuroborreliosis].

Whereas the diagnosis of acute neuroborreliosis by considering clinical and cerebrospinal fluid parameters is very reliable chronic neuroborreliosis is an excluding diagnosis. The clinical symptoms are uncharacteristic, and there is no reliable laboratory test permitting a safe diagnosis. Serological evidence of antibodies is no sign of activity of disease. Development of chronic infection after adequate treatment of acute neuroborreliosis seems to be very rare. We reinvestigated 15 patients half a year after antibiotic therapy of acute neuroborreliosis with regard to clinical and laboratory parameters. Most patients had a continuous intrathecal IgG antibody production against Borrelia burgdorferi, whereas no clinical signs of chronic neuroborreliosis existed. The antibody production against Borrelia burgdorferi must not be regarded as a sign of chronic infection.

Adult↗
PubMed1994

[Unilateral caudal cranial nerve paralysis in extracranial carotid dissection].

Focal cerebral ischemic symptoms, Horner's syndrome and mostly ipsilateral headache are the characteristic clinical triad of extracranial carotid artery dissection. Lower cranial nerve palsies seem to be uncommon and rare. By means of two cases with identical clinical symptoms and of a literature review we make clear, that ipsilateral lower cranial nerve palsies, especially a hypoglossal nerve palsy, are not uncommon. Without focal cerebral ischemic symptoms they can be the only sign of extracranial carotid artery dissection. Computed tomography of the skull base with regard to the high cervical internal carotid artery is as an usually quickly available examination an alternative to magnetic resonance imaging.

Aortic Dissection↗
PubMed1991

EMG analysis of the late exteroceptive suppression period of temporal muscle activity in episodic and chronic tension-type headaches.

EMG analysis of the late exteroceptive suppression period of the temporal muscle activity is discussed as comparative methodology in the assessment of patients suffering from chronic tension-type headache and from migraineurs. After electrical perioral trigeminal nerve stimulation during maximum voluntary jaw occlusion, early (ES1) and late (ES2) exteroceptive suppression periods can be registered above the temples using surface EMG recordings. In patients suffering from chronic tension-type headache the duration of the late suppression period is shortened (p less than 0.001) compared to migraineurs or controls. However, patients suffering from episodic tension-type headache display late suppression periods of temporal muscle activity of differing lengths.

Adolescent↗
PubMed1991

[EMG analysis of exteroceptive suppression of temporal muscle activity in tension headache].

In modification of a method published by Schoenen et al., early (ES 1) and late (ES 2) exteroceptive suppression periods elicited by perioral electrical trigeminus-stimulation during teeth-clenching were recorded with surface electrodes over the temporalis muscles. 29 patients with chronic tension headache, 20 with migraine, 7 patients with combined tension headache and migraine and 19 controls were examined. Duration of the late suppression period for the mean of three single shocks was highly significantly reduced in chronic tension headache sufferers and patients with combined tension headache and migraine when compared with migraine cases or controls. These results are in agreement with those of Schoenen et al. EMG analysis of temporalis late exteroceptive suppression is a helpful diagnostic method in primary headache. The reduction of ES 2 in chronic tension headache sufferers might suggest a deficient activation or excessive inhibition of the motoric trigeminus nucleus by pontobulbar inhibitory neurons which receive a strong input from limbic and nociceptive structures.

Adolescent↗
PubMed1987

Additional biochemical criteria in the differential diagnosis of myositis.

Thirty-six biopsy specimens of human biceps and vastus lateralis muscles were examined by histometric analysis and determination of enzyme activities (phosphorylase, triosephosphate dehydrogenase, 3-hydroxacyl-CoA-dehydrogenase, lactate dehydrogenase, hexose isomerase, citrate synthetase, 6-phosphogluconate dehydrogenase). The series included 13 specimens from patients suffering from a benign form of muscular dystrophy (limb girdle and Becker type of muscular dystrophy) and 12 specimens from patients with an acute (n = 5) or chronic (n = 7) form of myositis. Muscle fibres were atrophic in myositis and hypertrophic (with an increased variation of fibre diameters) in muscular dystrophies, as has been shown previously. When myositis samples were compared with either normal or dystrophic muscles, a highly significant lowering of glycolytic enzyme activity was found in chronic myositis, while the activity of 6-phosphogluconate dehydrogenase was elevated to highly significant levels. Measurements of the latter enzyme's activity might be of additional value in differentiating chronic forms of myositis from benign muscular dystrophies.

Adolescent↗
PubMed1986

Incidence of peripheral neuropathy and cerebellar ataxia in chronic alcoholics.

A total of 78 chronic alcoholics were examined neurologically as well as by electroneurography, myography and posturography. Clinical signs of peripheral neuropathy were detected in 45% of these patients, with electromyographic and neurographic abnormality in 67% and 55% respectively. Clinical signs of cerebellar ataxia were found in 33% of our patients, whereas posturographic measurements of increased sway were recorded in 69%. The posturographic characteristics of cerebellar anterior lobe atrophy were observed in two-thirds of the latter patients. The severity of cerebellar-ataxia did not correlate with the degree of neuropathy. This lack of correlation is interpreted as an indication of different pathogenetic mechanisms acting on peripheral nerves and cerebellum.

Adult↗