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Biomedical subjects

H E Nau

Publications and source records attributed to H E Nau.

At least 19 recordsLinked to original sources
PubMed1990

[Computed tomographic assessment of orbital fractures in traumatic damage of the optic nerve].

Ten patients with orbital fractures and optic nerve trauma are reported. Fractures of the optic canal could be demonstrated by computed tomography in six cases and fractures of the orbital apex in another three cases. Surgical decompression of the optic canal was performed in seven cases. Computed tomography enhanced decision for surgery in cases of intraorbital haematoma with exophthalmus and narrowing of the canal by bony fragments, especially in those patients presenting with incomplete or progressive visual disturbance.

Emergencies↗
PubMed1989

Two cases of sudden death by rupture of traumatic and bacterial aneurysms.

Unexpected subarachnoid hemorrhage with a fatal outcome was seen in two patients in intensive care in association with trauma and an intracranial inflammatory abscess. The cause of SAH was disclosed at autopsy: traumatic and bacterial aneurysms of the basilar artery respectively. In the reported cases the symptoms of SAH did not suggest an origin.

Adult↗
PubMed1989

Intramedullary pilocytic astrocytomas--a clinical and morphological study after combined surgical and photon or neutron therapy.

Ten patients suffering from intramedullary pilocytic astrocytomas (WHO-classification: astrocytoma grade I) were investigated catamnesticly. Combined surgery and radiotherapy was performed. Seven patients received neutron irradiation postoperatively. In four cases the neurological symptoms were improved after follow-up periods ranging from 33 to 89 months. The three other patients died after 6 to 21 months. The autopsy findings of a 14 year old child are presented. Our results are compared with reports in the literature. In addition, long-term problems of the spinal column are discussed. It seems that the combined surgical and neutron therapy improves the prognosis of pencil gliomas.

Adolescent↗
PubMed1989

[Syringomyelia from the neurosurgical viewpoint].

Indications for, and methods of, surgical treatment in patients with syringomyelia are described. In 16 patients a syringomyelic cavity was drained. Clinical, radiological and operative findings and results are reported and discussed. In six of twelve patients followed up, progressive deterioration was arrested by operation and two patients improved.

Adolescent↗
PubMed1988

Neuropathological findings in lesions of the optic nerve of different etiologies.

Cases of optic nerve lesions of various origins are described. These were seen in a systematic study of 59 autopsy cases with underlying neurological or neurosurgical diseases. The characteristic morphological signs of direct and indirect as well as primary and secondary lesions are discussed. Circulatory complications in cases with increased intracranial pressure are stressed.

Adult↗
PubMed1988

Prediction of outcome of decompression for carpal tunnel syndrome.

45 patients (55 hands) with carpal tunnel syndrome treated surgically have been studied. Painful nocturnal paraesthesiae occurred in patients with short histories and was a good prognostic feature. Electromyography proved of value in assessing motor lesions and the degree of the process. The first sign of muscle involvement was fibrillation potential. In longer histories, an increased amount of polyphasic potentials and reduced voluntary pattern was seen. The reduced pattern is reversible in cases of short duration and the absence of muscle wasting. In cases with marked alteration and signs of chronic muscle degeneration, the prognosis for pain is good, but not so for the neurological deficit. The nerve conduction velocity improved quickly after decompression of the median nerve in accordance with the complaints of the patient. Electrophysiological methods proved their value in staging and follow-up.

Adult↗
PubMed1988

[The value of evoked potentials in the neurosurgical intensive care unit].

In the neurosurgical intensive care unit 135 patients were studied by means of multi-modality evoked potentials. The majority part of them had low scores on the Glasgow Coma Scale and a higher lever of coma according to WFNS. This fact explains the high mortality (52 per cent). These patient data were compared with the changes of evoked responses (ER) in order to learn something about the value of ER in localisation of lesions, staging, and predicting the outcome of the patients. A classification of EP alterations is introduced. There was no correlation between alteration of evoked potentials and coma stage. The analysis of latencies and inter-peak latencies revealed no correlation between comatous and alert patients. Cerebral conduction time (CCT) did not give further information. In cases of brainstem lesions the alteration of evoked responses were more marked than in the other patients. Most of the patients died who had initially marked changes in ER. The sensitivity of BAER was greater than of SSEP. A loss of response was more frequent in BAER. In deep coma stages the motor evoked responses disappeared. This fact induces problems in diagnosing brain death. Evoked potentials yield further information in patients with coma and drug therapy. They are useful in follow-ups, esp. in predicting the outcome. Evoked responses complete clinical and findings obtained via the diagnostic equipment.

Brain Damage, Chronic↗
PubMed1988

[Data processing in neurophysiology: an automatic program for the assessment of dual stimulus responses in somatosensory evoked potentials].

An automatic programme is presented for evaluating somatosensory evoked potentials after double stimuli. The advantage of the programme is the computer-assisted procedure, the possibility of effecting changes at any time, and the imaging of both subtraction and addition curves. A variation of the programme for other modalities is possible.

Electric Stimulation↗
PubMed1987

Multimodality evoked potentials and electroencephalography in severe coma cases. Clinical experiences in a neurosurgical intensive care unit.

In a neurosurgical intensive care unit 26 patients with unconsciousness and unresponsiveness were investigated by means of multimodality evoked potentials and electroencephalography in order to obtain information on the functional state of the nervous system. Multimodality evoked potential techniques allowed us to differentiate patients with EEG alterations due to drug treatment from those without therapy. The functional state and prognosis can be better evaluated by means of evoked potential techniques. Patients with raised intracranial pressure seem to undergo some characteristic alterations in FEP and far field potential derivations.

Adolescent↗
PubMed1987

Optic nerve trauma: clinical, electrophysiological and histological remarks.

18 patients with post-traumatic visual disease of the optic nerve are presented. In the post-traumatic stage, visual evoked potentials were monitored. In amaurosis there was a high incidence of midface or frontobasal fractures. The severity of the trauma is not correlated with the severity of visual deficits. Flash evoked potential (FEP) findings were different: In most cases there was a correlation of clinical and FEP findings. In some we found false positive potentials in the acute stage. In smaller visual field deficits the alterations of FEP could not be correlated with the clinical disorders. FEP alterations depended on time. The pathophysiological mechanisms are discussed in regard to the pathological findings in 51 unselected autopsies with an investigation of the visual pathway from the intraorbital optic nerve to the visual cortex. Because of the different morphological alterations the clinical, neurological and ophthalmological examination should be followed by standard CT scanning to evaluate intracranial haematomas and by CT scanning with thin slices of the optic nerves and the soft tissue of the orbit. Visual evoked potentials (VEP) and in the unconscious patient, flash evoked potentials (FEP) do not give much more security for therapeutic decisions in comparison with former times. The histological findings do not support the hypothesis that operative decompression is successful.

Accidents↗
PubMed1987

Spinal cord compression by extensive epidural lipoma. A case report.

A 48-year-old man had a 3-year history of progressive sensory and motoric disturbance of the lower extremities. Computed tomography and magnetic resonance imaging revealed an extensive epidural lipoma reaching from T2 to T10 level. After hemilaminectomy the dorsally located epidural fat was removed. Ten months later the neurological deficit had greatly improved.

Epidural Space↗
PubMed1987

[Ventriculo-renal shunt in the therapy of hydrocephalus].

Ventriculo-atrial shunt has proved to be an effective therapy for hydrocephalus. We report about two patients, in whom due to different causes this therapy was not possible. Both of them were treated with ventriculo-pyeloureterostomy for liquor drainage. The shunt functioned well and without renal damage for four weeks in one patient and for 1 1/2 year in the other patient. The reported method is an alternative procedure when the usual type of liquor drainage is impossible.

Adult↗
PubMed1987

[Validity of the electroencephalogram and evoked potentials in the diagnosis of brain death].

Alterations of electroencephalogramm and evoked potentials in brain dead patients are known. We are going to discuss the value of the various parameters as well as their comparison with the clinical symptoms. Newer guidelines recommend the brain-stem acoustic evoked responses, too. So we analysed those comatose patients requiring for artificial respiration in whom brain stem acoustic responses could not be evoked. We found 21 patients out of 103 unselected consecutive patients with primary cerebral disease. All patients with isoelectric EEG were brain dead. Absence of acoustic response was not sure combined with clinical symptoms of brain death. Earlier SSEP components were frequent, deformed flash evoked potentials were found in all brain dead patients. In all brain dead patients there was an absence of early acoustic evoked responses and an isoelectric electroencephalogramm. The longer the symptoms of brain death lasted, the more complete the disappearance of evoked potentials was. The investigations demonstrate the value of clinical examination and electroencephalogramm in the diagnosis of brain death, but also point to the value of evoked potentials as additional parameter, esp. in order to get informations of the pathophysiological mechanisms leading to death.

Brain↗
PubMed1987

[Evoked potentials in intracranial operations: current status and our experiences].

Intraoperative neuromonitoring, especially evoked potential monitoring, has gained interest in recent years for both the anesthesiologist evaluating cerebral function and the neurosurgeon wishing to avoid neuronal lesions during intracranial operations. Before evoked potential monitoring can be introduced as a routine method of intraoperative management, experience with this method particularly in intensive care units, is imperative. We recorded evoked potentials with the Compact Four (Nicolet) and Basis 8000 (Schwarzer Picker International) computer systems. Preoperative derivations should be done with the same apparatus used intraoperatively and parameters of peri- and intraoperative derivations should not be changed. The patient's head must be fixed in a Mayfield clamp in order to avoid artefacts during trepanation. The possible artefacts due to apparatus, patient, or anesthesia are summarized in the tables. The derivations of evoked potentials should be supervised by a person who is not involved in the anesthesia or the surgical procedure; this condition may change in the future with full automatization of the recording technique and alarms. Good communication between surgeon, anesthesiologist, and neurophysiological assistant is a prerequisite. The modality is chosen in accordance with the affected neuronal system: visual-evoked potential (VEP) monitoring in the management of processes affecting the visual pathway, brain stem auditory-(BAER) and somatosensory-evoked potential (SSEP) monitoring in lesions affecting these pathways, in particular space-occupying lesions of the posterior fossa. VEP monitoring may be useful, but we observed alterations of the responses without changes in the level of anesthesia or manipulation of the visual pathways. In space-occupying processes of the cerebellopontine angle, BAER could not be developed in nearly all cases because the large underlying tumor had caused the disappearance of waves II-V. In these cases SSEP monitoring could be carried out. Despite these difficulties, evoked potential monitoring seems useful. We believe, however, that it is not routinely used in operating rooms at present because alterations of the responses can be due to different causes; for the neurosurgeon, the problem as to which interdependent degrees of alteration in evoked potentials are related to neuronal disturbances remains unsolved.

Brain↗