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Helmuth Steinmetz

Publications and source records attributed to Helmuth Steinmetz.

At least 19 recordsLinked to original sources
PubMed2006

Conjugate eye deviation in acute stroke: incidence, hemispheric asymmetry, and lesion pattern.

BACKGROUND AND PURPOSE: The authors studied clinical features and lesion patterns associated with conjugate eye deviation (CED) in acute stroke. METHODS: Consecutive patients with supratentorial stroke (<6 hours after symptom onset) were prospectively recruited. CED was classified according to the National Institute of Health Stroke Scale (NIHSS) item "gaze palsy" as being forced, partial, or absent. Lesion patterns on diffusion-weighted images (DWI) were analyzed in 46 patients using a normalization procedure for direct comparisons between patients. Perfusion data were analyzed for a subset of patients. RESULTS: Partial CED was found in 7 (6%) and forced CED in 31 (26.7%) of 116 patients. Forced and partial CED were associated with higher initial NIHSS scores compared with patients without CED (16 and 10 versus 5; P<0.05). DWI lesion volume was larger in patients with CED (103.24+/-102.4 mL, mean+/-SD) as compared with patients without CED (17+/-34.98 mL, P<0.001). CED was more frequent in right hemispheric stroke (44.6% versus 23%, P<0.02). DWI pattern analysis in patients with CED with right hemispheric stroke revealed a network of affected regions, including basal ganglia and temporoparietal cortex. In left hemispheric CED, lesions were larger than in patients without CED, but no consistent pattern could be established. In a subset of selected patients with CED, a small temporoparietal perfusion deficit was sufficient to elicit CED. CONCLUSIONS: Selective dysfunction of cortical areas involved in spatial attention and control of eye movements is sufficient to cause CED in patients with acute stroke. However, in the majority of cases, CED is an indicator of large infarcts involving more than one area, including both cortical and subcortical structures.

Aged↗
PubMed2006

Pretreatment with antiplatelet agents is not independently associated with unfavorable outcome in intracerebral hemorrhage.

BACKGROUND AND PURPOSE: This study investigated the effect of preexisting antiplatelet therapy on mortality and functional outcome in patients with intracerebral hemorrhage (ICH). METHODS: Our analysis was based on a large, country-wide stroke registry in Germany. All parameters relevant to this analysis, including age, prehospital status (according to the modified Rankin Scale, mRS), International Classification of Diseases-based diagnosis, and pretreatment with antiplatelet agents or oral anticoagulants, were recorded prospectively. Main outcome measures were in-hospital mortality rate and functional status at hospital discharge (mRS). RESULTS: Over a 2-year period, 1691 patients with ICH (ICD-10: I61) were documented (48% female; mean age, 72+/-12 years). At symptom onset, 26% were taking antiplatelet agents, and 12% were taking oral anticoagulants. By univariate logistic regression, pretreatment with antiplatelet drugs or anticoagulants was found to be a significant predictor of in-hospital mortality (odds ratio [OR], 1.42; P=0.008; OR, 1.53; P<0.001) and of an unfavorable functional outcome (defined as mRS >2 or death; OR, 1.33, P=0.039; OR, 1.51; P<0.001). However, after adjustment for age and prehospital status, antiplatelet pretreatment was no longer an independent risk factor of in-hospital death (OR, 1.12; P=0.490) or unfavorable functional outcome (OR, 0.97; P=0.830), whereas the influence of pretreatment with oral anticoagulants remained significant (OR, 1.45; P<0.001; OR, 1.42; P=0.009). CONCLUSIONS: In contrast to oral anticoagulants, pretreatment with antiplatelet agents is not an independent risk factor of mortality and unfavorable outcome in patients with ICH.

Administration, Oral↗
PubMed2005

Carotid intima-media thickening indicates a higher vascular risk across a wide age range: prospective data from the Carotid Atherosclerosis Progression Study (CAPS).

BACKGROUND AND PURPOSE: Carotid intima-media thickness (IMT) is an independent predictor of vascular events in age groups >45 years. However, there is little information about the predictive value of IMT in younger individuals. METHODS: In the Carotid Atherosclerosis Progression Study (CAPS; n=5056; age range 19 to 90 years; mean age 50.1 years), common carotid artery (CCA) IMT, bifurcation IMT, internal carotid artery IMT and vascular risk factors were evaluated at baseline. The incidence of stroke, myocardial infarction (MI), and death was determined prospectively. Data for younger (<50 years; n=2436) and older subjects (> or =50 years; n=2620) were analyzed separately using Cox proportional hazard regression models. RESULTS: During a mean follow-up period of 4.2 years, there were 228 cases of MI, 107 strokes, and 50 deaths. IMT at all carotid segments was highly predictive of all end points (eg, hazard rate ratios [HRRs] per 1 SD CCA-IMT increase were 1.43 [95% CI: 1.35 to 1.51] for MI, 1.47 [1.35 to 1.60] for stroke, and 1.45 [1.38 to 1.52] for MI, stroke or death; all P<0.0001). Even after adjustment for age, sex, and vascular risk factors, the predictive value of CCA-IMT and bifurcation IMT remained significant for MI and the combined end point. For the latter, the HRRs were considerably higher in the younger than in the older age group (eg, HRR per 0.1 mm CCA-IMT was 1.34 [1.16 to 1.55] vis-à-vis 1.10 [1.05 to 1.15]; P=0.011 for age-IMT interaction). CONCLUSIONS: Carotid IMT independently predicts future vascular events. Its predictive value is at least as high in younger subjects as in older subjects.

Adult↗
PubMed2005

Tissue plasminogen activator mediated blood-brain barrier damage in transient focal cerebral ischemia in rats: relevance of interactions between thrombotic material and thrombolytic agent.

Thrombolysis with tPA for acute ischemic stroke is associated with an increased risk of intracerebral hemorrhage. We investigated the impact of thrombolysis with tPA on the blood-brain barrier in a suture occlusion model in rats. Cerebral ischemia was performed for 2 h followed by 22 h of reperfusion. Treatment groups received either saline (A), 10 mg/kg bw rtPA (B) or "activated" rtPA (ArtPA, C, rtPA with in vitro clot contact). Blood-brain-barrier damage assessed by Evans blue extravasation as a permeability marker was significantly enhanced in basal ganglia of group C compared to groups A or B. Likewise was the upregulation of MMP-9. Interestingly, results of the rtPA and saline group showed only minor and not statistically significant differences. The results of the present study indicate a major role for thrombus-thrombolytic interaction in focal cerebral ischemia with subsequent increased BBB permeability.

Animals↗
PubMed2005

Relation between cerebrospinal fluid, gray matter and white matter changes in families with schizophrenia.

BACKGROUND: Gray matter reduction and ventricular enlargement belong to the best replicated findings in schizophrenia. Brain morphologic changes were also found in non-schizophrenic family members (FM). The intention of this study was to examine whether non-psychotic first-degree relatives reveal similar morphologic changes as schizophrenic patients and how state of genetic loading contribute to these abnormalities. METHODS: Forty-nine schizophrenic patients, 71 non-schizophrenic FM and 48 control subjects took part in this volumetric MRI study. All subjects were between 18 and 59 years old. Dependent variables were gray matter, white matter and total cerebrospinal fluid (CSF) volume, determined by SPM99 segmentation algorithm. As an important part of CSF lateral ventricle volume was determined manually by removing surrounding CSF areas. RESULTS: In schizophrenic patients compared to controls and non-schizophrenic FM total CSF volumes and lateral ventricles were increased. Gray and, to a lesser degree, white matter volumes were decreased as well. For CSF, gray and white matter there was no significant difference between uni- and multiple affected families. CSF correlated significantly negative with gray matter (r=-0.78) and, less intensive, with white matter (r=-0.40). There were negative correlations between gray and white matter volume as well (r=-0.26). These correlations were not significantly different between the diagnostic groups. CONCLUSION: CSF enlargement and gray matter reductions in schizophrenic patients compared to controls and non-affected FM seem to be interdependent findings. However, this correlation is independent of the factor diagnosis and is therefore not specific for schizophrenia.

Adult↗
PubMed2005

Evaluation of serum S100B as a surrogate marker for long-term outcome and infarct volume in acute middle cerebral artery infarction.

BACKGROUND: An easily accessible and valid surrogate marker for interventional stroke trials is needed. OBJECTIVE: To investigate the usefulness of various S100B serum measures to predict long-term outcome and infarct volume in patients with acute stroke. DESIGN: Inception cohort study. SETTING: Tertiary care university hospital. PATIENTS: Thirty-nine patients (mean +/- SD age, 69.1 +/- 11.5 years) with acute nonlacunar middle cerebral artery infarction presenting less than 6 hours after symptom onset. MAIN OUTCOME MEASURES: Functional outcome 6 months after stroke (modified Rankin scale score) and final infarct volume on day 7 by means of standardized volumetry of brain images. Serum S100B level was determined at hospital admission and 24, 48, 72, 96, 120, and 144 hours after symptom onset. RESULTS: Single S100B measures obtained 48 and 72 hours after stroke onset demonstrated the highest Spearman rank correlations with modified Rankin scale scores (rho = 0.68 and rho = 0.67, respectively; P<.001) and infarct volume (rho = 0.95 and rho = 0.94, respectively; P<.001). A 48-hour S100B value of 0.37 microg/L or less revealed a sensitivity of 0.87 and a specificity of 0.78 in predicting an independent functional outcome. In a multivariate model, S100B emerged as an outcome predictor that was independent of age, sex, stroke severity, etiology, lesion side, and risk factors. CONCLUSIONS: Single S100B values obtained 48 and 72 hours after stroke onset provide the highest predictive values with respect to functional outcome and infarct volume in nonlacunar middle cerebral artery infarction. More complex measures of the S100B kinetic (ie, area under the curve or peak value) were not superior. Therefore, these single S100B measures appear to be useful surrogate end points in acute interventional stroke trials.

Acute Disease↗
PubMed2004

Morphological brain differences between adult stutterers and non-stutterers.

BACKGROUND: The neurophysiological and neuroanatomical foundations of persistent developmental stuttering (PDS) are still a matter of dispute. A main argument is that stutterers show atypical anatomical asymmetries of speech-relevant brain areas, which possibly affect speech fluency. The major aim of this study was to determine whether adults with PDS have anomalous anatomy in cortical speech-language areas. METHODS: Adults with PDS (n = 10) and controls (n = 10) matched for age, sex, hand preference, and education were studied using high-resolution MRI scans. Using a new variant of the voxel-based morphometry technique (augmented VBM) the brains of stutterers and non-stutterers were compared with respect to white matter (WM) and grey matter (GM) differences. RESULTS: We found increased WM volumes in a right-hemispheric network comprising the superior temporal gyrus (including the planum temporale), the inferior frontal gyrus (including the pars triangularis), the precentral gyrus in the vicinity of the face and mouth representation, and the anterior middle frontal gyrus. In addition, we detected a leftward WM asymmetry in the auditory cortex in non-stutterers, while stutterers showed symmetric WM volumes. CONCLUSIONS: These results provide strong evidence that adults with PDS have anomalous anatomy not only in perisylvian speech and language areas but also in prefrontal and sensorimotor areas. Whether this atypical asymmetry of WM is the cause or the consequence of stuttering is still an unanswered question.

Adult↗
PubMed2004

Serum S100B predicts a malignant course of infarction in patients with acute middle cerebral artery occlusion.

BACKGROUND AND PURPOSE: Early predictors of infarct volume may improve therapeutic decisions in patients with acute cerebral ischemia. We investigated whether measurements of serum astroglial protein S100B can predict a malignant course of infarction in acute middle cerebral artery (MCA) occlusion. METHODS: We included 51 patients (24 women, mean age 69.1+/-12.4 years) admitted within 6 hours after stroke symptom onset caused by proximal MCA occlusion, as shown by magnetic resonance angiography (n=39), intra-arterial angiography (n=4), or transcranial duplex sonography (n=8). Blood samples were drawn at hospital admission and 8, 12, 16, 20, and 24 hours after symptom onset. Serum S100B concentrations were determined using a fully automated immunoluminometric assay. A malignant course of infarction was defined as the occurrence of clinical signs of cerebral herniation within the first 7 days of treatment or the clinical decision to perform decompressive hemicraniectomy caused by critical space-occupying swelling as detected by repeated neuroimaging. RESULTS: Sixteen patients developed malignant infarction (31%). Beginning with the 12-hour value, mean S100B serum concentrations were significantly higher in patients with a malignant course compared with those without (12 hours 1.23+/-1.24 versus 0.29+/-0.45 microg/L; 16 hours 1.80+/-1.65 versus 0.38+/-0.53 microg/L; 20 hours 1.90+/-1.53 versus 0.44+/-0.48 microg/L; and 24 hours 2.41+/-1.59 versus 0.57+/-0.66 microg/L; all P<0.001). A 12-hour S100B value >0.35 microg/L predicted malignant infarction with 0.75 sensitivity and 0.80 specificity. A 24-hour value >1.03 microg/L provided 0.94 sensitivity and 0.83 specificity. CONCLUSIONS: The serum marker S100B can predict a malignant course of infarction in proximal MCA occlusion. This finding may improve the identification and monitoring of patients at particularly high risk for herniation.

Acute Disease↗
PubMed2004

Mutations in the lysyl oxidase gene not associated with intracranial aneurysm in central European families.

BACKGROUND: Lysyl oxidase is a promising candidate gene for a mutation search in intracranial aneurysm families because (a) it controls the processing, cross-linking and maturation of collagen and elastin fibers in the blood vessel wall, (b) its expression levels and activity are altered in different animal models of aneurysm pathogenesis, and (c) it is encoded within the chromosome 5q22-31 region of suggestive linkage to intracranial aneurysms. METHODS: We have performed genomic sequencing of all 7 exons including the intron-exon splice sites and of the putative promoter region for lysyl oxidase in 25 patients from intracranial aneurysm multiplex families resident in Central Europe. RESULTS: We observed 4 genetic variants including 2 novel polymorphisms, 1 in the noncoding sequence of exon 7 and the other upstream from the lysyl oxidase promoter. None of these single nucleotide polymorphisms showed an allelic association or cosegregation with intracranial aneurysm in the families. CONCLUSIONS: Genetic variants in the lysyl oxidase gene do not appear to be a major factor in the etiology of intracranial aneurysms in Central Europe.

Adenine↗
PubMed2004

Gender differences in cortical complexity.

Cortical complexity, a measure that quantifies the spatial frequency of gyrification and fissuration of the brain surface, has not been thoroughly characterized with respect to gender differences in the human brain. Using a new three-dimensional (3D) analytic technique with magnetic resonance imaging, we found greater gyrification in women than men in frontal and parietal regions. Increased complexity implies more cortical surface area, which may offset gender differences in brain volume and account for behavioral gender differences.

Cerebral Cortex↗
PubMed2004

Functional impairment, disability, and quality of life outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction.

OBJECT: Whether decompressive hemicraniectomy is an appropriate treatment for space-occupying middle cerebral artery (MCA) infarction is still a controversial issue. Previous studies are in agreement on a reduction of the mortality rate, but the reported functional outcome was highly variable. The authors sought to determine functional impairment, disability, and health-related quality of life (QOL) outcome in long-term survivors who had undergone this procedure, and tried to identify factors related to functional outcome. METHODS: The study included 36 consecutive patients (mean age 58.8 +/- 12.7 years, 20 men and 16 women) who underwent decompressive hemicraniectomy for treatment of malignant MCA infarction (29 on the right and seven on the left side; mean time to surgery 37.8 +/- 20 hours). The survival rate was determined at 6 months: 13.7 +/- 6.7 months after the stroke, a cross-sectional personal investigation of survivors was performed to assess functional impairment, disability, and health-related QOL. Survival rates were 78% at 6 months and 64% at the time of the follow-up investigation; one patient was lost to follow up. Sixteen of 22 long-term survivors lived at home. The median Barthel Index (BI) was 45 (25th and 75th percentile 19 and 71) and the BI correlated negatively with patient age (r = -0.58, p = 0.005). Three patients reached a BI of at least 90. Older age, more severe neurological deficit on admission, and longer duration of intensive care treatment and mechanical ventilation were significantly associated with worse disability (BI < 50). The health-related QOL was considerably impaired in the subscales of mobility, household management, and body care. CONCLUSIONS: Decompressive hemicraniectomy improves survival in patients with malignant MCA infarction when compared with earlier reports of conservative treatment alone. Functional outcome and QOL remain markedly impaired, especially among elderly patients and in those with a severe neurological deficit at admission.

Adult↗
PubMed2003

Elastin polymorphism haplotype and intracranial aneurysms are not associated in Central Europe.

BACKGROUND AND PURPOSE: The occurrence of intracranial aneurysms and of aneurysmal subarachnoid hemorrhage are influenced by genetic factors. Recent genomic studies in Japan have defined 3 chromosomal loci and 1 haplotype of elastin polymorphisms as important risk factors, both for affected sib pairs and sporadic patients. METHODS: We have genotyped 2 single nucleotide polymorphisms in the elastin gene and evaluated their allelic association with intracranial aneurysm in a Central European sample of 30 familial and 175 sporadic patients and 235 population controls. RESULTS: We found no allelic association between this elastin polymorphism haplotype and intracranial aneurysm. CONCLUSIONS: Our data probably reflect increased genetic heterogeneity of intracranial aneurysm in Europe compared with Japan.

Adult↗
PubMed2003

Internal carotid artery angle of origin: a novel risk factor for early carotid atherosclerosis.

BACKGROUND AND PURPOSE: Established "systemic" vascular risk factors do not fully explain the occurrence of atherosclerosis at the carotid bifurcation. Local anatomic and hemodynamic factors may also influence the initiation of the atherosclerotic process. We determined whether the angle of internal carotid artery (ICA) origin is a risk factor for early atherosclerosis. METHODS: In 1300 individuals from a normal population aged 40 to 70 years, we measured both carotid intima-media thickness (IMT) at 3 arterial sites (common carotid artery; carotid bifurcation; ICA bulb) and the presence of any atherosclerotic plaque within the ICA bulb bilaterally by means of high-resolution ultrasound. A standardized transverse insonation was used to determine the angle of ICA origin, expressed as the angle of rotation relative to the external carotid artery. RESULTS: This angle was positively associated with ICA bulb IMT but not with IMT at other sites. After we controlled for age, sex, and other cardiovascular risk factors, a dorsal/dorsomedial ICA origin (angle >or=60 degrees ) conferred an odds ratio for having an ICA bulb IMT in the highest quartile of 2.99 (95% CI, 1.86 to 4.83) on the left and 2.01 (95% CI, 1.31 to 3.09) on the right side (both P<0.001). A similar relationship was found for plaque; odds ratios on multivariate analysis were 3.67 (95% CI, 1.49 to 9.03) on the left and 2.07 (95% CI, 1.10 to 4.83) on the right side (both P=0.035). CONCLUSIONS: This study suggests that the angle of ICA origin may be an independent risk factor for early atherosclerotic changes at the ICA bulb. This new hypothesis should be tested in prospective studies.

Adult↗
PubMed2003

Significant relation between MR measures of planum temporale area and dichotic processing of syllables in dyslexic children.

In the present study, we investigated differences between dyslexic and normal reading children in asymmetry of the planum temporale area in the upper posterior part of the temporal lobe and dichotic listening performance to consonant-vowel syllables. The current study was an extension of previous studies in our laboratory on the same participants, now including also girls and left-handers. There were 20 boys and 3 girls in the dyslexic group and 19 boys and 4 girls in the normal reading group. The age of the participants was 10-12 years for both groups. The participants were screened from a population of 950 students in the fourth school grade in the greater Bergen district. The planum temporale area was measured in sagittal magnetic resonance (MR) images. Mean left and right area and asymmetry index were compared between the groups. Dichotic presentations of consonant-vowel syllables made it possible to separately probe left and right hemisphere phonological function, and to correlate this with planum temporale area. The results showed a significantly larger left than right planum temporale area for both groups. However, while the right planum temporale area was similar for the dyslexic and control groups, the left planum temporale was significantly (one-tailed t-test) smaller in the dyslexic group. Both groups also showed a significant right ear advantage to the consonant-vowel syllables in the dichotic listening test. The relation between planum temporale and dichotic listening asymmetry showed a significant correlation for the dyslexic group only, indicating a positive relation between brain structure and function in dyslexic children. The results are discussed in terms of important subject characteristics with regard to brain markers of dyslexia.

Case-Control Studies↗
PubMed2003

Single-needle acupuncture alleviates gag reflex during transesophageal echocardiography: a blinded, randomized, controlled pilot trial.

OBJECTIVES: To study the effect of single-needle acupuncture in suppressing gag-reflex in transesophageal echocardiography (TEE). DESIGN: Prospective, blinded trial. Settings/locations: Patients with ischemic stroke or transient ischemic attack undergoing TEE because of presumed cardioembolic origin in a specialized stroke unit of the Johann Wolfgang Goethe-University, Frankfurt/Main, Germany. Subjects/Study interventions: Forty-one (41) patients were studied. Patients received single-needle acupuncture with a 0.2 x 13 mm disposable acupuncture needle (Suzhou Medical Appliances, China), 10-mm deep either at Chengjiang (midline between lower lip and chin) or superficially at a sham point (tip of the chin) during TEE or no acupuncture for alleviating gag reflex. OUTCOME MEASURES: Severity of gagging was rated on a visual-analogue scale. RESULTS: The acupuncture group experienced significantly less gagging than the sham group (p = 0.037) or the nonacupuncture group (p = 0.013). CONCLUSIONS: Acupuncture of CV24 is an easy to apply and effective method to reduce gag reflex during TEE.

Acupuncture Points↗
PubMed2002

Brain size and grey matter volume in the healthy human brain.

Magnetic resonance imaging was used to evaluate the influence of sex and brain size on compartmental brain volumes (grey matter, white matter, CSF) in a large and well-matched sample of neurologically normal women (n = 50) and men (n = 50). As expected, we found a significant sex difference for the absolute volumes of total brain, grey matter, white matter and CSF, with greater volumes for men. Relating these compartmental volume measures to brain volume resulting in proportional volume measures revealed a higher proportion of grey matter in women. No significant sex differences were found for white matter and CSF proportions. However, when the influence of sex was partialized out by regression analyses, brain volume explained 40-81% of the variance of the absolute grey matter, white matter and CSF volumes. Performing these regression analyses for the proportional volume measures revealed that brain volume explained approximately 16% of the variance in grey matter proportion. Sex or the interaction between sex and brain volume revealed no additional predicitve values. Interestingly, the correlation between brain volume and grey matter proportion was negative, with larger brains exhibiting relatively smaller proportions of grey matter. Thus, sex is not the main variable explaining the variability in grey matter volume. Rather, we suggest that brain size is the main variable determining the proportion of grey matter.

Adult↗