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Biomedical subjects

I Q Grunwald

Publications and source records attributed to I Q Grunwald.

16 recordsLinked to original sources
PubMed2006

Cognitive changes after carotid artery stenting.

INTRODUCTION: We aimed to test changes in cognitive performance after carotid artery stenting (CAS). METHOD: Ten patients were neuropsychologically tested at least 24 h before and 48 h after CAS. To diminish thromboembolic events, we used a proximal protection device. The following neuropsychological tests were selected: The Mini Mental State Examination (MMSE), symbol digit test and subtests of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery (verbal fluency, constructional practice, word list memory and delayed recall). Affective state was determined by the Beck Depression Score (BDS). RESULTS: No patient suffered from depression (BDS <1) or dementia (MMSE 29.9+/-1.5). Nine of the ten patients (P=0.12) showed increased speed in the Number Connection Test (NCT) (corresponding to trail making test). Most patients showed better or similar results concerning delayed recall (P=0.31). No change was observed in the symbol digit test, word list memory, verbal fluency or constructional practice. Better results concerning NCT and delayed recall after carotid stenting might be due to improved brain perfusion. CONCLUSION: After CAS, cognitive and memory performance seem to improve. Further studies with different time intervals and more refined testing, as well as perfusion-weighted imaging, are needed.

Aged↗
PubMed2006

[Imaging cervical myelo- and radiculopathy].

PURPOSE: This article gives an overview of the diagnostic possibilities available in the diagnosis of cervical myelo- and radiculopathy. We compared conventional myelography, CTM, and MRI. MATERIAL AND METHODS: Twenty-five patients with clinical evidence of cervical myelo- or radiculopathy were included. Sagittal and transverse T1-weighted (T1w) TSE and T2-weighted (T2w) TSE sequences were compared with myelography and CTM. Statistical analysis was performed using Wilcoxon's -test. RESULTS: Disc herniation could be depicted in CTM as well as in MRI. The extent of herniation did not differ between CTM and T1w. The extent of herniation seemed higher on T2w than on T1w (p <0.001). Foraminal encroachment was easier to diagnose in CTM. When regarding transverse T1w and T2w images simultaneously, a missing root in MRI corresponded to a missing root in CTM and conventional myelography and vice versa. Our data demonstrated the relative inability of MRI to determine whether the compression is by soft tissue or bony structures. CONCLUSION: The present study proposes that MRI, when available, should be the imaging method of first choice in patients with suspected radiculo- and myelopathy.

Adult↗
PubMed2006

[Vascular anomalies of the cerebellopontine angle].

Vascular anomalies of the cerebellopontine angle are rare compared to tumors in this area. Irritation of the trigeminal, facial, or vestibulocochlear nerve may cause trigeminal neuralgia, hemifacial spasm and vertigo, or tinnitus accordingly. Vessel loops in the cerebellopontine cisterns may cause compression at the root entry or exit zone of the cranial nerves V, VII, and VIII, a phenomenon which is called "vascular loop syndrome." Megadolichobasilar artery and aneurysms of the vertebrobasilar system can also lead to dislocation and compression of the cranial nerves and brain stem. Three-dimensional CISS MR imaging and MR angiography are useful in the detection of neurovascular compression. Microvascular decompression is an effective surgical procedure in the management of compression syndromes of the cranial nerves V, VII, and VIII.

Aged↗
PubMed2005

[Thrombolysis of the basilar artery: 5-year results from the Saarland stroke registry].

Acute thrombosis of the basilar artery has a fatal outcome if left untreated. The relatively good prognosis with intra-arterial thrombolysis makes it the therapy of choice for acute basilar thrombosis. In the Saarland stroke registry, we analyzed 47 patients with angiographically proven basilar artery thrombosis within the last 5 years. We observed a better outcome in patients with good income, with recanalization, and a short time between onset of symptoms and start of thrombolysis. The complications, such as intracerebral bleedings, occurred only in the group treated with rt-PA. Intra-arterial thrombolysis with urokinase or rt-PA is a relatively safe therapy, but should be performed in neuroradiological centers. With progressing symptoms the therapeutic window can be stretched up to 12 h, but coma lasting for more than 4 h is related to a bad outcome.

Acute Disease↗
PubMed2005

[Moyamoya disease].

Moyamoya disease is an idiopathic progressive vasculopathy characterized by slowly progressive narrowing involving the distal internal carotid artery and the proximal circle of Willis. Collateral vessels develop to compensate for the slowly progressive stenosis. These enlarged collaterals appear as a "puff of smoke" on angiography, which gives the disease its name. This review discusses the clinical manifestation, imaging findings, and angiographic features.

Cerebral Angiography↗
PubMed2005

[Imaging of the temporal bone. An overview].

Diseases of the temporal bone should be diagnosed by high resolution computed tomography (CT) and magnetic resonance imaging (MRI). Because of the excellent imaging of bony structures, CT is the method of choice for diagnosing pathologies of the external auditory channel, middle ear, and mastoid. Imaging of trauma is performed with CT. For examining the labyrinth system and interior auditory channel, MRI is the method of choice. This article gives an overview of the anatomy of the temporal bone and describes the most important pathologies.

Diagnosis, Differential↗
PubMed2005

Diffusion-weighted imaging with calculated apparent diffusion coefficient of enhancing extra-axial masses.

BACKGROUND AND PURPOSE: Sometimes intracranial contrast-enhancing tumors like meningiomas, metastases, lymphomas, and schwannomas can mimic each other. It was the aim of the present study to investigate if intracranial contrast-enhancing lesions can be reliably differentiated with the help of diffusion-weighted imaging with calculated apparent diffusion coefficients (ADCs). METHODS: 29 patients (ages ranging from 22 to 82 years, mean age of 58.6 years) were included. Nine meningiomas, 7 metastases, 6 lymphomas, and 7 schwannomas were investigated. The ADC value in the lesions and in the perifocal edema was analyzed. RESULTS: For the lymphomas, the authors measured the lowest ADC values in the contrast-enhancing part (0.59 +/- 0.09 . 10(-3) mm2/sec). The meningiomas showed a mean ADC value of 0.98 +/- 0.18 . 10(-3) mm2/sec. The schwannomas and metastases showed higher ADC values of 1.33 +/- 0.28 . 10(-3) mm2/sec and 1.05 +/- 0.20 . 10(-3) mm2/sec. The authors saw a statistically significant difference between lymphomas, meningiomas, and metastases concerning the ADC values in the contrast-enhancing part. CONCLUSIONS: In spite of a small sample size and partly a wide range of values, the authors found statistically significant differences between meningiomas, metastases, and lymphomas concerning ADC values. Nevertheless, a differentiation of these lesions only with the help of ADC values seems questionable.

Adult↗
PubMed2004

[Proximal protection systems using carotid artery stent].

Controversies as to whether or not a protection device should be used in carotid artery stenting exist. Currently three temporary cerebral protection devices are being used. These are devices with distal balloon occlusion or filtration baskets and proximal occlusion devices with flow reversal in the internal carotid artery. This article focuses on flow reversal systems and aims to give some advice as to which patients could benefit from their use.

Angioplasty, Balloon↗
PubMed2004

[Technique and approach to carotid stenting].

Assuming that the ongoing large randomized controlled trials comparing CAS and endarterectomy support the efficacy and safety of CAS, this method will play a major role in patients with carotid stenosis in the near future. Patient selection, establishing standards of treatment, and systematic training of the interventionist are major issues. This article aims to give an overview of current techniques and devices available in CAS.

Angioplasty, Balloon↗
PubMed2004

[Differential diagnosis of space demands in the cerebellopontine angle].

Most of the space demands in the cerebellopontine angle lie extra-axially. Important structures run within the cisterns of the cerebellopontine angle, such as the trigeminal, facial and vestibulocochlear nerves as well as the anterior inferior and posterior inferior cerebellar arteries and the veins which lead to the petrosal sinus. The most common space demands are caused by acoustic neuromas, meningeomas, vascular ectasia and aneurysms. Less common are epidermoid and other schwannomas as well as metastases, paragangliomas and arachnoidal cysts. Intra-axial tumours in the area of the cerebellopontine angle include the medulloblastoma, astrocytoma and the ependymoma, which occurs predominantly in children, in addition to the uncommon choroid plexus papilloma. Nearby, there are also space demands around the petrous bone, such as cholesterol granuloma, malignant otitis media, paraganglioma and metastases. For differential diagnosis, an understanding of the space requirements of the tumours in the cerebellopontine angle is needed in addition to knowledge of the anatomical structures.

Brain Stem Neoplasms↗
PubMed2004

Degenerative diseases of the lumbar spine. Comparison of the multiecho data image combination sequence with magnetization transfer saturation pulse versus lumbar myelography/postmyelographic computed tomography.

PURPOSE: To compare a T2* weighted 2D spoiled gradient echo multiecho sequence (MEDIC) with magnetization transfer saturation pulse versus lumbar myelography and postmyelographic computed tomography (pCT). MATERIAL AND METHODS: 84 disk levels in 27 patients were examined. The vertebral bodies, intervertebral disks, neural foramina, cauda equina, ligamentum flavum, and narrowing of the spinal canal were investigated using an evaluation scale. In addition, the pCT and the MEDIC sequence were evaluated for assessing the narrowing of the neural foramina in a phantom study using a cadaver preparation of the lumbar spine. RESULTS: A total of 28 disk herniations, 11 cases of osteophytes narrowing the spinal canal or the neural foramina, and 7 spinal canal stenoses were detected. The pCT was significantly better in visualizing the cauda equina. The MEDIC sequence was significantly superior in visualizing the extension of the ligamentum flavum. No statistical differences between either image modality were found concerning assessment of the narrowing of the neural foramina and the spinal canal, nor regarding evaluation of the vertebral disk and the vertebral body. Measurements of the phantom study showed that the MEDIC sequence did not overestimate narrowing of the neural foramina. CONCLUSIONS: The T2* MEDIC sequence has proved to be as accurate as pCT in evaluating osteophytes and narrowing of the neural foramina. In doubtful standard magnetic resonance imaging findings, this means that an additional axial T2* MEDIC sequence may be of value in reaching the same accuracy as pCT.

Adult↗
PubMed2002

[Nonruptured intracranial aneurysms: therapeutic recommendations].

With the development of new diagnostic noninvasive tools an increase in the diagnosis of asymptomatic nonruptured intracranial aneurysms has been shown. Physician and patient now have to decide wether to treat or to follow-up these aneurysms. This paper tries to review and to discuss the literature and to give guidelines for therapeutic decisions. The decision to treat an unruptured intracranial aneurysm must always comprise the individual factors such as age, life prognosis, neurological status, and the advantages and disadvantages of the considered method.

Aneurysm, Ruptured↗
PubMed2002

[Clinic, diagnosis, and therapy of subarachnoidal hemorrhage].

In most cases a saccular aneurysm is the cause of acute subarachnoidal hemorrhage (SAH). The usual symptoms are severe headache and meningism. Due to the high mortality rate caused by rebleeding an early occlusion of the aneurysm should be strived for. For this early diagnosis an exact identification of the aneurysm and its configuration is essential.

Angiography, Digital Subtraction↗