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Biomedical subjects

J Wappenschmidt

Publications and source records attributed to J Wappenschmidt.

At least 19 recordsLinked to original sources
PubMed1988

[Preoperative diagnosis: the Wada test with SPECT control for localizing brain function in therapy-refractory epilepsy].

Extensive diagnostic measures are necessary to clarify the indication for surgery in patients suffering from epilepsy that is refractory to treatment. Within the overall framework of neuropsychological diagnosis we conducted the Wada test, injecting 200 mg (or 3 mg/kg body weight) of sodium amytal on different days, in each case into the left or right internal carotid artery. This results in a 3-5 minute anaesthesia of the relevant hemisphere. By means of a neuropsychological short test it is possible to determine the performance of the non-blocked hemisphere. The extent of the blocking is also determined by simultaneous i.v. injection of HM-PAO (hexamethyl propylene amine oxime) labelled with 99m Tc, the uptake of which by various cerebral regions is visualised via SPECT. The Wada test supplies information on the lateralisation of cognitive functions (speech, memory etc.) whereas the SPECT examination enables additional determinations not only of processes that must be characterised as diaschisis, but also on the extent of blocking of a hemisphere. The results supply clues to expected postoperative cognitive deficits and thus enable a differentiated assessment of the indication for surgery. This is discussed on the basis of two clinical cases.

Adult↗
PubMed1987

Isolated supraclinoid occlusive disease of the internal carotid artery.

Isolated supraclinoid occlusive disease of the internal carotid artery is a rare cause of cerebral ischemia. The authors of the only review of this subject concluded that it is caused predominantly by factors other than atherosclerosis. We examined 6 patients with isolated supraclinoid occlusive lesions. Five of them had one or more risk factors for atherosclerosis. Thus, the isolated stenosis of that part of the internal carotid artery does not seem to represent a particular pathologic entity.

Adult↗
PubMed1987

[Dural angiomas].

The management of arteriovenous malformations confined exclusively to the dura and its duplications (DAVMs) is a challenge. The problems of diagnosis and the possible methods of treatment are discussed on the basis of 23 personal cases. Selective and superselective angiography for the detection of any multipedicular supply from separate arterial systems has proved essential before rational treatment can be instituted. Usually it is not possible to cure DAVMs by embolization alone: the approach now used for the main feeders arising from branches of the internal carotid and vertebral arteries is inadequate. However, it is usually possible to reduce the volume of the shunt flow and the pressure in the draining sinuses. Frequently the success is only temporary and a combined surgical and intravascular procedure is later necessary. In isolated cases, inoperable DAVMs can be transformed to operable ones by first performing embolization.

Cerebral Angiography↗
PubMed1987

Technetium-99m HM-PAO brain SPECT in epileptic patients before and during unilateral hemispheric anesthesia (Wada test): report of three cases.

The lipophilic brain SPECT agent [99mTc]hexamethyl propylene amine oxime (HM-PAO) was used in three cases before and during unilateral anesthesia of one hemisphere for lateralization of speech dominance (Wada test). This procedure led to a decrease of regional cerebral blood flow (rCBF) in each of the hemispheres to 55 and 90%, respectively. Diminution of rCBF was significantly more pronounced in the dominant hemisphere. A second phenomenon observed during the Wada test was crossed cerebellar diaschisis. These findings support the assumption that HM-PAO allows monitoring of brain perfusion, as rapid changes of rCBF due to decreased neuronal activity cause respective alterations of cerebral and cerebellar uptake of this new brain agent.

Adolescent↗
PubMed1987

[Foramina parietalia permagna].

We report a patient who presented with the foramina parietalia permagna feature. This harmless malformation of the skull has already been described long ago but is rare and fairly unknown. Therefore, it may present problems concerning differential diagnosis. To our knowledge our case is the first to be illustrated and analyzed by cerebral computed tomography.

Female↗
PubMed1986

Free and conjugated CSF and plasma GABA in Huntington's chorea.

Free and conjugated GABA concentrations were measured in CSF and plasma from 28 patients with manifest Huntington's chorea (HC) and 30 age- and sex-matched controls. GABA was determined by ion-exchange chromatography with fluorimetric detection (IE/F). Free and conjugated CSF GABA was significantly decreased in prolonged HC with advanced disease states and was suggested practicable as an additional diagnostic tool. However, in younger patients (less than 40 yrs) with a short period of HC (less than 2 yrs) an overlap with the age-matched normal range indicated GABA measurement inadequate to early diagnosis nor predictive for offspring at risk. An age-dependent decrease of conjugated CSF GABA was observed in patients and controls. The more pronounced decrease in patients might reflect the neurodegenerative feature of HC.

Adult↗
PubMed1986

'Open angioplasty' in carotid artery obstructions.

A new method has been introduced for the treatment of highly located or long-segment stenoses or obstructions of the internal carotid artery not accessible by conventional carotid-endarterectomy. Following conventional carotid-endarterectomy a balloon catheter is passed through the incised carotid artery as far as the stenosis and then inflated several times. Possibly dislodged plaque material can be washed out by the retrograde blood stream. The results in 30 cases, with angiopraphic, Doppler sonographic and neurologic follow-up examinations, are reported. It was possible to achieve a distinct additional cerebral blood supply through the recanalized internal carotid artery by this method, without a severe complication rate.

Carotid Arteries↗
PubMed1985

[Intracranial venous angiomas].

Until now there have only been 13 reports of clinically diagnosed intracranial venous angiomas, which have been operatively demonstrated and histologically examined. We have seen 2 further cases, both of which received operative treatment. Although this condition is pathologically commoner as arteriovenous angioma, it is rarely clinically diagnosed. The diagnostic value of the computer tomogram is stressed and the findings from 2 young patients are compared with the literature. The angiogram from these angiomas's show considerable differences depending on the method used. This could explain some of difficulties in histological diagnosis.

Adolescent↗
PubMed1984

[Anesthesia in neuroradiology].

Cerebral angiographies can be performed under general anaesthesia, analgosedation in the presence of an anaesthesiologist, and under local anaesthesia. The criteria governing the choice of the most appropriate method of anaesthesiology are discussed. In computed tomography of the head, general anaesthesia is indicated only if it proves impossible to achieve satisfactory cooperation with the patient. Discographies , myelographies and the now rare pneumoencephalography are performed almost without exception under local anaesthesia or without anaesthesia. If general anaesthesia is preferred, it will be necessary to take into account the special pathophysiological conditions obtaining in neurosurgical patients (disturbance of cerebral blood flow due to enhanced intracranial pressure or caused by stenosing vascular processes).

Adult↗
PubMed1981

Occlusions of the basilar artery: Pathologic-anatomical and clinical findings in different occlusion types and their prognosis.

Occlusions of the basilar artery are reviewed under pathologic-anatomical and clinical aspects. Special attention is devoted to correlations as well as discrepancies between pathologic-anatomical findings, clinical findings and the results of additional diagnostic procedures. The resulting possibilities of erroneous diagnostic and prognostic interpretations are discussed. The considerations lead to the conclusion that an attempt should be made to classify clinically the basilar artery occlusions into oral, median and caudal types. The present paper takes the pathologic-anatomical as well as the clinical findings into consideration. It has been reported in recent years that in some instances patients have survived basilar artery occlusions. Similar observations suggested the advisability of investigating the basilar artery occlusion among our patients with regard to pathogenetic, diagnostic and prognostic criteria.

Arterial Occlusive Diseases↗
PubMed1980

Superficial temporal-middle cerebral artery anastomosis in Moyamoya disease.

A 41-year-old Libyan woman with Moyamoya disease and persisting post-stroke neurological deficits was treated by a superficial temporal-middle cerebral artery (STA-MCA) anastomosis. The postoperative angiograms revealed that the STA was rapidly irrigating the territory of the middle cerebral artery including those regions that had been filled preoperatively via different networks of collaterals. Furthermore prompt venous drainage was seen to occur postoperatively. Following surgery EEG analyses revealed considerable increase in the electrical brain activity, and neurological examinations showed reversal of neurological deficits. The dependence of the postoperative neurological improvement on the increased cerebral blood supply through the new collateral channel could be demonstrated by the effect of temporary occlusion of the STA on the electrical brain activity.

Adult↗