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Biomedical subjects

K A Flügel

Publications and source records attributed to K A Flügel.

At least 19 recordsLinked to original sources
PubMed2002

[Isolated intracerebral cystic echinococcosis. Unusual presentation of a rare disease].

HISTORY AND CLINICAL FINDINGS: A 46-year-old woman was admitted with a first generalised tonic-clonic seizure. Past medical history was unremarkable. She reported no travels abroad within the past five years. INVESTIGATIONS: Brain MRI demonstrated disseminated cerebral and cerebellar focal lesions. Cerebrospinal fluid analysis showed a mild eosinophilic pleocytosis. Extensive imaging investigations and serological tests revealed no hints for a systemic parasitic disease. A stereotactic brain biopsy detected no pathogenic agent. 10 months following the initial admission, brain MRI showed multiple cystic lesions with ring-like enhancement following Gd-DTPA administration. At that time serological tests were positive for an infection with Echinococcus granulosus. DIAGNOSIS: The diagnosis was based on positive sequential serological tests and the typical MRI findings in conjunction with an eosinophilic cerebrospinal fluid pleocytosis. TREATMENT AND CLINICAL COURSE: An antihelmintic therapy with Albendazole was initiated. Following two-months of oral Albendazole administration, brain MRI revealed a clear reduction in size and number of the hydatid lesions. The patient was free of complaints and the clinical examination was unremarkable. CONCLUSION: Isolated intracerebral manifestation of cystic echinococcosis is very rare. Compared to the typical presentation with a solitary cerebral hydatid cyst, the dissemination of hydatid cysts is quite uncommon in cystic echinococcosis. Diagnosis should be based on the typical MRI findings and serological tests. The present case demonstrates that the later may be negative over a long period within the clinical course of the disease offering a real challenge to the clinician.

Albendazole↗
PubMed1996

Evaluation of extracranial vertebral artery dissection with duplex color-flow imaging.

BACKGROUND AND PURPOSE: We describe the diagnostic potential of duplex color-flow imaging in the evaluation of extracranial vertebral artery dissection. METHODS: Twenty patients with 24 extracranial vertebral artery dissections (four bilateral) were examined with duplex ultrasonography over a period of 6 years. Color-flow imaging was carried out in 16 of these patients. In 15 patients (75%), the dissection was temporally related to trauma. Angiography was available in 18 patients, confirming the diagnosis. RESULTS: In 15 patients, the diagnosis was primarily established with ultrasonography. Five patients with a dissection were referred for follow-up color-flow examinations. Six vertebral arteries were dissected at the origin or in the proximal V1 segment, one in the distal V2 segment, and one at the atlas loop. In contrast to other studies, the most frequent localization of the dissection in our patients was the region between the V1 and V2 segments (n = 16), where the most typical dissection site was the entrance of the artery into the transverse foramen of the C6 vertebra (n = 11). Typical ultrasonographic findings were irregular stenosis, dissecting membrane with true and false lumen, localized increase in diameter of the artery, pseudoaneurysm, intramural hematoma, and tapering stenosis with distal occlusion. In follow-up examination, a good regression of pathological findings was found in 17 dissections (70.8%). Two occlusions were completely recanalized. CONCLUSIONS: Extracranial vertebral artery dissections can be diagnosed noninvasively with duplex color-flow imaging. It is therefore a useful method for early diagnosis and follow-up examination.

Adolescent↗
PubMed1995

Color Doppler imaging of basal cerebral arteries: normal reference values and clinical applications.

Transcranial color-coded duplex ultrasonography is a new diagnostic procedure allowing the visualization of major intracranial vessels. The purpose of this report is to describe this method and to evaluate its practical potential in the routine examination of basal cerebral arteries. The results from the examination of 96 patients are presented. By means of color coding of Doppler frequencies, the major intracranial vessels were identified by nature of their anatomic location with respect to the echogenic brainstem structures in all subjects. The average maximal systolic velocity was, in the middle cerebral artery, 108 +/- 15 cm/s; in the anterior cerebral artery, 96 +/- 15; in the posterior cerebral artery, 76 +/- 16; and in the basilar artery, 59 +/- 17 cm/s. The determination of the angle between the ultrasonic beam and the examined vessel improved the accuracy of flow velocity measurements in comparison with conventional transcranial Doppler ultrasonography. The exact measurement of blood flow velocity in several segments of the visualized vessel proved helpful in the assessment of pathologic findings, especially in differentiation between a stenosis of the intracranial vessel and a vasospasm.

Adult↗
PubMed1994

Quantitative measurements of blood flow velocity in basal cerebral arteries with transcranial duplex color-flow imaging. A comparative study with conventional transcranial Doppler sonography.

Transcranial duplex color-flow imaging is a new diagnostic method that allows visual display of blood flow in the basal cerebral arteries. This method allows determination of and correction for the Doppler angle of insonation. Conventional transcranial Doppler sonography has no imaging component and assumes a 0-degree Doppler angle for the calculation of flow velocities. The magnitude of the angle of insonation and the effect on flow velocity estimates have not been clearly defined. In order to evaluate the angle of insonation and the effect of angle correction on velocity readings, 50 patients referred for evaluation of cerebrovascular disease were studied. The mean age was 45 years (range, 24-62 yr). All were examined with conventional transcranial Doppler and transcranial duplex color-flow imaging. Specific vessels of the circle of Willis were identified by location, course, and direction of flow on color-flow images and by depth, direction of flow, and transducer orientation with conventional Doppler sonography. Visually controlled measurements of the Doppler angle of insonation were made by color-flow imaging. The data show that the mean angle of insonation was 33 degrees (+/- 15) in the middle cerebral artery, 35 degrees (+/- 17) in the anterior cerebral artery, 45 degrees (+/- 18) in the posterior cerebral artery, and 15 degrees (+/- 14) in the basilar artery. Angle-corrected peak systolic flow velocities were higher in all vessel segments (middle cerebral = 15%, anterior cerebral = 18%, posterior cerebral = 30%, and basilar = 3%), compared to uncorrected velocity readings by conventional Doppler sonography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Advantages of color Doppler imaging for the evaluation of vertebral arteries.

Assessment of the vertebral arteries is often difficult with conventional duplex ultrasonography. This study of 60 patients aimed to determine the potential advantages of color Doppler imaging over conventional duplex ultrasonography in the evaluation of vertebral arteries, specifically three extracranial segments of these vessels. Both methods allowed visualization of the vertebral artery in the midcervical course (V2 and distal V1 segments) in all subjects. Color Doppler imaging appeared more effective for visualization of the V0 and the proximal V1 segments (on the right side in 88% of patients and on the left side in 73%). Conventional duplex ultrasonography imaged the ostium on the right side in 80% of patients and on the left side in 65%, but was difficult and time-consuming. Visualization at the atlas loop (V3 segment) was rarely successful with duplex sonography, whereas color Doppler imaging visualized the vertebral artery on the right side in 87% of patients and on the left side in 85%. Color Doppler imaging allows better visualization of the proximal and distal segments of the vertebral arteries, compared to conventional duplex ultrasonography.

Adult↗
PubMed1992

Duplex ultrasonography of vertebral arteries: examination, technique, normal values, and clinical applications.

A technique for the imaging of vertebral arteries at their origins and along the longitudinal extracranial course is described. The results of the examination of 108 normal vertebral arteries are shown. The vertebral artery could be distinguished in the pretransverse and intertransverse segment C5-C6 in 100%. The average diameter of the vessel was 3.81 +/- 0.46 mm on the right and 3.88 +/- 0.47 on the left side. The average maximal systolic velocity was 43.0 +/- 8.9 cm/s on the right and 43.3 +/- 9.6 on the left side. In 81% of the cases the vertebral origin could be located on the right and in 65% of the cases on the left side. The technical quality of visualization, especially of the vertebral origin, was greatly influenced by the depth of the examined structure. Examples of pathologic findings, such as hypoplasia, stenosis, and occlusion, demonstrate the practical possibilities of this noninvasive method.

Adult↗
PubMed1984

[Necrotizing retinitis in subacute sclerosing panencephalitis].

Between 1978 and 1982 the authors saw 5 patients (13, 14, 15, 24 and 28 years old) with SSPE. The first symptom was a sudden loss of visual acuity (unilateral in 3 patients and bilateral in 2). Four of the patients treated were suffering from necrotizing, central, partly hemorrhagic retinitis (not affecting the vitreous or the choroid). In the area affected by retinitis there was a residual "depression", and in some cases alterations of the retinal pigment epithelium indicative of tissue loss. In recognizing the early symptoms of this neuro-ophthalmological disease the ophthalmologist makes an important contribution to early diagnosis. In all 5 patients the diagnosis of SSPE was substantiated by the neurological course, the elevated measles titer and the cytoplasmic and nuclear antibodies counteracting SSPE antigen in the plasma and cerebrospinal fluid.

Adolescent↗
PubMed1984

[Somatosensory evoked potentials following stimulation of the lateral femoral cutaneous nerve in normal persons and in patients with meralgia paraesthetica].

Cortical somatosensory potentials evoked by stimulation of the N. cutaneus femoris lateralis at two different places (proximal and distal) were investigated in normal persons and patients with sensory disorders of this nerve. A relatively constant early peak (P 32 and P 37 respectively) proved to be a useful diagnostic parameter for normal and delayed nerve conduction. Abnormalities were found in two thirds of cases on the side clinically affected. Peripheral sensory nerve potentials, evoked by orthodromic or antidromic nerve stimulation, have been found to be of limited value because frequently they could not be recorded in normals and also because lesions of the nerve may be localized proximally from the section that is accessible with peripheral electroneurography.

Electric Stimulation↗
PubMed1983

[Can the electroencephalogram contribute to the indications for carotid surgery?].

In a follow-up study (performed in 1981) of patients who underwent endarterectomy because of arteriosclerotic carotid artery stenosis or kinking between 1962 and 1980, those cases were analyzed which did not suffer carotid ischemic attacks but were either asymptomatic or had uncharacteristic symptoms (like dizziness or syncopal attacks) or brain stem symptoms indicating vertebro-basilar insufficiency. In all of these patients EEG recordings were performed before operation. From a total group of 324 patients 44 had abnormal EEG findings. In these cases the incidence of surgical complications was somewhat higher as was the incidence of mortality and of strokes. Particularly in hemodynamically effective stenosis, mortality in the later course was higher in cases with pathologic EEG. Although an abnormal EEG cannot be regarded as an absolute contraindication for carotid surgery, these cases should be submitted to a thorough internistic examination and the indication for surgery should be made carefully.

Adult↗
PubMed1983

[Artificial nutrition in neurology--indications and problems].

36 patients with severe neurological diseases (craniocerebral trauma, cerebrovascular insufficiency, meningo-encephalitis, polyneuropathy, paraplegia, intoxication etc.) received for more than 3 months monosaccharides and polyols (Triofusin E 1000) and a 10-%-concentration of crystalline amino acids (Aminofusin L10% kohlenhydratfrei) via the parenteral route in combination with / or exclusively a nutrient-defined diet (Biosorb). Exclusive enteral nutrition was given preference if possible. Numerous laboratory parameters, as for example blood counts, "hepatic enzymes", electrolytes, trace elements, plasma proteins, lipids, urea and creatinine were determined once a week. Substitutions and secondary complications were registered in addition. Iron and plasma proteins had to be substituted most frequently. It could be proved that hypoferremia was caused by insufficient iron supply in case of exclusive/prevailing parenteral nutrition, incorrect application of the iron preparations, inflammatory complications with iron moving into the R.E.S., as well as malabsorption syndromes probably induced by bacteria. Inflammatory complications were also the major cause of protein deficiency syndromes (hypoalbuminemia). In case of relatibely often occurring diarrhea, however, it could clearly be proved that it was not induced by nutrition but was produced by a broad-spectrum antibiosis. Chronically persistent diarrhea with colitis-like colonic changes required enteral feeding with an oligopeptide diet (z.B. Peptisorb) via jejunal feeding tube. Nitrogen balances which were determined after more than 3 months of artificial nutrition formed the basis of a nutritional plan differentiated according to diagnostic groups and stages of disease.

Adolescent↗
PubMed1983

Incidence of abnormal EEG findings in patients with obstructions of the carotid artery and their prognostic value for the postoperative long-term course.

Between 1972 and 1980, a total of 706 patients were operated on at the Surgical Department of the University Hospital at Erlangen for chronic arteriosclerotic lesions, or kinking or coiling of the carotid artery; an evaluable preoperative EEG was recorded in 515 patients. Patients with an abnormal EEG revealed an increased early mortality rate, and a greater incidence of strokes in the long term. In patients with "controversial' indications for surgery, i.e., patients with asymptomatic carotid bruit, chronic cerebral ischemia, or nonhemispheric attacks, a low-grade increase in early mortality, the incidence of deaths, and the incidence of strokes in the long term, were established. Although an abnormal EEG cannot, by and large, be considered an absolute contraindication to surgery, it should, nevertheless, be a reason for carrying out a thorough internistic examination of the patient and for critically considering the surgical indications.

Arteriosclerosis↗