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Biomedical subjects

M Neveling

Publications and source records attributed to M Neveling.

At least 37 records · Page 2Linked to original sources
PubMed1997

Clozapine-induced agranulocytosis and thrombopenia in a patient with dopaminergic psychosis.

In patients with Parkinson' disease and dopaminergic psychosis, clozapine treatment is recommended as the drug is free from extrapyramidal side effects and does not worsen motor symptoms of the underlying disease. The use of clozapine, however, is limited due to its hematotoxic side effects. For treatment of clozapine-induced agranulocytosis, granulocyte colony-stimulating factors (G-CSF) are recommended. We report the case of a 72-years-old male patient with clozapine-induced agranulocytosis and thrombopenia. Neutropenia was successfully treated with G-CSF, but thrombopenia persisted and resolved spontaneously after 14 days. Bone marrow toxicity of clozapine is not restricted to white cell maturation, but may also impair thrombocytopoesis.

Aged↗
PubMed1997

Nontraumatic subarachnoid hemorrhage: value of repeat angiography.

PURPOSE: To evaluate the benefits and risks of repeat cerebral angiography in patients with subarachnoid hemorrhage of unknown cause. MATERIALS AND METHODS: Findings from 391 angiographic examinations (323 initial, 68 repeat) were retrospectively reviewed in 323 patients with nontraumatic subarachnoid hemorrhage to determine the cause of bleeding and the frequency of complications with neurologic deficit. RESULTS: At the initial angiographic examination, aneurysms were found in 195 patients (60.4%), and arteriovenous malformations were found in 11 patients (3.4%). Sixty-six patients with negative findings at initial examination underwent repeat cerebral angiography. Three additional aneurysms were detected, all of which could be seen retrospectively on the initial angiogram. In 63 patients, the cause of bleeding remained unexplained. Complications of the 391 angiographic examinations were definitive neurologic deficits in one patient (0.2%) and transient deficits in seven patients (1.8%). CONCLUSION: Repeat angiography is not necessary in patients with subarachnoid hemorrhage if technically good, carefully evaluated digital subtraction angiography was performed initially. Repeat angiography seems to be justified only when the initial examination is technically inadequate, when vasospasm is present, or if further bleeding occurs.

Adolescent↗
PubMed1993

Effect of propentofylline on regional cerebral glucose metabolism in acute ischemic stroke.

In a randomized double-blind placebo-controlled study in 30 patients with acute ischemic stroke, the effect of the adenosine uptake blocker propentofylline on regional brain glucose metabolism (rCMRglu) was investigated using repeated positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose (FDG). Treatment was initiated within 48 h after onset of symptoms. The clinical course was followed for 3 months. In the propentofylline group, after 14 days rCMRglu was increased in the infarct by 37.3% and was practically unchanged in other brain regions, whereas in the control group glucose metabolism had decreased in all regions (1.4-13.4%). These differences were significant between the two groups [Analysis of variance (ANOVA) p = 0.005]. Although there was a trend toward greater clinical improvement in the propentofylline-treated patients, this did not reach statistical significance. The results correspond to experimental data showing that propentofylline improves energy metabolism in cerebral ischemia. A clinical trial is needed to determine whether this new therapeutic principle can be successfully used in acute human stroke.

Acute Disease↗
PubMed1992

Early diagnosis and successful treatment of acute cytomegalovirus encephalitis in a renal transplant recipient.

We report the case of a 40-year-old male HIV-negative renal transplant patient with allograft rejection and immunosuppressive therapy who presented with acute cytomegalovirus (CMV) encephalitis. CT and MRI of the brain were normal but EEG showed diffuse slowing and dysrhythmia. In cerebrospinal fluid (CSF) initially 81 cells/microliters were found and immunocytochemistry showed a decreased CD4/CD8 ratio and increased values of activated lymphocytes, natural killer cells and immunoglobulin-containing cells. CMV-specific IgM antibodies in CSF and serum, immunostaining of CMV antigen in CSF cells and virus culture from CSF and urine were negative. During the first 3 weeks of illness no intrathecal production of immunoglobulins could be detected. Early diagnosis of CMV encephalitis was made by in situ hybridization (ISH) on CSF cell preparations and the polymerase chain reaction (PCR) which was positive in CSF and blood. On day 26 diagnosis was confirmed by detection of CMV-specific intrathecal IgG production. The patient was treated with ganciclovir, anti-CMV immunoglobulins and intrathecal beta interferon. He recovered completely after 2 months. Our data demonstrate the usefulness of ISH and PCR in the early diagnosis of CMV encephalitis and perhaps may encourage the use of intrathecal beta interferon in other patients with this disease.

Acute Disease↗
PubMed1992

[B-scan ultrasound findings in the carotid bifurcation area of hemodialysis patients].

Using B-mode ultrasonography, the frequency of carotid atherosclerosis was investigated prospectively in 50 patients on maintenance haemodialysis compared to healthy controls. The patients showed significantly more atheromatous plaques at the carotid bifurcation, as well in the internal and external carotid artery (chi-square-test, p less than 0.05). There was no statistical difference between normotensive patients on haemodialysis and the control group, but hypertensive patients showed statistically significant more plaques of the cervical vessels (chi-square-test, p less than 0.05). Therefore, atheromatous plaques in haemodialysis patients appear to be due to hypertension rather than to maintenance dialysis.

Adult↗
PubMed1990

Effect of nimodipine on regional cerebral glucose metabolism in patients with acute ischemic stroke as measured by positron emission tomography.

In a randomized double-blind placebo-controlled study of 27 patients with acute ischemic stroke, the effect on regional CMRglc (rCMRglc) of the calcium channel blocking agent nimodipine administered in addition to routine treatment was investigated. Following computed tomography-supported diagnosis of focal ischemia in the middle cerebral artery territory, positron emission tomography (PET) of 2-[18F]fluoro-2-deoxy-D-glucose (FDG) was performed, and the patients were entered into the study within 48 h after onset of symptoms, randomly receiving either nimodipine (2 mg/h constant i.v. infusion for 5 days, 120 mg/day orally for another 16 days) or carrier/placebo. FDG PET was repeated after completion of therapy. The clinical course was followed during the treatment period and for 6 months after the stroke, using the Mathew Score for early and the Barthel Index for late assessment. During that observation period, five patients died in the nimodipine group and four in the control group. Subsequently, the code was broken, and the clinical and PET data were analyzed in relation to treatment assignment, with the nimodipine group comprising 11 and the control group 12 eligible cases. The two groups were similar with respect to age and sex distribution, initial clinical deficit, and infarct size and location. While the infarct rCMRglc showed comparable slight increases over time in both groups, the metabolic changes in the other evaluated regions (contralateral infarct mirror region, ipsi- and contralateral cerebral gray matter, contra- and ipsilateral cerebellar hemispheres) differed significantly between treatment groups (side x region x treatment interaction p less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

[Diagnosis and prognosis of acute cerebellar infarcts. A retrospective study].

37 patients with acute cerebellar infarction were analysed retrospectively. Diagnosis of cerebellar infarction cannot be made by clinical symptoms alone rather together with CT and MRT displaying the localisation and size of the lesion. Evoked potentials do predict clinical outcome more accurately than EEG or doppler sonography do.

Adult↗
PubMed1990

Effect of nimodipine on glucose metabolism in the course of ischemic stroke.

We investigated the effect of the calcium channel-blocking agent nimodipine on regional cerebral metabolic rate of glucose in acute ischemic middle cerebral artery infarction diagnosed clinically and by computed tomography. Twenty-seven patients entered the study within 48 hours after onset of symptoms and randomly received either nimodipine (2 mg/hr constant intravenous infusion for 5 days, 120 mg/day orally for another 16 days) or placebo. Four of the 27 patients died within the first 3 weeks and could not be evaluated. Of the remaining 23 patients, 11 were assigned to the nimodipine group and 12 to a control group. We analyzed data from positron emission tomography, performed twice before and after completion of therapy, and clinical data from the treatment period and the next 6 months based on the Mathew Score for early assessment and the Barthel Index for late assessment. During the post-treatment period, two patients from the nimodipine group and three from the control group died. The evaluated patients were comparable for age and sex distribution, initial clinical deficit, and infarct size and localization. We found significant metabolic changes between both treatment groups for contralateral infarct mirror region, ipsilateral and contralateral cerebral gray matter, and contralateral and ipsilateral cerebellar hemispheres (side x region x treatment interaction p less than 0.025). The nimodipine group had bilaterally increased regional cerebral metabolic rate of glucose of morphologically intact cerebral (14.6% and 17.1%, respectively) and cerebellar structures (6.9% and 10%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Brain↗
PubMed1988

[Spontaneous pontine hemorrhage. An analysis of 38 cases].

In 38 patients suffering from spontaneous pontine hemorrhages arterial hypertension was the most common risk factor. 31 patients, of whom 30 died, suffered centro-paramedian pontine hemorrhage leading to coma, hypertensive crisis, respiratory failure, cardiac arrhythmia, miosis and tetraparesis. Most cases showed involvement of the mesencephalon [17] and fourth ventricle [14]. The other seven patients demonstrated dorsotegmental [5] or hemipontine [2] hemorrhages with complex neuroophthalmologic signs, other cranial nerve lesions, and ataxia or hemiparesis; all these patients survived, some even without neurological deficit. In most cases, arteriosclerotic hemorrhages of pontine vessels occurred; in rare cases arterial malformations [4] and anticoagulants [4] were responsible for the bleeding. Clinical signs, CT scans and MRT investigations led to the diagnosis. EEG and evoked potentials allowed statements regarding localisation and prognosis. Treatment was limited in most cases to conservative intensive care; in one case a ventricular shunt was implemented, and in two cases pontine hemorrhages in the presence of arteriovenous and cavernous angiomas were removed.

Adult↗
PubMed1988

[Multiple brain infarcts in zoster infection].

The clinical, CSF, CCT and PET findings in a 14-year-old female patient are reported. CCT and PET investigations demonstrated multiple cerebral infarctions; CSF examinations revealed inflammatory changes. Zoster antibodies were synthesized intrathecally, as detected by an ELISA after adjusting serum and CSF to identical IgG concentrations. Therefore the diagnosis of a cerebral zoster angiitis was made. Diagnostic and therapeutic problems of inflammatory vascular lesions are discussed.

Adolescent↗
PubMed1986

[Additional examinations for ascertaining the diagnosis of multiple sclerosis].

The relevance of additional findings was examined in 50 patients in whom multiple sclerosis had been diagnosed. Magnetic resonance (MR) technique revealed morphological changes in 49 patients (688 foci), whereas CT scan visualised foci with modified enhancement in 35 patients only (133 foci) (70%). Oligoclonal antibodies were found in the CSF of 96% of the patients as pointers towards the inflammatory immunological process. Enhanced daily IgG production was seen in 57-70% of the patients, whereas in 52% stimulated lymphocytes were identified in the CSF. Total protein content and cell count in the CSF differed in only 22 and 26%, respectively. Functional deterioration of the myelin sheath resulted in 72% of MS patients in an increased latency of visually evoked potentials. Hence, oligoclonal antibodies in the CSF and multiple foci revealed by MR are the most reliable additional findings in MS and should be considered as essential aids to confirm the diagnosis. A modified schema is suggested in which CT is replaced by MR and the proof of oligoclonal antibodies is given a higher ranking. Pathological changes in evoked potentials are relevant only if clinical symptoms are absent. Sensitivity disturbances and manifestations of brain stem disorders are somewhat less significant.

Adult↗
PubMed1985

Presentation of bilateral thalamic infarction on CT, MRI and PET.

Paramedian thalamic structures and part of the upper midbrain are frequently supplied by posterior thalamoperforating arteries originating from one common trunk. Local impairment of flow entails a bilateral more or less symmetric thalamic infarction with varying involvement of the midbrain. Diagnosis usually can neither be firmly established on clinical grounds nor by angiography alone. In the present series of four patients the two cases observed before the CT era were diagnosed correctly only at autopsy. Only one patient presented the classical syndrome of hypersomnia, thalamic dementia, and oculomotor nerve paralysis, while in the others clinical signs were probably masked by serious impairment of consciousness. In two cases X-ray computed tomography and magnetic resonance tomography (one case) afforded precise definition of infarct localization and size. Infarction in the described terminal vascular supply territory may be detected more often by these modern diagnostic techniques than anticipated from previous clinico-pathological experience as the underlying cause of coma in the elderly-a group of patients at particular risk for low-flow states. Positron emission tomography repeat studies with 18F-2-fluorodeoxyglucose (one case) revealed complex disturbances of brain energy metabolism; correlative analysis of clinical function and metabolic patterns during the course of the disease may not only advance individual prognostication but also contribute to the understanding and localization of brain function.

Adult↗
PubMed1984

[Spontaneous pontine hemorrhage].

Data from 11 observed patients with spontaneous pontine haemorrhages were compared to the findings in 235 cases reported in 9 studies. Causes of pontine haemorrhages which have an incidence of 2 to 4/100 000/year include hypertension, vascular malformations (a.v.-haemangioma, cavernous haemangioma, capillary teleangiectasies), anticoagulative treatment and inflammatory vascular disease. Diffusely spreading hypertensive haemorrhages are of apo-plectiform onset with fast developing coma, and show disturbance of vegetative function (disturbance of respiration, cardiac dysrhythmias, hyperthermia, hypertension), miosis and other neuroophthalmologic symptoms, flaccid tetraparalysis and blood-stained cerebrospinal fluid; mortality is high, reaching 50% after 24 hours and 90% after 3 weeks. Vascular malformations are the origin of circumscribed pontine haematomas with slowly progressing disturbance of consciousness and brain stem symptoms with variable course exhibiting multiple remissions and recurrences. In respect of symptomatology and clinical course, slight lateral hypertensive pontine haemorrhages must be placed between these two typical syndromes. Diagnosis of pontine haemorrhages is supported by x-ray computed tomography, but vascular malformations can be detected only by cerebral angiography. Treatment of patients with pontine haemorrhages must be based on intensive care with regular control via CT. Increased intracranial pressure and internal hydrocephalus caused by blockage of CSF passage necessitate ventricular drainage. While hypertensive pontine haemorrhages cannot be surgically treated, pontine haematomas and the causative vascular malformations can be removed.

Adult↗