PubMed Health⌕ Search

Biomedical subjects

M Prugger

Publications and source records attributed to M Prugger.

10 recordsLinked to original sources
PubMed1999

Primary central nervous system lymphoma presenting with a parkinsonian syndrome of pure akinesia.

The incidence of primary central nervous system lymphoma (PCNSL), once a rare tumour, has risen significantly in both immunocompetent and immunosuppressed patients. Although infiltration of the basal ganglia is not uncommon in PCNSL, extrapyramidal movement disorders are generally not recognised as a mode of clinical presentation of this type of cerebral tumour. We present the unusual case of a 75-year-old man who developed a parkinsonian syndrome of "pure akinesia" due to autopsy-confirmed PCNSL primarily involving the globus pallidus bilaterally. Parkinsonism due to bilateral pallidal lesions is known but rare, and such cases help in the understanding of basal ganglia function with regard to akinesia and freezing.

Aged↗
PubMed1988

Short latency somatosensory evoked potentials and brain-stem auditory evoked potentials in coma due to CNS depressant drug poisoning. Preliminary observations.

In patients in coma due to severe CNS depressant drug overdose the central somatosensory conduction time (CCT) after median nerve stimulation is prolonged and N20 is dispersed. Brain-stem auditory evoked potentials demonstrate delayed interpeak latencies (IPLs) I-III, III-V and I-V. This was observed in 4 out of 5 patients investigated after intake of an overdose of amitriptyline (2 cases), barbiturates, meprobamate and nitrazepam (one case each). Toxic levels of drug overdose were related to prolonged CCT and IPLs, whereas normal CCT and IPLs were found at therapeutic drug plasma levels. CCT, IPLs and dispersion of N20 decreased during the course of coma. All patients were successfully treated. It appeared that SSEP and BAEP investigations could make a distinction between a 'toxic' and a 'therapeutic' coma level in severe drug overdose. It further appeared that normalization of CCT and IPLs preceded clinical improvement.

Adult↗
PubMed1988

Central somatosensory conduction time and acoustic brainstem transmission time in post-traumatic coma.

Short-latency evoked potentials (SEPs) of the scalp and neck after median nerve stimulation and acoustic brainstem evoked potentials (BAEPs) were recorded in 85 patients in post-traumatic coma with clinical signs of brainstem impairment between days 2 and 6 after trauma. The central somatosensory conduction time (CCT), the amplitude ratio (AR) N20:N13, the interpeak latencies (IPL) I-III, III-V, I-V, and the ARs between waves I and V (I:V) and between wave I and the wave IV/V complex (I:IV/V) were calculated and related to the outcome of the patients. In cases of coma due to supratentorial lesions, CCT and ARs of SEPs were close to normal in patients with good outcome: CCT increased and ARs decreased with worsening of outcome. In cases of primary brainstem injury, a significant prolongation of CCT was also seen in patients with good recovery, whereas normal CCTs could be found in patients with severe disability and death outcome. In this case, unilateral absent scalp SEPs were frequently found. The IPLs I-III, III-V, I-V, and the ARs of BAEPs increased with worsening of outcome. Significant differences of IPL I-V and III-V (brainstem transmission time) were seen between patients with good recovery or moderate disability outcome and the patients with severe disability or death outcome. There was no difference in BAEPs between patients with primary brainstem lesion and patients with secondary brainstem lesion. Patients with bilateral absent SEPs and bilateral absent BAEPs not related to traumatic or preexisting hearing disorders died or survived severely disabled. Unilateral absence of scalp SEPs and unilateral absence of BAEPs were frequently found in patients who died or who had severe disability. Asymmetries in scalp SEPs appeared to be distributed equally to all outcome categories, but asymmetries in BAEPs increased with worsening of outcome too. In most of the patients who died or survived disabled, both SEPs and BAEPs were abnormal.

Adolescent↗
PubMed1988

[Hypophyseal abscess and cerebral arteritis in a fatal course of pneumococcal meningitis].

Even today uncomplicated courses of pneumococcal meningitis show relatively high fatality rates. Abscess formation leads to a drastic deterioration of prognosis; the same applies to the rarely observed occurrence of a cerebral arteritis. Up to 1985 only 50 cases of pituitary abscess had been described in the literature. This case report describes the signs and symptoms as well as the neuroradiological and post mortem findings on a patient who succumbed to a pneumococcal meningitis, complicated by formation of a pituitary abscess and cerebral arteritis.

Abscess↗
PubMed1986

Secondary cerebral amebiasis due to infection with Entamoeba histolytica. A case report with computer tomographic findings.

The clinical and serological findings and computer tomographic (CT) appearances of a case of secondary cerebral amebiasis due to Entamoeba histolytica are presented. The effect of therapy on the neurological symptoms as well as on the CT findings are described in detail. The multiple intracerebral lesions resolved almost completely and the patient survived without any neurological sequelae.

Amebiasis↗
PubMed1986

[How much reintegration can be achieved in patients after severe craniocerebral injury?].

152 patients, who had suffered head and brain injury during the years 1980 to 1982 were interviewed by letter using a standardized questionnaire to assess the individual outcome. There were questions concerning activities of daily life, invalidity, work activities, social relationships with family and other persons, leisure activity and the grade of persisting sequelae. There were 106 replies, 16 patients had died meanwhile. According to their neurological symptoms on admission at the intensive care unit the patients were divided into two groups. Group I included patient, who showed symptoms of midbrain syndrome stage 1 and 2, while group II presented patients had midbrain syndrome stage 3 and 4. Activities of daily life (feeding, dressing, toiletting and ability to get out of bed and move around the room) were restored in the great majority of patients. 15 patients of group II were classified as invalid. Significant changes in social relationships with the family were seen in 50% of the patients. Further, a decrease of contacts with friends, and a significant decrease in leisure activity (sport) was noted. 28.4% of the patients of group I and 36.8% of the patients of group II, who were at work before the trauma, now were out of work. The others generally worked below their previous level. Persisting sequelae included headache, lack of concentration and weakness of extremities. These symptoms were more prominent in the patients of group II; surprisingly little complaints concerned sexual life and somatic problems. It was found, that severe head and brain injury had significantly changed the patient's life in most cases. Work activities were strongly impaired in about 30% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1983

Central somatosensory conduction time and short latency somatosensory evoked potentials in post-traumatic coma.

Short latency evoked potentials (SEPs) were elicited by stimulation of the median nerve at the wrist and recorded simultaneously from the neck and the contralateral scalp in 44 comatose patients with signs of brain stem impairment due to head injury. Thirty-four patients were studied in acute coma on day 1 or 2 after brain injury. Twenty-three patients were studied in prolonged coma during days 3-12 after trauma. Six patients were examined in brain death. Brain stem involvement was divided clinically and by CT scan into secondary lesions due to supratentorial mass displacement and primary lesions due to direct violence to the brain stem. The central somatosensory conduction time (CCT) was measured by subtracting the peak latency of the major response from the neck (N14) from that of the primary scalp response (N20). The amplitude ratios (ARs) N20/N14 were calculated for each trace. Further asymmetries and absence of SEP over one or both hemispheres were noted. In cases in coma due to supratentorial lesions CCT and AR were close to normal in patients with good outcome. CCT increased and AR decreased with the worsening of outcome both in acute and prolonged coma. Asymmetries of SEPs indicated moderate or severe final disability. Patients with absent SEPs over one or both hemispheres due to supratentorial lesions died or survived severely disabled (1 case). In patients suffering from primary brain stem dysfunction, confirmed by a normal or slightly abnormal CT scan, prolonged CCT, asymmetric but also absent SEPs were also found in patients with good outcome both in acute and prolonged coma. AR was generally low in these cases. Early appearance of SEPs or early recovery of initially distorted SEPs and decrease of CCT in prolonged coma or during recovery was a favourable prognostic sign. Therefore even absent or severely distorted SEPs should be interpreted cautiously in patients who may suffer from primary brain stem involvement. Scalp SEPs were totally absent in patients with brain death.

Adolescent↗
PubMed1983

Incidence and prognostic value of spindles in post-traumatic coma.

One hundred and thirty-three EEGs were analysed from 80 comatose patients with signs of brain stem impairment due to head/brain injury. Seventy EEGs were taken in acute coma on day 1 or 2 after brain injury. Sixty-three EEGs were recorded in prolonged coma 3-12 days after brain injury. Brain stem involvement was divided by neurological signs and by CT scan into secondary lesions due to supratentorial mass displacement and primary lesions due do direct violence to the brain stem. Different EEG patterns were observed, but spindle activity was of special interest. Spindles were classified as typical (easily recognizable, well organized, 12-14 c/sec activity) or atypical (hardly recognizable, distorted form, 6-11 c/sec activity). Furthermore, asymmetries of spindles were noted. The spindles and their alterations were related to different stages of outcome. Spindles were seen in 91% of the EEGs in acute coma and in 30% in prolonged coma. In acute coma due to secondary brain stem involvement a good outcome was heralded by the occurrence of typical symmetrical spindles combined with early stages of secondary brain stem impairment at neurological examination. In cases of primary brain stem involvement typical spindles also suggested a good prognosis despite the observation of serious clinical signs (decerebrate posturing). The percentage of spindle activity decreased, and distortion and asymmetry of spindles increased with the worsening of outcome. Severe intracerebral lesions (confirmed by clinical and CT scan examinations) led to distortion, asymmetry and finally disappearance of spindles. In prolonged coma spindle activity was markedly reduced regardless of the final outcome. When spindles were present atypical and asymmetric forms significantly increased in patients with bad outcome. There were no significant differences in spindle activity in the different outcome categories, if primary and secondary brain stem lesions were compared.

Adolescent↗
PubMed1982

Some observations on the blink reflex in posttraumatic coma.

Blink reflex studies were carried out on 51 comatose patients with signs of brain stem impairment due to head injury. Twenty-five patients were studied in acute coma on day 1 or 2 after trauma. Twenty-six patients were studied in prolonged coma during days 3-12 after brain injury. Brain stem involvement was divided clinically and by CT scan into secondary lesions due to supratentorial mass displacement and primary lesions due to direct violence to the brain stem. Further, the comatose states were separated by behavioural and EEG signs of sleep into "sleep' and more "alert' states. The blink reflexes were recorded after mechanical and electrical stimulation. Mechanical stimulation appeared to be more effective in evoking late responses than the electrical stimulus. The elicitability of the late responses was also dependent on the time of stimulation. During "sleep', usually accompanied by a spindle-EEG, the late responses were totally absent after both mechanical and electrical stimulation in acute coma. In more "alert' states, usually accompanied by high voltage delta waves in the EEG, the late responses, especially direct R2, could be frequently elicited by mechanical stimulation. These differences decreased during prolonged coma. All patients with signs of secondary brain stem involvement who had at least one late component in the acute stage of coma recovered well. So did all patients, with one exception, with primary brain stem injuries. Early recovery of the blink reflexes in cases of primary brain stem injury was a further favourable sign. Consistent absence of R2 (and R1) in prolonged coma indicated a bad outcome. The presence of all components in prolonged coma was of less prognostic significance than in the acute stage.

Adult↗