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Biomedical subjects

P Berlit

Publications and source records attributed to P Berlit.

At least 19 recordsLinked to original sources
PubMed2000

Valsalva-induced syncope during apnea diving.

A young man had two dangerous episodes of transient loss of consciousness during apnea diving in a swimming pool. Medical and neurologic examination results were normal. Standard autonomic test results (including heart rate variability, baroreflex sensitivity, tilt-table test, and Valsalva ratio) were unremarkable, with the exception of an increased blood pressure decrease during early phase II of the Valsalva maneuver. Syncope with arrhythmic myoclonic jerks could be evoked by a strong straining maneuver. Simultaneous physiologic recordings showed extreme blood pressure and cerebral blood flow velocity decreases and electroencephalographic slowing during syncope. The electrocardiogram showed a continuous sinus rhythm with a progressive tachycardia. The authors' findings were not compatible with baroreflex failure or vasovagal mechanisms (Bezold-Jarisch reflex activation) as the underlying causes. The authors concluded that mechanical factors (strong reduction of blood reflux to the heart) in combination with a reduced threshold of the brain for developing ischemia-related arrhythmic myoclonic jerks were responsible for Valsalva-induced syncope in the patient.

Adult↗
PubMed2000

[Stroke. Options for primary prevention].

Age, gender, race, and genetic factors count among the nonmodifiable risk factors for stroke. But primary prevention is possible through modification of other vascular risk factors. The treatment of arterial hypertension, with optimal values around 135/85 mmHg, reduces the risk of stroke by 50%. A significant risk reduction for ischemic stroke is possible with at least 30 minutes of physical activity twice a week, cessation of cigarette smoking, and treatment of hypercholesterolemia with statins. Dietary measures should include a reduction of animal proteins, normalization of body weight and a large amount of fruit and vegetables; small amounts of wine are allowed. A hyperhomocystinemia is treated with folic acid. Low dose estrogens (< 50 micrograms) do not increase the risk of ischemic stroke in young females, but are capable of reducing hypercholesterolemia in postmenopausal women if triglycerides are normal. Neither primary prevention of stroke with antiagreggants nor surgery for asymptomatic carotid artery stenoses is recommended as preventive treatment, but low dose anticoagulation is the prophylaxis of choice for atrial fibrillation.

Alcohol Drinking↗
PubMed2000

Significantly increased prevalence of factor V Leiden in patients with dural arteriovenous fistulas.

Resistance to activated protein C (APCR) is the most common genetic risk factor for venous thrombosis and is generally caused by a mutation in the factor V (FV) gene leading to FV Leiden. The recent finding of FV Leiden in three of seven patients with dural arteriovenous fistulas (DAVFs) prompted us to evaluate systematically the role of APCR due to FV Leiden in the pathogenesis of DAVFs in 22 patients and age- and sex-matched controls. We found a significantly higher frequency of APCR and FV Leiden in the patient group than among controls (5/22 vs. 0/22, P=0.048, Fisher's exact test). We conclude that APCR due to FV Leiden is of pathogenetic significance in a subgroup of DAVFs.

Activated Protein C Resistance↗
PubMed1999

Pseudo Chiari type I malformation secondary to cerebrospinal fluid leakage.

Cerebrospinal fluid (CSF) leakage may occur spontaneously, iatrogenically or from spinal trauma. Postural headache is the cardinal symptom; dizziness, diminished hearing, nausea and vomiting are additional symptoms. In neurological examinations cranial nerve palsies may be found. Due to low CSF pressure neuroimaging studies may reveal dural enhancement and vertical displacement of the brain. We describe a patient with the history of an uncomplicated lumbar discectomy at the level L4-5 and the typical clinical symptoms of intracranial hypotension. MRI of the craniocervical junction showed typical features of a Chiari type-I malformation. After neurosurgical ligation of a CSF leak at L4-5 caused by lumbar disc surgery, the patient was free of orthostatic headache. A repeated MRI showed a striking reduction of the previous downward displacement of the cerebellar tonsils and pons.

Adult↗
PubMed1999

Hashimoto's encephalitis as a differential diagnosis of Creutzfeldt-Jakob disease.

OBJECTIVES: During an epidemiological study of Creutzfeldt-Jakob disease in Germany, Hashimoto's encephalitis was encountered as a differential diagnosis, which has not yet been described in this context. METHODS: The symptoms and findings of seven patients who fulfilled the criteria for "possible" Creutzfeldt-Jakob disease are presented. RESULTS: A Hashimoto's thyroiditis with antibodies against thyroglobulin or thyroid peroxidase, or both and a hypoechoic thyroid ultrasonogram were found in all cases. Analysis of CSF disclosed an increased leucocyte count in three patients, and a raised CSF:serum concentration ratio of albumin (QA1b) in four patients. The 14-3-3 protein, typical of Creutzfeldt-Jakob disease, could not be detected in any of our patients. No periodic sharp wave complexes, which are typical of Creutzfeldt-Jakob disease, were detected on EEG in any of the cases. By contrast with Creutzfeldt-Jakob disease, which leads to death within a few months, the patients with Hashimoto's encephalitis often recover quickly when treated adequately. All the patients improved after administration of corticosteroids. CONCLUSION: The clinical symptomatology of both diseases may be very similar: dementia, myoclonus, ataxia, and personality change or psychotic phenomena are characteristic symptoms.

Adult↗
PubMed1998

Spontaneous blood pressure oscillations and cerebral autoregulation.

The relationship between spontaneous oscillations in cerebral blood flow velocity (CBFV) and arterial blood pressure (ABP) was analysed in normal subjects in order to evaluate whether these relationships provide information about cerebral autoregulation. CBFV was measured using transcranial Doppler sonography and continuous ABP and heart rate using Finapres in 50 volunteers. Measurements were made over 5 min in a supine position and 6 min in a tilted position. Coefficients of variation were calculated using power- and cross-spectral analysis in order to quantify amplitudes within two frequency ranges: 3-9 cycles per min (cpm) (M-waves); and 9-20 cpm (R-waves). Correlations, coherence values, phase angle shifts and gains were also computed between corresponding waves in CBFV and in ABP. A clear correlation was seen for M-waves and R-waves between CBFV and ABP and coherence values were large enough to calculate phase angle shifts and gains. Phase angles for M-waves were larger and gains lower than was the case for R-waves, either tilted or supine. These data are consistent with a highpass filter model of cerebral autoregulation. Relatively high CBFV/ABP gain values (between 1.4 and 2.0) suggest that the principle of frequency-dependent vascular input impedances has to be considered in addition to autoregulatory feedback mechanisms. Spontaneous ABP oscillations in the M-wave and R-wave ranges may serve as a basis for continuous autoregulation monitoring.

Adult↗
PubMed1998

[Isolated vertigo in vertebrobasilar ischemia--does it exist?].

An isolated vertigo may occur in vertebrobasilar ischemia, especially as the first symptom of cerebellar ischemia or basilar artery occlusive disease. Based on neuroanatomical findings, these short-lasting vertigo attacks result from transient insufficiency of the anterior inferior cerebellar artery (AICA), which supplies the inner ear and leads to ischemia of the upper parts of the vestibular labyrinth. Persisting vertigo with or without lateropulsion may occur in cerebellar infarctions with involvement of the medial inferior hemispheres due to occlusion of the medial branch of the posterior inferior cerebellar artery. Caloric testing with oculography can usually differentiate cerebellar infarction and peripheral vestibular disease. Since ischemic lesions with AICA insufficiency may cause pathological results in caloric testing, both clinical and neurophysiological analysis of associated oculomotor signs is essential for a correct diagnosis.

Cerebellum↗
PubMed1998

[Clinical application of transcranial color-coded duplex ultrasound for detection of intracranial aneurysms].

We investigated 88 Patients with a total of 102 angiographically diagnosed intracranial aneurysms by means of transcranial colour coded Duplex sonography (TCCD) during a time period of 15 months. Both the size and the localization of the aneurysms were determined. Seventy aneurysms (77%) with a diameter of 16 +/- 8 mm (6-55 mm) were detectable, with excellent visualization in 36 (42%), moderate visualization in 34 (40%), and no sufficient visualization in 16 (16%) aneurysms, respectively. In another 16 cases (16%) there was no sufficient vone window. Thrombotic material inside the aneurysm was detectable in 16/20 cases (75%), visualization of coil embolized aneurysms in 12/25 patients (48%). TCCD allows the follow up of cerebral aneurysms, with the detection of thrombosis and treatment effects after embolization. The method is not valid for the detection of intracranial aneurysms.

Adolescent↗
PubMed1998

Association of resistance to activated protein C and dural arteriovenous fistulas.

Resistance to activated protein C (APCR), shown to be the most common genetic risk factor for venous thrombosis, is mostly caused by a mutation in the factor V (FV) gene leading to FV Leiden. As dural arteriovenous fistulas (DAVFs) are associated with cerebral venous thrombosis, we looked for the FV Leiden mutation in seven patients with such fistulas. The APCR ratio was determined according to standard procedures. For APCR ratios considered pathological (less than 2.0), mutation analysis was done by a reverse hybridization assay. Three of the seven patients with DAVFs showed pathological APCR ratios and heterozygosity for FV Leiden mutation. Thus, it is hypothesized that FV Leiden might be involved in the pathogenesis of DAVFs.

Activated Protein C Resistance↗
PubMed1998

Multiple sclerosis presenting with a Brown-Séquard syndrome.

The Brown-Séquard syndrome as spinal hemiplegia with contralateral sensory deficits has been related to a variety of underlying diseases. We describe the case of a 35-year-old right-handed white female presenting with a Brown-Séquard syndrome as the first and sole symptom of multiple sclerosis, underscoring the importance of multiple sclerosis as a rare condition for the Brown-Séquard syndrome.

Adult↗
PubMed1998

A new 1-MHz probe for transcranial Doppler sonography in patients with inadequate temporal bone windows.

Recent large-scale transcranial Doppler sonography (TCD) studies have revealed that, in 3%-5% of patients, the temporal bone window is insufficient for examination with 2-MHz probes. The diagnostic value of a new 1-MHz probe for TCD was compared with a standard 2-MHz probe in patients with an insufficient ultrasonic window. From a total population of 514 consecutive patients, the study involved only patients in whom a bad or absent temporal bone window was revealed during 2-MHz TCD examination. Fifty patients (39 women and 11 men) with a mean age of 71 +/- 9 y were investigated with a 2-MHz probe and subsequently with a 1-MHz probe. Using the 2-MHz probe, 18 patients (group I) lacked a temporal insonation window bilaterally, while 12 had an absent bone window unilaterally (group II). Twenty patients (group III) had bilateral bone windows, but with insufficient detection of the anterior and posterior cerebral arteries. In four of the 18 patients in group I (22%), the circle of Willis could be demonstrated with the 1-MHz probe. In 11 of the 12 patients in group II (92%), it was possible to demonstrate the contralateral vessels through the ipsilateral bone window with the 1-MHz probe, while this was only possible in 25% with the 2-MHz probe. All 20 patients of group III could be successfully examined with the 1-MHz probe. The 1-MHz probe provides an opportunity to perform TCD studies in older patients presenting with absent or insufficient temporal bone windows for examination with 2-MHz probes.

Aged↗
PubMed1998

Reduced baroreflex sensitivity and cardiorespiratory transfer in amyotrophic lateral sclerosis.

INTRODUCTION: Clinically relevant autonomic disturbances have been reported for respirator-dependent ALS patients while subclinical involvement may be present in the early course. METHODS: Eighteen patients with early-stage ALS and 18 age-matched controls were studied by means of standard autonomic tests (heart off + response to deep breathing and tilt-table testing), and spectral analysis of heart rate (HR) and arterial blood pressure (ABP), using the associated transfer function as a measure of baroreflex sensitivity for the mid-frequency band (MF band, 0.05-0.15 Hz) and as a measure of cardiorespiratory transfer for the high-frequency band (HF band, 0.15-0.33 Hz). RESULTS: Mean HR and ABP were increased in ALS, while results of standard autonomic tests were similar for ALS and controls. Transfer function analysis revealed reduced baroreflex sensitivity and diminished cardiorespiratory transfer during normal breathing. CONCLUSIONS: Cardiovascular autonomic functions are intact in patients with ALS. There is evidence of sympathetic enhancement and vagal withdrawal, accompanied by reduced baroreflex sensitivity. These findings are similar to those reported for essential hypertension and may point to a common central autonomic derangement in both disorders.

Aged↗
PubMed1998

Cerebral embolism and epileptic seizures--the role of the embolic source.

OBJECTIVES: To study the clinical outcome of patients with epileptic seizures due to ischemic stroke (IS) of cardiac or artery-to-artery embolism. METHODS: Seizures due to IS of cardiac or artery-to-artery embolism are differentiated by clinical, neuroimaging and cardiovascular test data. RESULTS: From 174 cases with supratentorial IS, 13 patients suffered from epileptic seizures due to cardiac embolism, 11 patients due to artery-to-artery embolism. The patients with cardiac IS showed an equal sex distribution and EEG abnormalities in 6 patients, the initial seizure occurred on average after 222 days (SD, +/-69 days). Among the 11 patients with artery-to-artery embolic IS, there were 9 males and 2 females and EEG abnormalities in 10 patients. The initial seizure occurred on average after 447 days (SD, +/-177 days). CONCLUSION: In seizures due to artery-to-artery embolism, there is a male preponderance and a higher incidence of EEG abnormalities, symptomatic seizures appear later compared to IS due to cardiac embolism.

Adult↗