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P Wessely

Publications and source records attributed to P Wessely.

At least 19 recordsLinked to original sources
PubMed1992

Tension headache and the cervical spine--plain X-ray findings.

The aim of the present study was to investigate if there is any causal connection between plain X-ray findings of the cervical spine and tension headache. We evaluated the X-rays of the cervical spine of 243 patients, in 91 of which the diagnosis was "tension headache", in 102 "headache not fulfilling the criteria of tension headache" and in 50 "spondylogenic complaints without headache". We compared these three groups with regard to frequency and severity of radiologically assessable changes of the cervical spine and found that patients with tension headache had normal findings significantly more often and significantly less often functional or organic changes or both than patients of the other two groups. The radiologically assessable changes of the cervical spine are unlikely to have an essential role in the cause or mechanism of tension headache.

Adult↗
PubMed1992

Speech arrest as first symptom of a tumour in the supplementary motor area.

There are only few reports in the literature on isolated episodes of speech arrest as first symptom of a tumour in the supplementary motor area. These episodes of speech arrest are due to seizure activity and must be distinguished from speech arrest due to transient ischaemic attacks. The diagnosis may be difficult because the tumour may erroneously be suspected in the lower portion of the sensorimotor strip and may, hence, be missed on CT if apical sections of the regions are not performed. Clinical and experimental aspects of this problem are discussed on the basis of a case report and a review of the literature.

Aged↗
PubMed1991

Long-term results of migraine prophylaxis with flunarizine and beta-blockers.

We followed-up 64 migraine patients after discontinuation of successful interval prophylaxis with flunarizine, propranolol or metoprolol, to investigate how long the therapeutic success would last, if further prophylaxis would be successful again, and what factors would influence the prognosis. We found that 16 out of 64 patients experienced a lasting reduction of migraine frequency, whereas 48 patients did improve initially, but later experienced a relapse. Further prophylaxis was effective in 29, poorly effective in 11, and ineffective in 8 of these patients; in 7 of the 8 non-responders prophylaxis was not changed. Negative prognostic factors were frequent attacks, a history of analgesic abuse and/or analgesic withdrawal therapy and ineffective previous prophylaxis. In conclusion, the therapeutic success decreases dramatically in the majority of patients several months after discontinuation of prophylaxis; further prophylaxis is more effective if the substance class is changed; increased analgesic intake is the most important prognostic factor. As a strategy for migraine prophylaxis we propose sequential changing of interval prophylaxis or--in patients with negative prognostic factors--long-term prophylaxis.

Adult↗
PubMed1991

Thalamic ischemia in transient global amnesia: a SPECT study.

We performed 99mTc-HMPAO SPECT in a patient during transient global amnesia and twice thereafter. SPECT during the attack showed a significant diminution of regional blood flow in the left thalamus and a less marked diminution in the right thalamus. Quantitative evaluation of global 99mTc-HMPAO uptake indicated a diffuse depression of cerebral blood flow. At follow-up to 40 days after the attack, global uptake and thalamic flow indices normalized, but there was a persistent reduction of left frontal flow values.

Amnesia↗
PubMed1991

Subarachnoid hemorrhage of unknown etiology: early prognostic factors for long-term functional capacity.

Forty-one patients suffering subarachnoid hemorrhage (SAH) of unknown etiology were re-investigated at an average of 91 months after the bleed to determine functional capacity. Nineteen patients were performing at their previous level of work, five were employed part-time, and four could not work due to the SAH. Five patients showed a moderate disability in activities of daily living but were not dependent on help, one patient was severely disabled, and two had died. There was one rebleed. Early prognosis of an unfavorable outcome was possible on the basis of three clinical variables on admission: a history of hypertension, a Hunt and Hess grade of greater than II, and the presence of focal neurological deficits. In addition, the presence of an organic mental syndrome at discharge was identified as a predictive factor for reduced functional capacity later on. Other clinical variables in the acute stage, including sex, age, history of headache, interval between SAH and admission, impaired consciousness, and cognitive deficits, were not related to a limited functional level. Residual neurological deficits and the Glasgow Outcome Scale score on discharge were also not predictive of restrictions in global functions evaluated by means of the Karnofsky Performance Scale status at follow-up review.

Activities of Daily Living↗
PubMed1990

[24-hour blood pressure determination in Shy-Drager syndrome. A case report].

The case history is presented of a 57 year-old male patient suffering from the Shy-Drager syndrome. This syndrome was first described by G. M. Shy and G. A. Drager in 1960. The clinical manifestations are extrapyramidal, with Parkinsonian features, combined with severe orthostatic hypotension and failure of the autonomic nervous system. Apart from the standard clinical investigations in this condition, namely the orthostasis test and polygraphic recording of the EEG, ECG, breathing and blood pressure on the tilting table, additional non-invasive long-term determination of the blood pressure was carried out. This method allows simultaneous measurement of blood pressure and heart rate without appreciably interfering with the patient's daily activities.

Autonomic Nervous System↗
PubMed1990

[The significance of EMG artefacts in isoelectric EEG].

Five potential organ donors showed muscle artefacts during isoelectrical EEG recording. The electromyographic examination revealed MUAP activity occurring as doublets, triplets and quadruplets. All patients had normal blood chemistry except reduced CO2 and increased O2 partial pressures. We assume that the recorded "tetaniform" muscle activity is due to hyperexcitability of the nerve membrane caused by artificial hyperventilation.

Adult↗
PubMed1989

Longterm prognosis of analgesic withdrawal in patients with drug-induced headaches.

We studied long-term prognosis and prognostic variables for therapeutic outcome of analgesic withdrawal in 54 patients with drug-induced headaches. The duration of headache history was 21.9 +/- 12.8 years. Each patient took an average of 38.8 +/- 22.8 tablets or suppositories a week and an average of 2.5 distinct drugs. Most patients used drugs containing several components. Caffeine was contained in at least one drug in all cases, ergotamine in 80.0% and pyrazolone in 77.1%. All patients were admitted to the hospital for two weeks. The analgesics were discontinued abruptly and the withdrawal symptoms were alleviated by neuroleptics and neurotropics. During the second week of hospital stay we started a basic therapy with calcium antagonists or beta blockers in patients suffering from migraine initially and with tricyclic antidepressants, physical therapy or biofeedback in patients suffering from tension type headaches initially. At the end of the study (mean follow-up period = 16.8 +/- 13.6 months) 38 patients (70.1%) were evaluated. 76.3% of these patients had significantly reduced their analgesic intake, 60.5% had experienced a significant relief of headache both in intensity and frequency, and 23.7% were therapeutic failures. Analysis of the time course of relapse revealed the first six months after hospital discharge as the critical period determining long-term success. The variables tested for prognostic relevance (age, sex, duration of headache history, number of tablets or suppositories taken a week, organic mental syndrome, and type of initial headaches) were not statistically significant.

Adult↗
PubMed1979

The value of CT and EEG in cases of posttraumatic epilepsy.

The results of the clinical neurological investigation were compared with those of electroencephalography (EEG) and computed tomography (CT) in 64 patients suffering from verified posttraumatic epilepsy. Only 18 patients (28%) showed central neurological features with corresponding focal disorders on CT (15 cases) and EEG (11 cases). The combined application of both methods led to positive results in 94% on the part of at least one accessory examination. The clinical neurological investigation as well as the EEG and CT were normal in only 3 cases, although the traumatic etiology of epilepsy was beyond doubt. In addition to the clinical neurological investigation, EEG and CT are most important accessory examinations for the diagnosis and followup studies in cases of posttraumatic epilepsy.

Adolescent↗
PubMed1979

Electroneurographic investigations of misonidazole polyneuropathy.

13 patients with malignant tumors were treated by the radiosensitizer misonidazole (Ro 07-0582), total dosage 20-29 g. The electrophysiological investigations showed (1) an early increase of distal latency, the motor nerve conduction velocity (NCV) of the peroneal nerve and the NCV of the sural nerve remaining normal or only signlty reduced, and in a few cases a marked reduction of the compound action potential or of the nerve action potential (NAP), indicating a primary axonal neuropathy; (2) greater changes in the parameters of sensory nerves (n. suralis) than of motor nerves; (3) the distal latency is a good indicator of subclinical neuropathies; (4) the electrophysiological parameters showed a normalization 6 months after the end of therapy. The mechanisms possibly responsible for the misonidazole neuropathy are discussed.

Action Potentials↗
PubMed1979

The significance of combined risk factors for the incidence of posttraumatic early fits and epilepsy.

After a brief outline of autonomic incidence of posttraumatic early fits as compared to "real" posttraumatic epilepsy, such traumatologic and neurologic factors are compared that lead much more frequently to early fits. Furthermore, the conditions of early fits and their relation to the occurrence of chronic posttraumatic epilepsy are investigated. Statistically and prognostically reliable data are only found when combined groups of high risk factors of different valence rather than individual data are considered. Such a statistically proved combination is the connection of intracranial hematomas, posttraumatic amnesia of more than 3 hours, neurologic dysfunctions and a persisting organic psychosyndrome.

Adult↗
PubMed1978

[Recurrence of pseudotumour cerebri (intracranial hypertension) after renal transplantation (author's transl)].

The case report is presented of a 24-year-old male who developed the clinical signs and syptoms of pseudotumour cerebri (intracranial hypertension) twice during the course of protracted rejection 1 and 4 months after renal transplantation. Clinically, headache, nausea, hypertensive crisis and, finally, severe coma with an acute mid-brain syndrome was observed. Neurologically a mild left-sided hemiparesis was found on the second occasion. Examination of the fundi revealed bilateral papilloedema. Electroencephalograms showed pathological changes of a diffuse nature, later followed by abnormal delta range activity in the right frontotemporal projection. The withdrawal of corticosteroid therapy may have been responsible for the pseudotumour cerebri in this case.

Adult↗