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Biomedical subjects

R Biniek

Publications and source records attributed to R Biniek.

At least 19 recordsLinked to original sources
PubMed2005

[Dysphagia. Are swallowing sounds diagnostically useful?].

The origin and importance of swallowing sounds in dysphagia have been discussed in previous research. Those studies report a general similarity in the sound patterns of different swallowing actions. The current paper confirms this. In addition, the origin of swallowing sound patterns is examined more closely. Finally, we simultaneously analyzed the swallowing sounds of healthy voluntary subjects and patients with swallowing disorders using X-ray cinematography. Videoendoscopy was also done. As expected, we found a variety of sound sequences differing from those of healthy subjects. Patients with tracheal tubes or cannulae constitute a special group whose swallowing sounds give additional information about the act of swallowing.

Auscultation↗
PubMed2004

A new anti-neuronal antibody in a case of paraneoplastic limbic encephalitis associated with breast cancer.

Paraneoplastic neurological syndromes are rare remote effects of different types of cancer. Paraneoplastic limbic encephalitis is a specific syndrome, most often associated with small cell lung carcinoma. This report describes the case of a pure limbic encephalitis in association with breast cancer. An anti-neuronal antibody was found in the serum and CSF of the patient which has not been reported so far.

Antibodies↗
PubMed2000

Neurologic complications in immune-mediated heparin-induced thrombocytopenia.

OBJECTIVE: To evaluate neurologic complications in patients with immune-mediated heparin-induced thrombocytopenia (HIT) with respect to incidence, clinical characteristics, outcome, and therapy. METHODS: One hundred and twenty consecutive patients with immune-mediated HIT were recruited over a period of 11 years and studied retrospectively for the occurrence of neurologic complications. Diagnosis of HIT was based on established clinical criteria and confirmed by detection of heparin-induced antibodies using functional and immunologic tests. RESULTS: Eleven of the 120 patients (9.2%) presented with neurologic complications; 7 suffered from ischemic cerebrovascular events, 3 from cerebral venous thrombosis, and 1 had a transient confusional state during high-dose heparin administration. Primary intracerebral hemorrhage was not observed. The relative mortality was much higher (Chi-square test, p < 0.01) in HIT patients with neurologic complications (55%) as compared to patients without neurologic complications (11%). The mean platelet count nadir in neurologic patients was 38 +/- 25 x 10(9)/l on average, and was lower in patients with fatal outcome compared to those who survived (21 +/- 13 x 10(9)/l versus 58 +/- 21 x 10(9)/l; p < 0.05, Wilcoxon test). In three patients neurologic complications preceded thrombocytopenia. There was a high coincidence of HIT-associated neurologic complications with other HIT-associated arterial or venous thrombotic manifestations. CONCLUSION: Neurologic complications in HIT are relatively rare, but associated with a high comorbidity and mortality. HIT-associated neurologic complications include cerebrovascular ischemia and cerebral venous thrombosis. They may occur at a normal platelet count.

Adult↗
PubMed1999

[Cocaine-induced acute CNS diseases].

Drug-associated/-induced neurological complications are well known in the literature. Cocaine is of major interest due to its widespread use. On the basis of a case report, we discuss the broad spectrum of medical and, in particular, neurological complications. The risk of cerebrovascular damage and epileptic seizures is indicated. The pathophysiological mechanisms of cerebrovascular complications are not well understood.

Brain Damage, Chronic↗
PubMed1998

[Subacute encephalopathy with epileptic seizures in a patient with chronic alcoholism (SESA syndrome)].

Subacute encephalopathy with seizures in alcoholics (SESA syndrome) is a rare disease entity following chronic alcohol ingestion. It is quite distinct from alcohol withdrawal syndromes, such as delirium, withdrawal seizures or CNS complications of alcohol, such as Wernicke-Korsakow syndrome, central pontine myelinolysis or Marchiafava-Bignami disease, and was proposed in 1981 by Niedermeyer and coworkers. This syndrome consists of multiple neurological deficits, such as hemiparesis or hemianopia, and of recurrent focal and generalized seizures associated with prominent EEG features (periodic lateralized discharges, PLEDs). A 72-year-old Caucasian male with chronic alcoholism and an otherwise unremarkable past medical history was admitted to our hospital because of several secondary generalized simple partial seizures. Laboratory investigations revealed elevated levels of gamma-glutamyltranspeptidase and of mean corpuscular volume. Other laboratory investigations and the CSF examinations on three occasions revealed normal values. Cranial computed and magnetic resonance tomography showed cerebral microangiopathy and generalized atrophy. Despite triple anticonvulsive therapy and an intravenous treatment with acyclovir and thiamine, the epileptic seizures persisted. Several EEGs revealed left parietooccipital periodic lateralized epileptiform discharges (PLEDs). The patient died of an intercurrent pulmonary infection about 3 months after the onset of symptoms. The described clinical picture resembles the symptoms of SESA syndrome.

Aged↗
PubMed1997

[Coma-associated neuropathy].

To evaluate signs of peripheral nerve dysfunction, over a period of 31 months all patients treated for more than 14 days in our intensive care unit (ICU) had clinical and electrophysiological examination. The results of 78 patients were analysed: 53 had diseases of the central nervous system, 25 suffered from general cerebral hypoxia, mainly after cardiopulmonary reanimation. 54 showed bilateral signs of denervation activity, additionally 10 patients had fibrillation potentials unilateral to their spastic hemiparesis. 19 patients had denervation potentials only in proximal muscles of the upper limbs. Generalized denervation activity developed mainly after septic organ failure. On the other hand 35 patients showed denervation potentials already between day 14 and 21, suggesting an affection of peripheral nerve function in the first week of ICU treatment. Time course, pattern of distribution and frequency of electrophysiological abnormalities are not generally consistent with alterations of nutrition, metabolism or hypoxia in the course of ICU treatment. Clinical signs of peripheral nerve dysfunction were present in 40% of the patients showing denervation in the EMG.

Adolescent↗
PubMed1997

[Megadolicho basilar artery as indication of intensive care relevant vertebrobasilar ischemia].

An ectasia and enlargement of the basilar artery by a fusiform aneurysm is called megadolicho basilaris. We report five cases with this condition identified at our clinic since 1989, reflecting an incidence of 0.05 percent (5/9300 scans). All patients presented with an acute brainstem syndrome (medullary in 2, pontine in 1 and pontomedullary in 2 patient). With one exception, all cases required intensive care due to respiratory insufficiency. Two patients died, one required total care, and two patients made a good recovery, one of these under therapeutic anticoagulation. All but one patient experienced additional episodes of cerebrovascular ischemia before or after presentation. Vascular risk factors were found in four patients. The detection of a megadolicho basilaris identifies a patient subgroup that is highly prone to vertebrobasilar ischemia and therefore of high significance for neurological intensive care medicine. Recurrence rate for ischemia is high. While even a severe brainstem syndrome may be reversed under anticoagulation in the individual case, presence of multiple vascular risk factors often prevents the employment of this treatment modality.

Aged↗
PubMed1996

[Examination of the unconscious patient].

The unconscious patient presents an challenging emergency in the intensive care unit. Patient evaluation and treatment must occur simultaneously. After checking vital signs, deciding about cardiopulmonary resuscitation or intubation, an intravenous line must be established, blood samples collected and glucose and thiamine should be given. The physical and neurological examination should be performed in a efficient way and must consider the following eight points: best reaction to loud commands, best motor reaction to noxious stimuli, respiratory pattern, size and reactions of pupils, eye movements, corneal and blink reflex, meningismus, muscle tone and deep tendon reflexes. With this approach it is possible to formulate a working diagnosis, and the appropriate diagnostic steps can be performed.

Coma↗
PubMed1995

An unusual case of central nervous system cryptococcosis.

Opportunistic infections of the central nervous system (CNS) in immunocompromised patients often represent a diagnostic and therapeutic challenge due to the variety of possible infectious agents causing CNS disease. We report the case of a severely immunocompromised 43-year-old woman presenting with headache, confusion, abnormal CSF findings (cell count 237/mm3 with 50% eosinophils and elevated protein), multiple contrast enhancing lesions on CT and MRI in the basal ganglia, and serologic findings compatible with latent or reactivated toxoplasmosis with high IgA and IgG antibody titers against Toxoplasma gondii in whom a final diagnosis of CNS cryptococcosis was made. This case illustrates the considerable difficulties in the differential diagnosis of opportunistic CNS infection in the immunocompromised host. We conclude from our report that (1) the diagnosis of toxoplasma encephalitis should not be based on serological findings but rather be proven by either PCR, mouse inoculation or brain biopsy, (2) CNS cryptococcosis can be associated with marked CSF eosinophilia and multiple cryptococcomas, and (3) cryptococcomas can persist on CT and MRI despite successful antifungal treatment.

Adult↗
PubMed1994

Adult Toxocara canis encephalitis.

A 48-year-old patient with Toxocara canis infection developed severe ataxia, rigor and neuropsychological disturbances. An aetiology was proven by an indirect immunofluorescence test. CT and MRI revealed both diffuse and circumscribed white matter lesions. Angiography showed multiple occlusion of branches of the middle cerebral artery. Anthelminthic treatment was beneficial in the initial stage of the disease, but had no effect on progression of CNS symptoms. Immunosuppressive therapy with prednisolone and azathioprine yielded partial recovery and stabilisation of the patient.

Animals↗
PubMed1994

[Home ventilation in neurologic diseases. Survey of 62 patients].

Home ventilation has developed as a sufficient and safe method in many neurological diseases afflicting respiratory functions. To achieve an overview of the situation of these patients in Germany, a questionnaire was distributed by the manufacturer of the most commonly used ventilator in Germany. The patients were asked to send the form back, even anonymous, to the Department of Neurology, RWTH Aachen. 65 of 110 questionnaires were answered, most of patients with muscle dystrophy's (n = 14), Polio (n = 14) and spinal cord injuries (n = 11). Home ventilation in ALS was performed in 3 cases only. The majority of patients (n = 30) was aged between 20 and 49 years, but here were also 5 children younger than 10 years. Most patients were ventilated not more than 4 years, but there were also 5 patients ventilated for over 20 years, all of them Polio-patients. 70% of all lived at home with their relatives, who take care for them. Nevertheless, 13 were full- or part-time working.

Activities of Daily Living↗
PubMed1992

Non-traumatic subarachnoid hemorrhage with normal angiogram. Long-term follow-up and CT predictors of complications.

We investigated 91 patients with non-traumatic subarachnoid hemorrhage (SAH) in whom no aneurysm was found on initial angiography. In 31 of these patients CT did not show subarachnoid blood. A typical feature was a localized blood clot in the prepontine or interpeduncular cistern. Follow-up was obtained 6 months to 11.8 years after SAH by personal re-examination (n = 49) or questionnaire sent to patients or their doctors. 79 patients were free of neurological signs, 3 had a mild and one a severe neurological deficit. Five patients had died from SAH. Those patients who died or had complications often had blood in the frontal basal interhemispheric fissure. None of the 3 therapeutic regimens applied proved to be superior. We conclude that prognosis is good, but an unidentified aneurysm must be considered and repeat angiogram is warranted if blood is found in the anterior part of the basal cisterns. When the hemorrhage is in the prepontine cistern, repeat angiogram is not necessary.

Adult↗
PubMed1992

Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalization.

We evaluated the influence of time of recanalization or degree of initial leptomeningeal collateral blood flow in cardioembolic or arterio-arterial middle cerebral artery (MCA) occlusion on infarct size and clinical outcome in a series of 34 consecutive acute stroke patients with main stem (N = 31) or major branch (N = 3) occlusions using CT, initial cerebral arteriography (N = 21), repetitive close-meshed transcranial Doppler ultrasonography, and a neurologic stroke scale. We treated 15 patients with tissue plasminogen activator intravenously within the first 6 hours. The type and size of infarction depended on the location of the occluding lesions within the MCA trunk. Proximal MCA occlusion always led to infarction involving the striatum and internal capsule. Sixty-five percent of patients showed recanalization of the occluded MCA within 1 week. Following MCA recanalization, hyperperfusion was present in 38 to 44% of cases. There was a marginally significant relation between size of infarction on CT and recanalization time within the first 24 hours. The more rapidly recanalization occurred, the smaller the size of the infarct. When recanalization time was greater than 8 hours, the lesions always extended to the cortex. An additional good leptomeningeal collateral blood flow significantly reduced the size of the infarct and improved clinical outcome after 17 days and after 10 months. Early recanalization of embolic MCA occlusions within up to 8 hours, in conjunction with good transcortical collateralization, has a favorable impact on infarct size and outcome and may constitute the therapeutic window of opportunity.

Aged↗
PubMed1992

[The Aachen Aphasia Bedside Test--criteria for validity of psychologic tests].

The Aachen Aphasia Bedside Test (AABT) has been developed in order to examine aphasic patients within the first 4 to 6 weeks after onset of illness. The psychometric properties of the AABT were established by repeated examination of 82 acute stroke patients, ratings by 20 raters on the basis of 10 videotapes, repeated examination of 28 chronic aphasics three times with an interval of 2 days, and parallel examination of 47 chronic aphasic patients with the AABT and the Aachen Aphasia Test (AAT), administered on the same day. Objectivity, reliability and validity of the AABT were highly rated, indicating its usefulness in acute stroke cases. Data on the 82 acute stroke patients showed that an initial prognosis can be made as early as the fourth day after the stroke.

Adult↗
PubMed1992

High frequency vibration induced gating of subcortical and cortical median nerve somatosensory evoked potentials: different effects on the cervical N13 and on the P13 and P14 far-field SEP components.

Subcortical and cortical somatosensory evoked potentials (SEP) to median nerve stimulation were recorded before, during and after high frequency (270 Hz) vibration of the fingers 1-3 in 8 healthy subjects. A marked decrease of the amplitude of all potentials was observed. The attenuation of the sensory nerve action potential (SNAP) of the median nerve and the attenuation of SEP components N9, N11 and N13 showed no differences, while the attenuation of the subcortical P14 component was significantly higher. This is in accordance with a generator of the cervical N13 in the interneurons beside the lemniscal pathway. The cortical N20 (post-rolandic) was significantly more decreased in amplitude than P14 while P22 (pre-rolandic) remained reduced in amplitude like P14. An increased latency of the far-field subcortical P14 was observed, while P13 recorded in the same montage remained unchanged in latency. These findings suggest different generators of these peaks. A generator of P14 above the nucleus cuneatus is confirmed. A presynaptic generator of P13 is suspected.

Action Potentials↗