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Biomedical subjects

R Hagenah

Publications and source records attributed to R Hagenah.

At least 19 recordsLinked to original sources
PubMed1996

Morphometric investigations of the connections between the posterior C-1 root and the accessory nerve in the human cranial cervical region.

The anastomosis of the spinal section of the accessory nerve and the posterior C-1 root was examined in eight human corpses at the light-microscopical level by image analysis. The numbers of nerve fibers caudal and cranial to the anastomosis were compared. The morphometric data suggest that somatic efferent fibers of the spinal accessory nerve extend to proprioceptors in the sternocleido-mastoideus and trapezius muscles.

Accessory Nerve↗
PubMed1995

[Nuclear magnetic resonance tomography in multiple sclerosis. Comparison of spinal and cerebral findings].

Out of a total number of 49 patients with clinically defined multiple sclerosis 46 were examined by cerebral and 44 by spinal MRI. Fifteen out of 44 patients with a sensory level as a symptom of spinal cord lesion on neurological examination had corresponding lesions in the spinal MRI. Morphological lesions were revealed by MRI in three patients without spinal symptoms. There were two patients without any spinal signs at clinical examination who had no spinal lesions in MRI. In this study the sensitivity of detecting multiple lesions by MRI was high with 98% in the brain and 82% in the spinal cord. The number of cerebral and spinal MRI lesions was compared. It is concluded that there is a correlation between the extent of cerebral and spinal lesions in MRI and the clinical status described by the Kurtzke disability status scale.

Adolescent↗
PubMed1993

[Myasthenia gravis in AIDS and neurosyphilis].

The co-occurrence of myasthenia gravis and AIDS in a 38 year old drug addict with HIV-infection is reported. The diagnosis "myasthenia gravis" is based on clinical features with muscle weakness worsening with exercise and depending on the time of day, and secondly on the result of electrophysiological tests, with a typical decrement in repetitive nerve conduction study, and on the presence of antibodies to acetylcholine receptors. A co-existing neurosyphilis was treated intravenously with penicillin G, resulting in good improvement of the associated myopathy. The remaining muscle weakness responded well to treatment with pyridostigmine bromide started after the end of the antibiotic therapy. A tumor in the anterior mediastinum measuring 3 by 2 cm was diagnosed by CT scan and removed, histology showed normal thymus tissue. After operation the patient became asymptomatic on treatment with low dosage pyridostigmine (3 x 30 mg). The association of myasthenia gravis with AIDS may derive from an alteration of the immune system based on changes in the thymus gland. Differential diagnosis in AIDS patients with generalized weakness should include a myasthenic reaction.

AIDS-Related Opportunistic Infections↗
PubMed1986

Bilateral microsurgical lysis of the spinal accessory nerve roots for treatment of spasmodic torticollis. Follow up of 33 cases.

In 1981 we reported about a new surgical procedure for the treatment of spasmodic torticollis (ST). 33 patients, who failed to respond to the available conservative treatment, underwent a bilateral microsurgical lysis (BML) of the spinal accessory nerve roots (SRAN). Anastomoses between SRAN and the dorsal roots of the first and second cervical nerve (DRC 1/DRC 2) were cut. DRC 1 and sometimes DRC 2 were divided bilaterally. Moreover, SRAN was freed of all adhesions and vascular contacts. Up to 60 months after surgery we have excellent results in 5(5), good results in 10(7) and improved symptoms in 12(8) patients. In 3(7) patients symptoms were unchanged, 2(1) patients deteriorated (patients self assessment is given in brackets). One patient died during hospitalisation. Comparing torticollis symptoms and the post-operative outcome it can be shown that patients with horizontal ST have the best results (21 out of 22). Bad results were obtained in patients with combined torticollis symptoms such as retrocollis, antecollis and the rotatory/horizontal type (5 out of 9). These results support the hypothesis of a peripheral factor in the aetiology of horizontal ST. It is assumed that a unilateral disturbance of proprioceptive afferents for head control, which reach the CNS via anastomosis between DRC 1/DRC 2 and SRAN (in 94% of the cases) could be involved. This hypothesis is discussed with special regard to different anatomical findings in patients with ST and those revealed in a study on human cadavers without this disease.

Accessory Nerve↗
PubMed1986

Relationship between the spinal accessory nerve and the posterior root of the first cervical nerve in spasmodic torticollis and common autopsy cases.

Operative findings on the topographical relationship of the spinal root of the accessory nerve to the posterior root of the first cervical nerve in 30 patients suffering from severe spasmodic torticollis are compared with anatomical findings in 50 common autopsy cases. Anastomoses between the SRAN and DRC 1 were found much more frequently in torticollis-patients (87%:46%). These results support the hypothesis of a peripheral pathogenic factor in the etiology of ST.

Accessory Nerve↗
PubMed1984

Importance of laboratory clinical investigation in the diagnosis of immune vasculitis with neurological manifestation.

In this study 23 cases of immune vasculitis with predominance of neurological symptoms were analysed. Besides patient history and neurological examination, myelotomy is the most relevant means of diagnosis in immune vasculitis. For this reason myelotomy should be integrated in routine diagnostic methods if the diagnosis immune vasculitis is discussed. Other laboratory parameters have no great relevance in the diagnosis of immune vasculitis. A higher specificity of antibody tests, especially in the case of ANA, might be able to replace myelotomy in the diagnosis of immune vasculitis. The relevance of laboratory parameters in the diagnosis of immune vasculitis in neurological patients was examined.

Adult↗
PubMed1984

[Significance of iliac crest biopsy in the diagnosis of immunovasculitis in neurologic disease pictures].

In the present study we evaluated and analysed 81 patients with mainly neurological symptoms in whom iliac crest biopsy was performed because of a suspected immunovasculitis. In 20 of these patients, an immunopathy could be verified via the iliac crest biopsy. The relevance, reliability and accuracy of iliac crest biopsy is compared with the corresponding properties of other conventional methods of biopsy and neurological examination. The clinical syndromes of patients with immunovasculitis are analysed and compared with those of a group without detectable immunovasculitis in the iliac crest biopsy sample. For immunovasculitides with neurological symptomatology, no typical complex of symptoms was seen compared with the control group which would support a suspected diagnosis of immunovasculitis. Four selected case histories are described in keyword style. It follows from the result of this study that iliac crest biopsy is a low-risk examination method which the patient can be expected to tolerate, which is far more accurate in respect of the specific question of an immunodisease such as immunovasculitis with a strongly predominant neurological syndrome, compared with all other conventional neurological examination methods including other biopsy methods.

Adult↗
PubMed1983

Anatomic topographical relationship of the intraspinal accessory root to the upper cervical roots and to the vessels of the cranial cervical region.

The object of this investigation was to provide a statistical interpretation of macroscopic anatomic findings in the cranial cervical region, which is very rich in variation. In this way rare nervous and vascular variations could be related statistically. The first cervical posterior root demonstrated the most striking variations, which, according to anlage and connection with the accessory nerve, was divided into four anlage types of formation. In this way it was shown that in only 23% of the cases, no posterior C-1 root had been formed. It was further demonstrable that in at least part of the cases the accessory nerve was sensibly mixed with the first posterior root. Furthermore, nervous structures and peculiarities in the vessels were investigated. Special courses taken by the posterior inferior cerebellar artery, in addition to those already known, were statistically interpreted. Nervous as well as vascular contact and courses were analyzed, especially in relation to their topography to the accessory nerve, in order to provide clinicians with possibilities for explanations of irritations or compressions of this cranial nerve.

Arteries↗
PubMed1983

[Lumbar intervertebral disk prolapses in adolescents].

Six adolescent patients aged 13 to 17 years with lumbar disc prolapse all had a positive Lasègue's test. Clinical symptoms were varied, vertebral symptoms were more pronounced. In all cases myelographic findings corresponded with those at operation. The neurological deficits mostly disappeared after operation. In contrast to adults disc herniation in adolescents was recognized only after some time since lumbar intervertebral disc protrusion is rare and often shows atypical symptoms in teen-aged patients.

Adolescent↗
PubMed1983

[Treatment indications in psychiatric emergencies].

6 investigators of a "Psychiatric Emergency Service" recorded 299 outpatient emergency cases which required immediate involuntary admission in accordance with a new Hamburg Civil Law. To identify the factors exercising an influence on the indication for involuntary admission, the 299 interventions were compared resulting in outpatient treatment (n = 93) vs. voluntary admission (n = 84) vs. involuntary admission (n = 122). It was shown that the factors "diagnosis", "hazard", and, in particular, the interaction between patient and emergency physician, mainly determine the indication. The interactions of these factors are differentiated in detail, with respect to age, sex, and social factors.

Adolescent↗
PubMed1981

Treatment of neurogenic torticollis by microvascular lysis of the accessory nerve roots - indication, technique, and first results.

For treatment of spasmodic torticollis (s.T.) microsurgical decompression of the intraspinal-intracranial portion of the accessory nerve (a.N.) has been performed in 11 patients with proved neurogenic lesions of the accessory nerve-dependent muscles. Neurogenic lesions were discovered by meticulous electromyographic (EMG) examination in 26 out of 32 patients with s.T. Based on the EMG findings and a.N. roots were exposed, mostly bilaterally. During operation we found in each case tight adhesions to adjacent structures, in particular the vertebral artery (v.A.), the posterior inferior cerebellar artery (PICA), and spinal arteries. Moreover, various nerve anastomoses were found between the upper dorsal cervical roots and the spinal a.N. roots. After neurovascular lysis and dissection of anastomoses, to C 1 in particular, the a.N. was protected with teflon-foam (Prosthex). Immediately after surgery torticollis had improved in all but one case. Further improvement was achieved by exercises. These first favourable results, and the fact that nerve decompression is less destructive that other surgical procedures in treatment of s.T., make us feel justified in recommending this procedure further to patients suffering from s.T. with proved neurogenic lesions.

Accessory Nerve↗
PubMed1981

[Initial experiences in psychiatric emergency service. Comments on the prevention or indication of compulsory hospitalization in accordance with the Hamburg Law on Aid and Protective Measures in Mental Diseases (author's transl)].

On the basis of the rules of the Hamburg Law on Aid and Protective Measures in Mental Diseases, a psychiatric emergency service operates at night and on weekends. This emergency service is called upon to decide on the need for compulsory hospitalization and to prevent the same, if possible, via therapeutic alternatives. The article illustrates by documents an initial phase of the activities of this public service. Within the framework of a preliminary study, 63 recorded incidents of service by four physicians are presented who collected data on the situation encountered by them at the time of examination, on the social and anamnestic background of the patients, on their psychiatric evaluation and on the indication for compulsory hospitalization or alternative treatment methods. 22% of the patients were subjected to compulsory hospitalization. Provisional hypotheses on the conditions under which compulsory hospitalization becomes more probable, are developed from the recorded data. The concept of the risk situation is specially reflected upon. The therapeutic possibilities in connection with institutional factors are discussed with a view to promote further development of crisis intervention in the sense of preventing compulsory hospitalization.

Commitment of Persons with Psychiatric Disorders↗
PubMed1979

[Neuropharmacologic and neurotoxic studies on the Renshaw mechanism].

Recurrent axon collaterals of alpha-motoneurons formed with Renshaw cells cholinergic synapses. The effects of ethanol, pyritinol-HCl and type A botulinum toxin on this central nervous cholinergic synapse were studied. Ethanol caused a marked increase in Renshaw cell activity. The excitatory influence effects above all the Renshaw cell synapses directly. Pyritinol-HCl decreased the activity of Renshaw cells. The increase of Renshaw cell activity, caused by ethanol, changed into a decrease after pyritinol-HCl application so that pyritinol-HCl has a protective effect on this cholinergic system. The injection of the neurotoxin botulinum type A into the muscle or even into the ventral root was without effect on the Renshaw cell activity during the test period. Only the direct application of botulinum toxin type A into the spinal cord led to a decrease of the early and the late response of Renshaw cells. The results are discussed and the clinical relevance is considered. The cholinergic Renshaw cell synapse is not only considered as a special synapse but also as a model for cholinergic transmission which is assumed in several parts of the central nervous system.

Acetylcholine↗
PubMed1978

Botulism: clinical neurophysical findings.

Four cases of mild botulinus type B intoxication are reported with the clinical neurophysiological studies. Electromyographically tetanic stimulation of the N. ulnaris initially led to tetanic potentiation of the muscle action potential. After an interval without any symptoms tetanic reduction became apparent between the fourth and seventh week of the illness. The electroneurographic finding was normal during the observation period of three months. Infrared reflex pupillographic studies revealed that the cholinergic autonomous synapses were disturbed for a period much longer than the symptoms clinically established. The speed at which the pupillographic findings returned to normal varied considerably according to the patient. Electroencephalographic results indicated generalized groups of slow high amplitude waves in three of the four cases during the period of observation. The pathophysiology of botulinus intoxication is discussed with a consideration of the literature and the results of this study.

Adult↗
PubMed1978

Simultaneous recording of pupillary hippus and EEG. Report of a case.

Pupillary hippus was observed and recorded in a man of 44 years, who had epileptic seizures, chronic alcoholism with liver disease and Primidon intoxication, during a period of unconsciousness of 24 h. During this time the simultaneous records of the EEG and pupillogram over a long period of time revealed that the basic EEG rhythm and hippus had the same frequency. Both recordings were temporarily in phase, time-locked, and could be blocked by painful and acoustic stimuli. The etiology and interpretation of hippus are discussed.

Adult↗
PubMed1977

[Cryptogenetic facial paralysis. Studies on the disease course].

A report on 22 patients with idiopathic facial paralysis is given. A systematic interdisplinary examination in short intervals was carried out. The efficiency of the more time consuming and technically more difficult methods was checked. At the same time it was investigated whether as a result of these findings new aspects of early therapy and prognosis could be expected.

Adult↗