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Biomedical subjects

R M Müri

Publications and source records attributed to R M Müri.

At least 37 records · Page 2Linked to original sources

Thiamin deficiency in HIV-positive patients: evaluation by erythrocyte transketolase activity and thiamin pyrophosphate effect.

BACKGROUND AND AIMS: The aim of the study was to determine the thiamin status in HIV-positive patients. METHODS: Measurement of erythrocyte transketolase activity (ETK) and thiaminpyrophosphate (TPP) effect in 55 consecutive HIV-positive patients of a specialized outpatient clinic were grouped into five groups according to their CD4 counts. Comparison of results of HIV-positive patients with age-matched control group of 22 healthy subjects. RESULTS: Of the patients, 27% had a pathologically-increased TPP effect, 18% of the patients had pathologically-low ETK. The percentage of pathological values of TPP effect in the patients was significantly higher compared with the control group. There was no statistically significant correlation between pathological thiamin status and stage of the disease, zidovudine therapy or nutritional status of the patients. CONCLUSIONS: Thiamin deficiency in HIV-positive patients was found in a higher percentage than previously reported. Thiamine deficiency is not only present in advanced stages of HIV-infection, but also in clinically asymptomatic patients.

Adult↗

Recording of electrical brain activity in a magnetic resonance environment: distorting effects of the static magnetic field.

The technical limitations of electroencephalography (EEG) and flashed visually-evoked potentials (VEP) recordings in the static magnetic field of the MR system were systematically studied. A main artifact occurring in the magnetic field was found to be correlated with the heart cycle and had amplitudes in the range of EEG and VEP signals. For VEP recordings, a substantial reduction of this effect was achieved by subtraction of the averaged artifact from the averaged composed signal (VEP and artifact) resulting in the VEP signal alone. However, for continuous EEG recordings, there is no such solution, since the observed effect is not sufficiently constant in amplitude, and the standard deviation of the amplitude of the effect is often larger than the EEG amplitude.

Artifacts↗

Functional organisation of saccades and antisaccades in the frontal lobe in humans: a study with echo planar functional magnetic resonance imaging.

The cortical activation pattern of saccades and antisaccades (versus rest) in the frontal lobe was analysed using an echo planar imaging (EPI) technique in 10 healthy subjects. Statistical analysis of activity in the dorsolateral prefrontal cortex disclosed a significantly greater activation during antisaccades in this region than during saccades. On the other hand, activity in the frontal eye fields was not statistically different in both tasks. These results confirm the important role of the dorsolateral prefrontal cortex for the correct performance of antisaccades obtained by studies in humans with isolated lesions of the dorsolateral prefrontal cortex.

Adult↗

Contrast-enhanced transcranial color-coded duplex sonography in ischemic cerebrovascular disease.

BACKGROUND AND PURPOSE: Echo contrast agents have been shown to provide conclusive examinations in most patients with insufficient ultrasound penetration through the temporal bone. We investigated the diagnostic value of contrast-enhanced (CE) transcranial color-coded duplex sonography (TCCD) in patients with ischemic cerebrovascular disease and insufficient temporal windows and evaluated TCCD criteria that predict whether CE-TCCD studies may become conclusive. METHODS: Thirty-three patients presenting with ischemic strokes (n = 21) and transient ischemic attacks (n = 12) were investigated. Extracranial color duplex imaging showed normal findings in 24 patients, eight > or = 70% stenoses and one occlusion of the carotid arteries in 8 patients, and severe occlusive disease of both vertebral arteries in 1 patient. Seven carotid stenoses and vertebral artery obstructions were confirmed by angiography. The galactose/palmitic acid-based echo contrast agent was injected intravenously as bolus of 200, 300, or 400 mg/mL in a dosage of 10, 5, and 5 mL, respectively. RESULTS: Thirty-two of the 33 patients were completely examined because 1 patient who felt pain at the injection site declined further investigations. Twenty-one (66%) of 32 CE studies were conclusive and showed cross-flow through three anterior and two posterior communicating arteries, but no stenoses and occlusions. Precontrast identification of any cerebral artery provided an overall accuracy of 97% in predicting a conclusive CE investigation. Precontrast TCCD identified no arterial Doppler signals in patients with inconclusive CE studies. CONCLUSIONS: CE-TCCD provided conclusive examinations in two thirds of patients with ischemic cerebrovascular disease and ultrasound-refractory temporal windows. Precontrast detection of any cerebral artery reliably predicted a conclusive CE investigation.

Adult↗

Transoccipital power-based color-coded duplex sonography of cerebral sinuses and veins.

BACKGROUND AND PURPOSE: Power-based transcranial color-coded duplex sonography is a new development for cerebrovascular imaging that is suited for detection of slow velocities. The purpose of this study was to evaluate the ability of this technique to detect cerebral sinuses and veins by means of the occipital window and to provide reference data. METHODS: The straight and inferior sagittal sinuses, great and internal cerebral veins, and basal veins were insonated in 120 normal subjects. The number of identified vessels, peak systolic (PSV) and end-diastolic (PDV) velocities, and resistance indices were determined. RESULTS: In subjects aged 20 to 59 years, straight sinuses were identified in 81% and great and internal cerebral veins in 34%. In subjects aged 60 to 79 years, straight sinuses were detected in 50%, great cerebral veins in 20%, and internal cerebral veins in 13%. All insonated inferior sagittal sinuses and basal veins were missed. Velocities were highest in straight sinuses (PSV, 35 [7 to 64] cm/s; PDV, 23 [2 to 43] cm/s), slower in great cerebral veins (PSV, 23 [12 to 34] cm/s; PDV, 16 [7 to 26] cm/s), and slowest in internal cerebral veins (PSV, 14 [10 to 18] cm/s; PDV, 10 [5 to 15] cm/s) (mean with 95% confidence intervals [CIs]). Straight sinus velocities decreased with age for PSV (20 to 39 years, 40 [7 to 73] cm/s; 60 to 79 years, 28 [9 to 46] cm/s; P < .01) and PDV values (20 to 39 years, 28 [4 to 52] cm/s; 60 to 79 years, 16 [5 to 26] cm/s; P < .001) (mean with 95% CIs) and were higher in women than men in the group aged 20 to 39 years. (P < .05). Resistance indices increased with age in the straight sinus (20 to 39 years, 0.30 [0.18 to 0.42]; 60 to 79 years, 0.42 [0.31 to 0.53]; P < .001) (mean with 95% CIs). CONCLUSIONS: Transoccipital power-based color-coded duplex sonography enabled imaging and velocity measurements in the straight sinus of subjects aged 20 to 59 years. In elder subjects detection rate of the straight sinus decreased, and it was low for deep cerebral veins in all age groups.

Adult↗

Transtemporal power- and frequency-based color-coded duplex sonography of cerebral veins and sinuses.

PURPOSE: To determine the ability of transtemporal power- and frequency-based transcranial color-coded duplex sonography to aid in the assessment of cerebral veins and sinuses, as well as to provide reference data for flow direction and velocity. METHODS: Using a color duplex device equipped with a 2.0/2.5-MHz sector scan, we insonated 120 healthy volunteers and three patients with cerebral venous thrombosis. RESULTS: In subjects 20 to 59 years old, deep middle cerebral veins were identified in 88%, basal veins in 97%, straight sinuses in 60%, and transverse sinuses in 42%. The corresponding values for subjects 60 to 79 years old were 53%, 86%, 23%, and 20%, respectively. Velocities were highest in transverse and straight sinuses, slower in basal veins, and slowest in deep middle cerebral veins. Flow was directed lateromedially in the deep middle cerebral vein, rostrocaudally in the basal vein and straight sinus, and mediolaterally in the transverse sinus. Two patients with straight sinus thromboses showed reversed flow direction in the basal veins, and one patient with superior sagittal sinus thrombosis showed elevated velocities in a deep middle cerebral vein. CONCLUSION: Transtemporal power- and frequency-based color-coded duplex sonography enabled imaging and velocity measurements in deep cerebral veins in subjects 20 to 59 years old, but detection of the straight and transverse sinuses was low. In older subjects, only the basal vein was regularly assessed.

Adult↗

Recordings of eye movements for stimulus control during fMRI by means of electro-oculographic methods.

A method for monitoring eye movements in humans during functional MRI is presented. It is based on the acquisition of electro-oculographic (EOG) signals near one eye. EOG potentials were amplified and converted into an optical signal just outside the head coil. An optical fiber was used for signal transmission from inside the magnet bore to the control room. The EOG sensor was tested during EPI sequences at 1.5 Tesla without contamination of the MR signal. Some flow related artifacts on the EOG were observed inside the magnet, but no additional interactions from the MR sequence. An analysis of the latency, direction, and amplitude of the saccadic eye movements was possible.

Electrooculography↗

Saccade disturbances after bilateral lentiform nucleus lesions in humans.

OBJECTIVE: To determine the roles of the putamen and pallidum in ocular motor control. METHODS: Eye movements were recorded electro-oculographically in nine patients with bilateral focal lesions affecting the lentiform nucleus, and in 12 age matched control subjects. Reflexive visually guided saccades (gap task), antisaccades, memorised sequences of saccades, memory guided saccades (with visual input only, and with both visual and vestibular inputs), and predictive saccades (with and without gap) were studied. RESULTS: Latency and accuracy of visually guided saccades were normal. The percentage of errors in the antisaccade task and latency of correct antisaccades did not differ significantly from the results of controls. The percentage of errors in saccade sequences was significantly increased. Accuracy of the two types of memory guided saccades was impaired bilaterally. The percentage of predictive saccades was significantly decreased when a gap existed, but unchanged without a gap, compared with controls. Therefore, saccades made immediately in response to an external target (reflexive visually guided saccades and antisaccades) were performed without difficulty, whereas those requiring an internal representation of such a target (such as memory guided saccades, predictive saccades, and saccade sequences) were performed with significant disturbances. CONCLUSIONS: The lentiform nucleus influences the cortical areas involved in the control of saccades when the experimental paradigm requires the use of an internal representation of the target for correct planning and execution of the ensuing saccade.

Adult↗

Location of the human posterior eye field with functional magnetic resonance imaging.

The frontal eye field and parietal eye field are known to be involved during visually guided saccades. As the location of the human parietal eye field is not yet well known, functional MRI was used during such a saccade task to better localise this field. Besides activity in visual areas of the occipital cortex, bilateral activity was seen in the precentral sulcus, corresponding to the frontal eye field, and in the deep region of the intraparietal sulcus. It is suggested that this intraparietal area, bordering areas 39 and 40 of Brodmann, corresponds to the human parietal eye field.

Adult↗

Effects of single-pulse transcranial magnetic stimulation over the prefrontal and posterior parietal cortices during memory-guided saccades in humans.

1. We used single-pulse transcranial magnetic stimulation (TMS) to explore the temporal organization of the cortical control of memory-guided saccades in eight humans. The posterior parietal cortex (PPC) or the dorsolateral prefrontal cortex (DPFC), which are both known to be involved in the control of such saccades, were stimulated on the right side at different time intervals after the presentation of a flashed lateral visual target. The memorization delay was 2,000 ms. Single pulses were applied at 160, 260, and 360 ms after the flashed target, during the period of 700 and 1,500 ms, and finally at 2,100 ms, i.e., 100 ms after the extinguishing of the central fixation point. The effects of TMS were evaluated by calculating the percentage of error in amplitude (PEA) and latency of memory-guided saccades. The PEA was determined for the primary saccade (motor aspect) and the final eye position, i.e., after the end saccade (mnemonic aspect). Stimulation over the occipital cortex at the same time intervals served as control experiments. 2. After PPC stimulation, a significant increase in the PEA of the primary saccade and final eye position existed for contralateral saccades, compared with the PEA without stimulation, when stimulation was applied 260 ms after target presentation, but not at other time intervals. There was no significant effect on ipsilateral saccades. Latency was significantly increased bilaterally when stimulation was performed 2,100 ms after target presentation. 3. After prefrontal stimulation, a significant increase in the PEA of the primary saccade and final eye position existed for contralateral saccades, when stimulation was applied between 700 and 1,500 ms after target presentation, but not at other time intervals. There was no significant effect on ipsilateral saccades. Latency was not affected by prefrontal TMS at any stimulation times. 4. Occipital stimulation resulted in no significant effect on the PEA and latency of ipsilateral or contralateral saccades, in particular including the application at 260 ms after target presentation or during the memorization phase. 5. From these results it may be concluded that the observed effects of TMS on saccade accuracy were specific to the stimulated region and specific to the stimulation time. The PPC seems to be involved in the preparation of saccade amplitude, during the early phase of the paradigm, i.e., the sensorimotor processing period, whereas the DPFC could play a role during the later phase of the paradigm, i.e., the memorization period. Therefore in humans these results support the experimental findings suggesting that sensorimotor integration is controlled by the PPC and spatial memory by the DPFC. Furthermore, our results suggest that the PPC, although not the DPFC, plays a role in saccade triggering.

Adult↗

Ocular motor consequences of damage to the abducens nucleus area in humans.

A patient with a complete unilateral conjugate gaze paralysis caused by a small lesion affecting the region of the right abducens nucleus, documented by magnetic resonance imaging, is reported. Eye movements were quantitatively evaluated using electro-oculography. A gaze-evoked nystagmus to the contralateral side and impairment of smooth pursuit and vestibular ocular reflex in the contralateral hemifield of movements were found. The differential diagnosis of conjugate gaze paralysis and the additional ocular motor abnormalities are interpreted in light of clinical and experimental findings.

Abducens Nerve↗

Effects of transcranial magnetic stimulation over the region of the supplementary motor area during sequences of memory-guided saccades.

Transcranial magnetic stimulation (TMS) over the region of the supplementary motor area (SMA) was used to study the cortical control of sequences of memory-guided saccades. In ten healthy subjects, TMS was applied during (a) the target presentation (learning) phase, (b) the memorization phase, and (c) the execution phase of such saccade sequences. Stimulation during the presentation phase resulted in a significant increase in errors, compared to the results without stimulation. In contrast, stimulation during the memorization or execution phases had no significant influence on the performance of these sequences. The effect of TMS during the presentation phase seems to be specific for an interaction with the SMA function, since, in a control experiment with TMS of the occipital cortex during the same phase, the results were similar to those without stimulation. It is hypothesized that different cortical areas are involved in the learning, memorization and execution of sequences of memory-guided saccades. The SMA action could be crucial during the learning phase, but not during the memorization and execution phases of such sequences.

Adult↗

Influence of transcranial magnetic stimulation on the execution of memorised sequences of saccades in man.

Memorised sequences of saccades are cortically controlled by the supplementary motor area (SMA), as shown in animal experiments and in humans with isolated SMA lesions. We applied transcranial magnetic stimulation (TMS) in eight healthy subjects executing memorised sequences of saccades. Sequences of three targets were presented. Then, upon a go-signal, the subjects had to execute the appropriate sequences. Ten to fifteen sequences were performed in each experiment, and the number of errors were counted. The number of errors increased significantly if TMS was given 80 ms before or 60 ms after the go-signal, with the stimulation coil overlying the SMA. There was no significant increase in errors if different stimulation intervals were chosen (160 ms and 120 ms before the go-signal; 100 ms, 140 ms or 240 ms after the go-signal), if the coil was positioned inappropriately (e.g. over the occipital cortex), or if the stimulator output was too low. We conclude that TMS can interfere specifically with the function of the SMA during a critical time interval close to the go-signal.

Adult↗

Eye movement disorders after frontal eye field lesions in humans.

Eye movements were recorded electro-oculographically in three patients with a small ischemic lesion affecting the left frontal eye field (FEF) and in 12 control subjects. Reflexive visually guided saccades (gap and overlap tasks), antisaccades, predictive saccades, memory-guided saccades, smooth pursuit and optokinetic nystagmus (OKN) were studied in the three patients. Staircase saccades and double step saccades were also studied in one of the three patients. For both leftward and rightward saccades, latency in the overlap task (but not in the gap task) and that of correct antisaccades and of memory-guided saccades was significantly increased, compared with the results of controls. There was a significant decrease in the amplitude gain of all rightward saccades programmed using retinotopic coordinates (gap and overlap tasks, predictive and memory-guided saccades), whereas the amplitude gain of corresponding leftward saccades was preserved. Such an asymmetry between leftward and rightward saccades was significant. In the staircase paradigm as well as for the first saccade in the double step paradigm (with the use of retinotopic coordinates in both cases), the amplitude gain of rightward saccades was also significantly lower than that of leftward saccades. Moreover, in the double step paradigm, the amplitude gain of the first rightward saccade was significantly lower than that of the second rightward saccade (programmed using extraretinal signals), which was preserved. The percentage of errors in the antisaccade task did not differ significantly from that of normal subjects. In the predictive saccade paradigm, the percentage of predictive rightward saccades was significantly decreased. The left smooth pursuit gain for all tested velocities, the right smooth pursuit gain for higher velocities, and the left OKN gain were significantly decreased. The results show, for the first time in humans, that the FEF plays an important role in (1) the disengagement from central fixation, (2) the control of contralateral saccades programmed using retinotopic coordinates, (3) saccade prediction and (4) the control of smooth pursuit and OKN, mainly ipsilaterally. In contrast, the left FEF did not appear to be crucial for the control of the only type of saccades programmed using extraretinal signals studied here.

Brain↗

The role of the right medial temporal lobe in the control of memory-guided saccades.

The role of the hippocampal formation in the control of memory-guided saccades is unclear. We tested two types of memory-guided saccades with short memorization delay in three patients with a lesion affecting the right medial temporal lobe and involving the hippocampal formation. In single memory-guided saccades, testing spatial working memory, the gain of the patient group did not differ from that of an age-matched control group. In contrast, in sequences of memory-guided saccades, testing chronological working memory, there was a marked and significant increase in the percentage of erroneous sequences in patients, compared to controls. These results suggest an important role of the hippocampal formation in the memorization of the chronological order of saccade sequences. In contrast, this structure does not appear to be crucial for spatial working memory, used in single memory-guided saccades.

Aged↗

[Vertigo and migraine].

Vertigo consists of a variety of syndromes and can be due to many etiologies. One of these causes is migraine, which in our experience is often overlooked, although migrainous vertigo is well known in the literature. Vertigo in migraine can occur as aura or during the headache phase, or independent of the attacks as aura without headache. The aim of this retrospective study was to analyze cases with vertigo and migraine: 23 (8%) of 298 patients with migraine examined in a neurological outpatient department also had rotational vertigo. 48% of these patients had vertigo independent from typical migraine headache. Two types of vertigo were found: permanent vertigo, and vertigo with the characteristics of paroxysmal positional vertigo. 57% of the vertiginous attacks lasted hours, 26% even days, and 17% minutes. Most of the patients had several attacks of vertigo, some involving up to 30 episodes. To recognize migraine as a cause of vertigo has therapeutic implications. Most of our patients with vertigo and migraine showed a good response to antimigraine therapy.

Adult↗

Transcranial stimulation of the human frontal eye field by magnetic pulses.

Single transcranial magnetic pulsed stimuli were applied over the cortical area of the putative right frontal eye field (FEF) in 11 healthy subjects. An especially designed figure of eight shaped twin coil was used, to focus the stimulus, the strength of which was adjusted to the individual motor threshold of the left hand muscles. Eye positions and movements were recorded by an infrared reflection technique. Three different experiments were performed: 1. Stimulation during different primary gaze position did not evoke any discernible eye movement. 2. Stimulation just prior to visually elicited horizontal saccades did not cause a significant alteration of the latency, velocity, or amplitude of the saccades. 3. Only stimulation during an antisaccade task induced a significant latency prolongation, when the stimulus was applied between 50 to 90 ms after the target flashed up. This latency prolongation was found in all subjects for the antisaccades to the right, with a statistically significant average latency difference of +66 +/- 55.5 ms. In contrast, the antisaccades to the left were prolonged in the female subjects only by an average of +98 +/- 41.8 ms (p = 0.0064), whereas in the male subjects they did not alter with stimulation (average difference: -3 +/- 41.9 ms, p = 0.753). Significant latency prolongations were only obtained when the magnetic FEF stimuli were applied within a vulnerable period, which varied from subject to subject.

Adult↗

Quantitative analysis of slow eye movements with an IBM/AT compatible personal computer in the diagnosis of multiple sclerosis.

A self-developed software program is presented, by means of which it is possible to make routine recordings and automated analysis of slow eye movements in patients with suspected multiple sclerosis. The menu-guided program runs on an IBM/AT compatible personal computer and allows on-line survey of slow eye movements. Furthermore, interactive evaluation of the data is possible. Hard copies can be made from interesting slow eye movements and their calculated parameters. Finally, tables containing various parameters such as gain, pursuit amplitude, phase difference and number of corrective saccades as well as some simple statistical calculations can be printed out.

Electrooculography↗