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Biomedical subjects

R Reuther

Publications and source records attributed to R Reuther.

At least 19 recordsLinked to original sources

[Primary degeneration of the thalamus with dementia--2 cases with family background].

This is a report on two male patients aged 22 and 43 years, respectively, who developed a fatal progressive demential syndrome that lead to the death of one after 16 months and of the other patient after 25 months and that presented with the typical clinical pattern of "subcortical dementia". In both the cases, the hospital had suspected Creutzfeldt-Jacob's disease but this was not confirmed by microscopy of the tissue; the typical form of manifestation was absent. Instead, microscopy of the brain revealed a marked symmetric degeneration of the thalamus with special preference given to the anterior and media nuclear groups. Predilection for the neothalamic against the palaeothalamic and archithalamic structures produced a very strong impression of a system-related thalamic degeneration process of the type occasionally discussed on the basis of similar observations. Parallel to the atrophic process there were also degenerative changes that were less pronounced, in the rubro-olivo-cerebellar system and in one case a moderately pronounced involvement of the second motor neuron. Both observations of a "thalamic dementia" are discussed against the background of relevant literature published so far on the subject.

Adult

[The clinical picture and course in basilar impression].

We have reviewed 29 cases of patients who suffered from basilar impression and had undergone hospital treatment since 1969. 12 of these patients were reexamined. The predominant symptoms were lesions of the long tracts while the ,,classical signs" such as headache and nystagmus occurred less frequently than expected. Only a quarter of our patients showed a marked deterioration during follow-up. The outcome for four patients who underwent operation is reported.

Adult

Basilar artery disease--clinical outcome and Doppler sonographical follow-up.

In the past 5 years we have investigated 29 patients with symptomatic basilar artery stenoses (14 cases) and occlusions (14) and a patent primitive trigeminal artery with thin-calibered basilar and vertebral arteries (1) using directional continuous-wave Doppler sonography of the vertebral arteries. A total of 19 patients survived, and 17 of them were clinically and sonographically reexamined after 40.4 +/- 15.8 months (mean +/- SD). Among the 8 patients with basilar stenoses, 6--with no further transient ischemic attacks (TIAs) in the interval--exhibited an increase in the summed modified Pourcelot indices (relative end-diastolic flow velocities) of the vertebrals by 0.18 +/- 0.16; the other 2 showed a decrease by 0.26 each, in 1 case temporally related to a TIA, in the 2nd case without further clinical deterioration. In the 8 survivors with basilar occlusions, 5 remained--by sonographic criteria--unchanged with summed modified Pourcelot indices of the vertebrals of 0.00, while 3 patients exhibited a slight increase in the summed modified Pourcelot indices of 0.13 +/- 0.03. While the difference between the outcome of subsets of patients treated with regimens of 30,000-40,000 units heparin/day or phenprocoumon and less radical drugs were statistically not significant, the former regimen appeared clinically more efficacious in preventing further deterioration in approximately two-thirds of the patients affected. Due to the potential recurrence of neurological symptoms, a treatment period with phenprocoumon of 6 months after discharge from hospital appears justified. Due to these therapeutic efforts, approximately half of the patients initially affected survived with no or only a mild neurological deficit.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged

The efficacy of EC-IC anastomoses: evaluation by directional c-w Doppler sonography.

We report the results obtained by means of directional c-w Doppler sonography on 33 patients with superficial temporal-to-middle cerebral artery anastomoses. The efficiency of the anastomosis was evaluated by the modified Pourcelot indices (relative end-diastolic flow velocities) of the preauricular superficial temporal artery and of the bypass-supplying branch at the edge of the burr-hole. The influence of intermittent compression of the bypass-supplying branch on the modified Pourcelot index of the ipsilateral common carotid was used as a further criterion in the sonographic evaluation. All efficient anastomoses, defined by a modified Pourcelot index of at least 0.20 at the edge of the burr-hole, exhibited a reduction of the relative end-diastolic flow velocity of 0.08 on the average in the common carotid during compression. In the 18 cases with unilateral occlusion of the internal carotid, bypass surgery was predominantly efficacious in those patients who showed a reduction in the sum of the modified Pourcelot indices of the remaining brain-supplying arteries of at least two standard deviations with respect to the mean of age-matched controls. The subgroups of patent and absent collaterals through the ophthalmic artery did not show any difference with respect to the percentage of efficient anastomoses. In all 4 patients with bilateral internal carotid artery occlusion, bypass surgery was effective, while 50% of the patients with intracranial carotid artery disease exhibited an insufficient anastomosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Vertebral artery Doppler sonography.

We have examined the vertebral and subclavian arteries in 1,205 patients using directional continuous-wave (c-w) Doppler sonography, and compared the sonographic findings with the results of unilateral or bilateral retrograde brachial arteriographies in the same patients. Doppler sonography revealed 33 false positives among 909 cases with normal angiographic findings. Some types of vertebral artery (VA) lesions allowed an excellent, others a fairly good differentiation by Doppler sonography: the complete subclavian steal syndrome with constant reversal of VA flow was reliably detected (16 cases). In the incomplete steal syndrome (5 cases) sonography was superior to angiography. Two bilateral distal VA occlusions and seven basilar artery occlusions - six in the proximal third and one in the rostral third - were detected sonographically; four basilar occlusions sparing the caudal third and one case exhibiting rete mirabile anastomoses were not identified by Doppler sonography. Our acoustically defined sonographic criteria did not permit an unequivocal assignment to an anatomical variant or a vascular lesion. The sensitivity in the detection of a severe stenosis at the VA origin amounted to 16 out of 31, and to 12 of 25 in cases with a proximal VA occlusion and reconstitution of the distal VA through cervical collaterals. Our results confirm that the conventional hand-held c-w Doppler sonography cannot replace angiography in the evaluation of vertebro-basilar insufficiency. It rather serves as an aid to the decision for or against angiography, and in the follow-up of angiographically proven lesions. However, several therapeutically important lesions are readily diagnosed by sonography.

Angiography

The detection of intracranial carotid artery disease by continuous-wave Doppler sonography.

We have investigated 6,587 patients with directional continuous-wave (c-w) Doppler sonography of the carotid arteries during the last 33 months, and have developed criteria for the diagnosis of a significant increase in peripheral resistance of the internal carotid artery in conjunction with 1,671 retrograde brachial and direct carotid angiograms. We distinguished stenoses proximal (15 cases) and distal (4) to the origin of the ophthalmic artery, supraclinoid internal carotid artery occlusions (8), stenoses (2) and acute occlusions (10) of the middle cerebral artery. Stenoses in the carotid siphon (proximal or distal to the origin of the ophthalmic artery) of at least 60% reduction in lumen diameter showed a reduction of the relative end-diastolic flow velocity (modified Pourcelot's index) of more than 40%; additionally, stenoses proximal to the origin of the ophthalmic artery exhibited a variable alternating flow, or flow reversal, in the supratrochlear artery. Stenoses distal to the origin of the ophthalmic artery rarely revealed the theoretically expected increase in orthograde flow velocity in the supratrochlear artery. Stenoses of the middle cerebral artery consisting of more than atherosclerotic irregularities proved to be an exception. Supraclinoid occlusions of the internal carotid artery were reliably demonstrated by Doppler sonography. However, the majority of acute occlusions of the middle cerebral artery could not be detected by this means, probably due to anastomoses between the anterior and the middle cerebral arteries, which were detected by angiography. Thus, we believe that c-w Doppler sonography is a reliable tool to detect stenoses of the carotid siphon of more than 60% reduction in lumen diameter and and supraclinoid carotid artery occlusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Arterial Occlusive Diseases

[Doppler sonographic diagnosis of basilar stenoses and obliterations].

We have examined 10,162 patients during the past 5 years using directional continuous-wave Doppler sonography of the vertebral arteries. On the basis of 1,989 retrograde brachial angiograms, we have developed sonographic criteria for demonstrating a significant increase in the peripheral resistance of both distal vertebral arteries and/or the basilar artery. All 11 cases of basilar artery stenosis of at least 60% reduction in lumen diameter (as shown by angiography) exhibited an approximately 40% or higher reduction in the sum of the modified Pourcelot indices of both vertebral arteries in comparison with age-matched controls. The 3 stenoses below 60% reduction in lumen diameter were not detected by sonography. Even a good collateral circulation through rete-mirabile anastomoses did not normalize the modified Pourcelot indices. One case of persistent primitive trigeminal artery with thin-calibred vertebral arteries was also detected by sonography. The high percentage of patients with one hypoplastic vertebral artery in the group of basilar artery stenoses indicates an increased risk for atherosclerosis of the basilar and/or the distal vertebral artery in these patients. All 14 angiographically verified occlusions of the basilar artery were detected by sonographic criteria independent of the occlusive localization. Thus, we believe that directional continuous-wave Doppler sonography is a reliable technique for detecting basilar artery stenoses of at least 60% reduction in lumen diameter and basilar artery occlusions.

Aged

[Doppler ultrasonic evaluation of the efficiency of extra-intracranial anastomoses].

We report on the results obtained by means of directional continuous-wave Doppler sonography in 33 patients with superficial temporal-to-middle cerebral artery anastomoses. Recurrent transient ischaemic attacks or a recent mild neurological deficit were considered as justification for bypass surgery in cases of angiographically proven occlusions of one or both internal carotids, severe intracranial carotid artery disease, or stenoses and occlusions of the M-1 segment of the middle cerebral artery. The efficiency of the anastomosis was evaluated by the modified Pourcelot indices (relative end-diastolic flow velocity) of the preauricular superficial temporal artery and of the bypass-supplying branch at the edge of the burr-hole. The influence of intermittent compression of the bypass-supplying branch on the modified Pourcelot index of the ipsilateral common carotid was used as a further criterion for sonographic evaluation. All efficient anastomoses, defined by a modified Pourcelot index of at least 0.20 at the edge of the burr-hole, exhibited an average reduction of 0.08 in the relative end-diastolic flow velocity in the common carotid during compression. In the 18 patients with unilateral occlusion of the internal carotid, bypass surgery was predominantly efficacious (by the above criterion) in those patients who showed a reduction in the sum of the modified Pourcelot indices of the remaining brain-supplying arteries of at least 10% as compared with age-matched controls. The subgroups of existing and absent collaterals through the ophthalmic artery did not show any differences with respect to the percentage of efficient anastomoses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Detection of carotid thrombi with indium-111 platelet scintigraphy.

In order to prove that platelet scintigraphy (PSC) is able to detect carotid thrombi formations, we performed PSC in 15 patients directly before or immediately after a percutaneous carotid angiography. PSC was successful in demonstrating iatrogenic fresh carotid thrombi in 13 out of 15 cases. Out of 53 patients with cerebrovascular disease and carotid stenosis a pathologic platelet accumulation was seen in 39 carotid arteries, 31 on the symptomatic side; more often in slight- and middle-sized stenoses than in high degree stenoses. We assume that in these cases PSC detected carotid thrombi which caused arterio-arterial emboli.

Angiography

Doppler sonography in basilar artery occlusion.

We have investigated 6,972 patients with directional continuous-wave Doppler sonography within the last three and a half years, and have derived criteria for the sonographic diagnosis of basilar artery occlusion or tight stenosis in conjunction with 1,071 retrograde brachial angiograms. By sonographic patterns, we have suspected obstruction of the basilar artery or of both distal vertebral arteries in nine cases. Either bilateral sonographic silence or the absence of a diastolic flow component of the vertebral arteries served as criteria in the sonographic evaluation. Angiography of the vertebro-basilar system, performed in eight cases, showed near or complete occlusion in the distal vertebrals or in the proximal basilar artery. Degrees of stenosis less than an 80 percent reduction in lumen diameter could not be detected sonographically. Two further basilar artery occlusions were detected by means of angiography despite negative Doppler sonography: one of these patients showed an extensive collateral circulation between the posterior inferior and the superior cerebellar arteries, and one patient had an occlusion only of the middle and rostral thirds of the basilar artery, the proximal third and the anterior inferior cerebellar arteries being widely patent. Thus, we believe that directional CW Doppler sonography is very useful in the diagnosis of near or complete occlusion of both distal vertebral arteries or of the proximal basilar artery.

Angiography

[Doppler sonography in intracranial circulation disorders of the internal carotid artery. A comparative Doppler sonography-angiography study].

During the past 33 months we have investigated 6,587 patients using directional continuous-wave Doppler sonography of the carotid arteries. On the basis of 1,671 retrograde brachial and direct carotid angiograms we have developed criteria for demonstrating a significant increase in the peripheral resistance of the internal carotid artery. We distinguished stenoses proximal (15 cases) and distal (4) to the origin of the ophthalmic artery, supraclinoid internal carotid artery occlusions (8), stenoses (2) and obliterations (10) of the middle cerebral artery that developed suddenly. Stenoses in the carotid siphon (proximal or distal to the origin of the ophthalmic artery) showed a reduction of more than 40% in the relative end-diastolic flow velocity (modified Pourcelot's index); in addition, stenoses proximal to the origin of the ophthalmic artery exhibited an alternating flow, or flow reversal, in the supratrochlear artery to a variable extent. Stenoses distal to the origin of the ophthalmic artery only rarely revealed the increase in orthograde flow velocity that had been theoretically expected in the supratrochlear artery. Stenoses of the middle cerebral artery exceeding the extent of atherosclerotic irregularities proved to be an exception. Supraclinoid obliterations of the internal carotid artery were reliably demonstrated by Doppler sonography. However, the reliably demonstrated by Doppler sonography. However, the majority of the occlusions of the middle cerebral artery that developed suddenly could not be detected by this means, probably due to anastomoses between the anterior and middle cerebral arteries, which were detected by means of angiography. Thus, we believe that continuous-wave Doppler sonography is a reliable tool for detecting stenoses of the carotid siphon of more than 60% reduction in lumen diameter as well as supraclinoid carotid artery occlusions. Resistance to the cerebral blood flow that is located more peripherally cannot be diagnosed reliably by this method.

Brain Ischemia

[Cerebellar atrophy in epileptic patients: computer tomography study].

We examined the CT-scans of 310 patients with epilepsy and found a cerebellar atrophy (CA) in 56 cases. 8 of them concerned the cerebellar hemispheres and 48 the vermis. The CA was predominantly observed in patients treated with phenytoin, who had experienced one or more phenytoin intoxications. The combination of phenytoin and carbamazepine resulted in a high risk of acquiring a CA. The CA did not depend on the age of the patients or on the presence of major generalised tonic-clonic seizures.

Adult

[Pathologic nystagmus and related phenomena. A review].

Pathological nystagmus may be spontaneous, positional, or gaze-evoked. Peripheral vestibular nystagmus is usually rotatory, the horizontal component being most prominent. It is - in contrast to a central vestibular nystagmus - strongly inhibited by fixation. Spontaneous congenital nystagmus is also prominent with fixation, but it can usually be distinguished from acquired fixation nystagmus based on its long duration, atypical waveforms and high frequency. Two general types of positional nystagmus can be identified on the basis of nystagmus regularity: static and paroxysmal. The most common variety of positional nystagmus is the so-called benign paroxysmal positional nystagmus, which in the majority of cases occurs as an isolated symptom of unknown cause. Gaze-evoked nystagmus, prominent with fixation, includes dissociated, rebound and gaze-paretic nystagmus forms. Symmetrical gaze-evoked nystagmus is most commonly produced by ingestion of certain drugs. Phenomena related to nystagmus include: amblyopic, voluntary, and convergence-retraction nystagmus, ocular dysmetria, ocular flutter, opsoclonus, ocular bobbing, and ocular myoclonus.

Amblyopia

[Detection of intracardiac thromboses with 111-In platelet scintigraphy].

A scintigraphy with Indium-111 labelled platelets was performed in 11 patients with suspected brain embolism. In six patients, an intracardial thrombus was found: four in the region of the left ventricle and two in the left atrial. The echocardiography revealed no pathological findings in 2 of the 6 patients with positive scans. Angiography in both patients indicated occlusions of the carotis interna siphon, which frequently accompany embolisms. Subsequent angiographies four weeks later showed that the occlusions had reopened. The thrombus investigation, performed with the aid of Indium-111 platelet scintigraphy, appears to be a valuable extension of the present diagnostic potential in the determination of questionable cardial embolisms.

Adult

[Differential diagnosis of tinnitus and vertigo. A review].

Tinnitus and vertigo, two common neurological complaints, often challenge the physician's ability with respect to possible etiology. Objective tinnitus can result from an abnormally patent eustachian tube, from tetanic contractions of the muscles of the soft palate, or from vascular abnormalities within the head or neck. Subjective tinnitus refers to lesions involving the external ear canal, tympanic membrane, ossicles, cochlea, auditory nerve, brainstem, and cortex. As many as 50% of patients with tinnitus do not exhibit associated hearing loss; in these patients, the cause of the tinnitus is rarely identified. An illusion of movement is specific for vestibular system disease--a peripheral or central location depending upon associated audiologic and neurologic symptoms, respectively. However, a presyncopal, light-headed sensation is most commonly associated with diffuse cerebral ischemia: in the young patient, this may be caused by a hyperventilation syndrome; in the aged individual, this can result from diffuse atherosclerotic cerebrovascular disease and decreased cardiac output. Postural and gait imbalance associated with acute vertigo indicates a unilateral peripheral vestibular or a central vestibular lesion; if vertigo is absent, either a cerebellar, proprioceptive, or bilateral peripheral vestibular lesion is likely. Transient oscillopsia suggests unilateral peripheral vestibular lesions. Permanent oscillopsia indicates a bilateral peripheral vestibular lesion or--in the absence of severe vertigo--brainstem or cerebellar damage.

Brain Diseases

[Value of visual evoked potentials (VEP) in compression of the anterior visual pathway, especially in the area of the chiasm].

We investigated 86 patients by pattern half-field stimulation presenting clinically with temporal field-defects or with a mass causing compression of the visual pathways found by C.T.-scanning. Pattern half-field stimulation proved to be a very sensitive method for detecting a compression of the anterior visual pathways. In 65 cases the results of perimetry and VEP were congruent, 6 times the evoked potential was pathologic the perimetry showing no abnormalities, only 1 false negative VEP was observed. Thus we stress the importance of an investigation by VEP including half-field stimulation in all patients with suspected compression of the anterior visual pathways.

Evoked Potentials, Visual