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T Nägele

Publications and source records attributed to T Nägele.

At least 19 recordsLinked to original sources
PubMed2006

Surviving glioblastoma for more than 5 years: the patient's perspective.

The authors performed a comprehensive analysis of the functional outcome of 10 patients who had survived 5 years from a diagnosis of glioblastoma. Neurologic deficits were mild in most patients, but neuropsychological testing demonstrated cognitive deficits in all patients. Depression and anxiety were common. Although most patients thought that their social functioning and work ability were impaired, little reduction in overall quality of life was perceived.

Activities of Daily Living↗
PubMed2006

[Cardiovascular whole-body MR imaging in patients with symptomatic peripheral arterial occlusive disease].

PURPOSE: To examine patients with peripheral-arterial-occlusive-disease (PAOD) for systemic effects associated with atherosclerosis using a comprehensive state-of-the-art whole-body MR examination protocol. The protocol comprises the assessment of the complete arterial vasculature (except coronary arteries), the brain, and the heart. MATERIALS AND METHODS: Multi-station whole-body 3D MR angiography was performed in sixty consecutive patients with clinical suspicion for PAOD at 1.5 T (Magnetom Avanto, Siemens, Erlangen, Germany). Functional and delayed enhancement cardiac images were acquired, as well as FLAIR images of the brain and TOF angiography of intracranial vessels. MR and DSA images were assessed by independent observers for atherosclerotic manifestations and other pathology. Sensitivity and specificity for the detection of vascular pathology was calculated for MR data using conventional DSA of the symptomatic region as standard-of-reference. RESULTS: Sensitivity and specificity for the detection of significant vascular stenosis (> 70 % luminal narrowing) was 94 % and 96 % (PPV 87 %, NPV 98 %). Significant microangiopathic tissue alterations (n = 7) and/or cerebral infarction (n = 18) were diagnosed in 23/60 patients. Thirty-eight of 60 patients presented with systolic left ventricular wall motion abnormalities. In 24 patients subendocardial or transmural delayed enhancement was detected in corresponding regions, indicating prior myocardial infarction. CONCLUSION: For patients with PAOD and suspected systemic atherosclerotic disease a comprehensive diagnosis of accompanying cardiovascular pathology and therefore staging of systemic atherosclerotic disease is feasible within one MR examination.

Aged↗
PubMed2006

Progressive multifocal leukoencephalopathy: value of diffusion-weighted and contrast-enhanced magnetic resonance imaging for diagnosis and treatment control.

Progressive multifocal leukoencephalopathy (PML) is caused by the replication of JC virus in oligodendrocytes of immunocompromised patients. Diagnosis usually relies on the polymerase chain reaction (PCR)-based demonstration of JC virus DNA in the cerebrospinal fluid. As previous reports have suggested that some patients may benefit from antiviral therapy, non-invasive early diagnosis is highly desirable. Repetitive magnetic resonance imaging (MRI) examinations (two to nine) were obtained in seven patients (aged 40-67 years, six males, one female) with classical clinical and imaging findings of PML. Five patients had underlying hematological disorders and two acquired immune deficiency syndrome. PCR of the cerebrospinal fluid (CSF) specimen was positive for JC virus DNA in six patients. MRI sequences included T2-, T1- and diffusion-weighted (DW) images in all patients and diffusion-tensor imaging (DTI) in four cases. DTI was once performed at 3T, in the remaining patients at 1.5T. All patients received antiviral treatment with cidofovir in addition to the treatment of the underlying disorder. MRI showed areas of T2 hyperintensity with involvement of the subcortical U-fibers and restricted diffusion in all patients. Areas of diffusion abnormality correlated with disease progress. Contrast enhancement was encountered once after successful treatment and heralded clinical remission with virus elimination from the CSF. Hence, MRI including DW and contrast-enhanced images may be used to evaluate disease activity. Contrast enhancement may indicate an inflammatory response and thus herald immunologic virus elimination.

Adult↗
PubMed2006

Preoperative embolization of cervical spine osteoblastomas: report of three cases.

Our aim was to describe the technique and clinical results of preoperative embolization of cervical spine osteoblastomas. We treated 3 patients with these tumors with transarterial embolization and subsequent surgical excision. In all 3 patients, distal access to the tumor-supplying vessels was gained with a microcatheter and embolization was performed with polyvinyl alcohol particles. No complications occurred. Surgical resection was performed in all patients without relevant bleeding. The postoperative course was uneventful in all patients. Preoperative embolization is a valuable adjunct to the surgical treatment of osteoblastomas of the cervical spine.

Adult↗
PubMed2005

Primary central nervous system lymphomas (PCNSL): MRI response criteria revised.

The authors investigated the applicability of Macdonald response criteria to patients with primary CNS lymphoma (PCNSL). Four of 68 patients with persisting contrast-enhancing lesions after primary therapy did not receive further therapy, and none showed tumor progression after up to 54 months. Because contrast enhancement may not necessarily indicate residual, biologically active lymphoma, the authors propose a modification of the Macdonald response criteria.

Adult↗
PubMed2005

MRI and proton MR spectroscopy in acute disseminated encephalomyelitis.

INTRODUCTION: Acute disseminated encephalomyelitis (ADEM) is one of a group of demyelinating disorders of the central nervous system (CNS). It is said to be attributed to an overshooting immunologic response following an infection or vaccination. The clinical course and type of manifestation is heterogeneous. The early application of corticosteroids has been shown to be beneficial to outcome; thus, an early diagnosis is highly desirable. METHODS: The potential diagnostic value of advanced MR techniques such as proton MR spectroscopy and diffusion-weighted imaging (DWI) was investigated in two paediatric patients with ADEM, one of whom had a remitting and relapsing clinical course and presented with additional cranial nerve involvement. Proton MR spectroscopy revealed typical signs of acute demyelination, such as increased macromolecules, not found in other forms of non-necrotising pathology. CONCLUSION: The addition of proton MR spectroscopy and DWI adds to the diagnostic power of MRI in the setting of post-infectious demyelinating disorders of the CNS or ADEM and may obviate the need for biopsy.

Adolescent↗
PubMed2005

Transient encephalopathy after intrathekal methotrexate chemotherapy: diffusion-weighted MRI.

Methotrexate (MTX) is an indispensable antimetabolite for the treatment of oncological and immunological disorders in all age groups. Chronic leukoencephalopathy is a well know side effect of MTX, especially in conjunction with intrathecal administration and whole brain radio therapy. However, acute neurotoxicity with confusion, disorientation, seizures and focal deficits has also been reported. Because acute neurological symptoms in patients under chemotherapy for neoplastic disorders may have many reasons, MR-imaging is usually necessary to identify the underlying pathology. Apart from conventional sequences, diffusion-weighted imaging (DW-MRI) is frequently performed. We report on clinical and imaging findings of reversibly restricted diffusion in a patient with transient encephalopathy after intrathecal administration of MTX for recurrent acute lymphatic leukaemia.

Adolescent↗
PubMed2005

[Detection of subclinical and overt hepatic encephalopathy and treatment control after L-ornithine-L-aspartate medication by magnetic resonance spectroscopy ((1)H-MRS)].

Hepatic encephalopathy (HE) is a common problem in liver cirrhosis and is associated with typical changes of cerebral metabolite pattern observed by proton magnetic resonance spectroscopy (MRS). In HE, a reduction of the cerebral myo-inositol (mI) and choline (Cho) and an increase of glutamine/glutamate (Glx) can typically be detected with this method. In the present study MRS was used to assess prospectively specific parameters of cerebral metabolism before and after 6 days of treatment with a low-protein diet and with L-ornithine-L-aspartate (LOLA). 6 patients with liver cirrhosis were included in this pilot study. According to standardized neuropsychological tests overt HE or subclinical HE was detected in all patients. All patients received a low-protein diet (< 60 g/d) and were treated additionally with LOLA (20 g QD i. v.). MRS examinations were done before and after 6 days of treatment and the results were compared with those of healthy volunteers. Before treatment mI/Cr ratios in the grey matter were reduced significantly in cirrhotic patients as compared to healthy volunteers (0.30 +/- 0.22 vs. 0.68 +/- 0.11; P = 0.028). In addition, patients showed a (non-significant) reduction of the Cho/Cr-ratio (0.19 +/- 0.03 vs. 0.25 +/- 0.02; P = 0.17) and an elevated Glx/Cr-ratio (1.84 +/- 0.63 vs. 1.29 +/- 0.31; P = 0.05). After 6 days of treatment a significant increase of the Cho/Cr ratio (0.23 +/- 0.03 vs. 0.19 +/- 0.03; P = 0.028) was detectable and 5 of the 6 patients showed a (not significant) decrease of the elevated Glx/Cr ratios. After cessation of treatment an improvement in neuropsychological tests as shown by number-connection testing (P = 0.046) as well as a decrease of elevated pre-treatment ammonia blood levels were noted. These findings, however, did not correlate with the Child-Pugh classification or evidence of clinical/subclinical HE. Using (1)H-MRS it is possible to observe a specific pattern of cerebral metabolites in patients with overt and subclinical HE. In this pilot study a fast change of cerebral metabolite pattern after specific therapy of HE with LOLA was detected. Therefore, future studies with larger patient groups are needed to establish (1)H-MRS as an objective method for detection and treatment control in overt and subclinical HE, especially when compared to commonly used parameters such as ammonia levels or standardized neuropsychological tests.

Adult↗
PubMed2004

Eosinophilic meningomyelitis in toxocariasis: case report and review of the literature.

Toxocariasis is a worldwide-occurring parasitic infection leading to tissue damage in various organs due to wandering Toxocara larvae (visceral larva migrans). More than 40 cases of CNS involvement in children and immunocompetent adults have been documented in detail to date. Here, we present evidence of eosinophilic meningomyelitis in an adult without known risk factors and with positive Toxocara antibody response in CSF, but not in blood. Toxocariasis has to remain among the differential diagnosis in patients with eosinophilic CNS infection even if serological tests in blood are negative. Adult cases seem to be more frequent than previously thought (about 60%).

Adult↗
PubMed2004

Bilateral Wallerian degeneration of the middle cerebellar peduncles due to paramedian pontine infarction: MRI findings.

Wallerian degeneration is a frequent finding in lesions of the pyramidal tract, but has been observed after damage of the other fibre systems as well. Few reports exist about Wallerian degeneration of cerebellar fibres after distant lesions to the axons. Here, we report on a patient who developed degeneration of both middle cerebellar peduncles after a paramedian pontine infarction.

Aged↗
PubMed2004

MRI for the management of neonatal cerebral infarctions: importance of timing.

PURPOSE: Focal ischemic stroke in neonates is a rare occurrence. Diagnosis with most imaging modalities is difficult, but necessary for initiating an anticoagulatory treatment. The purpose of this study was to evaluate the sensitivity of MRI sequences within the first 14 days of birth. PATIENTS AND METHODS: Four patients with neonatal stroke presenting as seizures were examined using a standard MRI protocol including diffusion-weighted images (DWI) and magnetic resonance angiography (MRA) within 72 h of birth. The time between the onset of symptoms and MRI ranged from 6 h to 48 h. Follow-up examinations were performed on days 5 ( n=1), 7 ( n=2), and 14 ( n=1) for the control of a treatment with low-molecular heparin. RESULTS: Eight infarctions were detected in the four patients, 5 in the middle cerebral artery (MCA), three in the posterior cerebral artery (PCA) territory. All lesions were visible using DWI, four on T2-weighted images. Whereas in two patients small lesions contralateral to a large stroke were missed on T2-weighted images, the diagnosis would have been missed altogether without DWI in one patient. On follow-up, the visibility of the infarctions had declined using DWI after 5 days and the lesions were invisible after 1 week. Fourteen days after the stroke, an increased diffusion was detected in the infarcted brain tissue. By this time, all lesions were visible on T2-weighted images. CONCLUSION: In neonates, infarcted brain tissue can be detected using DWI with high sensitivity during the first 2 days after stroke and before other sequences are diagnostic. However, the diffusion restriction does not persist beyond 1 week. After 5 days, diagnosis has to rest mainly on T2-weighted images.

Brain Mapping↗
PubMed2004

Modern MRI tools for the characterization of acute demyelinating lesions: value of chemical shift and diffusion-weighted imaging.

Acute demyelinating lesions occur in various inflammatory disorders of the CNS. Apart from multiple sclerosis, most cases can be attributed to an overshooting immunological response to infectious agents called acute disseminated encephalomyelitis (ADEM). ADEM, which is mostly characterized by a monophasic course, has a multiphasic variant (MDEM). The early application of corticosteroids has been shown to be beneficial for the outcome; thus, an early diagnosis is highly desirable. Furthermore, the differential diagnosis ruling out neoplastic disorders may be difficult using conventional MRI alone. The potential diagnostic value of advanced MR techniques such as chemical shift imaging (CSI) and diffusion-weighted imaging (DWI) was investigated in a patient with MDEM, who had a new lesion in continuity with the initial disease manifestation. CSI was performed at 1.5 T with a long echo time of 135 ms for the evaluation of N-acetyl-aspartate (NAA) and choline (Cho) and with short TE of 30 ms for macromolecules (mm) and myo-Inositol (mI). DWI was performed using a single-shot isotropic EPI sequence. Whereas acute and chronic areas of demyelination were neither distinguishable on T2- nor on contrast-enhanced T1-weighted images, CSI and DWI revealed different metabolite concentrations and diffusion characteristics within the composite lesion, clearly separating acute from chronic areas of demyelination. In conclusion, the addition of CSI and DWI may add to the diagnostic power of MRI in the setting of demyelinating disorders by identifying areas of acute and chronic demyelination, even in the absence of contrast enhancement.

Adult↗
PubMed2004

Diffusion-weighted MRI in herpes simplex encephalitis: a report of three cases.

Herpes simplex virus encephalitis (HSVE) is the most frequent fatal viral infection of the brain. Because antiviral treatment may improve the prognosis significantly, early diagnosis is mandatory. Imaging diagnosis rests on conventional MRI for the visualization of lesions in the limbic system, the hallmark of HSVE. Diffusion-weighted MRI (DW-MRI) has not been used for the evaluation of HSVE. We report on the DW-MRI findings in three patients with HSVE, who had cortical diffusion abnormalities in affected brain parenchyma, partially as the initial or most sensitive sign of encephalitis. Sequential imaging showed that the diffusion abnormality started to return to normal after 2 weeks in the presence of persistent contrast uptake. Thus, DW-MRI may be a valuable tool for early detection and diagnosis of HSVE whereas contrast-enhanced images are indispensable after the first week.

Aged↗