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Thorleif Etgen

Publications and source records attributed to Thorleif Etgen.

9 recordsLinked to original sources
PubMed2004

Cardiac troponins and N-terminal pro-brain natriuretic peptide in acute ischemic stroke do not relate to clinical prognosis.

BACKGROUND AND PURPOSE: The prognostic value of cardiac troponins and natriuretic peptide in acute ischemic stroke is uncertain. We measured cardiac troponin T (cTnT), cardiac troponin I (cTnI), and N-terminal pro-brain natriuretic peptide (NT-proBNP) at admission in acute ischemic stroke patients without evident myocardial damage. METHODS: In 174 consecutive patients with MRI-confirmed ischemic stroke, serial measurements of cTnT, cTnI, and NT-proBNP were performed at 3 different time points in the hyperacute phase (at admission, on days 1 and 2). Relation of laboratory values to risk factors, stroke subtype classification, and clinical outcome after 3 months was analyzed. RESULTS: The highest proportion of raised parameters was found at day 2 for cTnI in 8 of 103 (7.8%), at day 3 for cTnT in 8 of 174 (4.6%), and NT-proBNP in 114 of 174 (65.5%) patients. Proportion of patients with good outcome was significantly reduced in the group with highest NT-proBNP quartile. However, using multivariate regression analysis, no significant relation to morbidity and mortality was found for cTnT, cTnI, or NT-proBNP. Significant impact on the outcome was detected for lesion size, insular involvement, sex, age, and stroke severity. CONCLUSIONS: NT-proBNP is raised in nearly two thirds of acute stroke patients, whereas elevated cardiac troponins are found only in a small number of acute ischemic stroke patients. Neither NT-proBNP nor cardiac troponins influence clinical outcome if other risk factors are considered.

Age Factors↗
PubMed2004

Bilateral thalamic gray matter changes in patients with restless legs syndrome.

Restless legs syndrome (RLS) is a common neurological disorder of a primary unpleasant sensation with an urge to move the legs occurring at rest. The etiology of idiopathic RLS is unknown and structural cerebral abnormalities have so far not been detected. We studied 51 right-handed patients with an idiopathic restless legs syndrome in two independent samples (Regensburg RLS-group: n = 28, Munich RLS-group: n = 23) and compared them to 51 sex- and age-matched healthy volunteers. High-resolution T1-weighted magnetic resonance imaging (MRI) of each subject was obtained and analyzed using voxel-based morphometry (VBM) to detect regionally specific differences in gray matter between patients and controls. Conjunction analysis was used to combine results from both centers. In patients with idiopathic RLS, both study centers observed independently a bilateral gray matter increase in the pulvinar. In the conjunction analysis including all patients and controls from both study centers, a significant gray matter increase in the pulvinar bilaterally (right: x = 16, y = -21, z = 12, Z = 4.57; left: x = -16, y = -24, z = 12, Z = 4.10) was present. This is the first demonstration of structural changes in the brain of patients with idiopathic RLS. These changes in thalamic structures are either involved in the pathogenesis of RLS or may reflect a consequence of chronic increase in afferent input of behaviorally relevant information.

Adult↗
PubMed2004

Detection of acute brainstem infarction by using DWI/MRI.

Even using diffusion-weighted images (DWI) detection of acute brainstem infarction (BI) is still a challenge. To evaluate the clinical efficacy of a DWI protocol with improved spatial resolution all images of 44 patients with clinically possible BI on admission (24 patients with definite BI and 20 patients with other etiologies) and first DWI within 24 h after symptom onset were blindly reanalyzed for visibility and detection of BI on the first DWI by reviewers with different expertise levels. Neuroradiologists identified definite BI in 21 out of 24 patients (sensitivity 90%, specificity 100%); neurologists and junior house officers achieved similar results (sensitivity 86 and 83%, specificity 98 and 97%). The use of DWI allows a definite diagnosis of BI, even if raters have limited experience.

Adult↗
PubMed2004

Transient ischemic attack and stroke can be differentiated by analyzing early diffusion-weighted imaging signal intensity changes.

BACKGROUND: Diffusion-weighted imaging (DWI) has been established to diagnose acute cerebral ischemia. Signal intensity changes occur not only in patients with definite stroke but also in up to 67% of transient ischemic attack (TIA) patients. We investigated the predictive value of DWI signal intensity changes to distinguish between TIA and stroke. METHODS: Clinical data, conventional magnetic resonance imaging (MRI), and DWI were collected in 60 consecutive patients with TIA and 37 consecutive patients with stroke. DWI was performed within 24 hours after symptom onset. Using an image analyzing system, we calculated the ratio of the lesion and corresponding contralateral normal tissue average signal intensity (rAI). RESULTS: Eighteen of 60 TIA patients (30%) revealed focal abnormalities on DWI. The mean duration of symptoms was 5.3 hours in TIA patients with DWI lesions and 5.2 hours in patients without lesions. The time to DWI was comparable in TIA and stroke patients. Even within 6 hours after symptom onset, the signal intensity was significantly higher (P=0.03) in stroke patients (n=13, rAI=1.26) as compared with TIA patients with DWI lesions (n=9, rAI=1.16). CONCLUSIONS: Our data indicate that already within 6 hours after symptom onset, TIA and stroke might be differentiated by analyzing the signal intensity of the lesions.

Aged↗
PubMed2004

Progression of early carotid atherosclerosis is only temporarily reduced after antibiotic treatment of Chlamydia pneumoniae seropositivity.

BACKGROUND: Chlamydia pneumoniae (Cp) infection has been associated with atherosclerosis and cardiovascular events. There are controversial results regarding the beneficial effects of antibiotic therapy on future cardiovascular end points. METHODS AND RESULTS: We determined the long-term effect of a 30-day roxithromycin therapy on intima-to-media thickness (IMT) progression of the common carotid artery in 272 consecutive Cp-positive and Cp-negative patients with ischemic stroke in a prospective, double-blind, randomized trial with a follow-up of 4 years. Cp IgG (> or =1:64) or IgA (> or =1:16) antibodies were initially found in 125 (46%) patients. During the 3 years before antibiotic therapy, Cp-positive patients showed an enhanced IMT progression even after adjustment for other cardiovascular risk factors (0.12 [0.11 to 0.14] versus 0.07 [0.05 to 0.09] mm/year; P<0.005). The 62 Cp-positive patients given roxithromycin showed a reduced IMT progression during the first 2 years compared with the Cp-positive patients without therapy (0.07 [0.045 to 0.095] versus 0.11 [0.088 to 0.132] mm/year; P<0.01). However, IMT progression increased again during the third and fourth year to similar values as before treatment. No significant difference in the occurrence of future cardiovascular events was found between both groups during follow-up. CONCLUSIONS: The only limited positive impact of antibiotic therapy on early atherosclerosis progression in Cp-positive patients observed in our study may explain the negative results of most antibiotic trials on clinical end points.

Aged↗
PubMed2003

Hemiballism with insular infarction as first manifestation of Takayasu's arteritis in association with chronic hepatitis B.

BACKGROUND: Takayasu's arteritis is a chronic inflammatory idiopathic disease involving large arteries like the aorta and its primary branches. Cell-mediated autoimmunity leading to vascular injury has been suspected in its pathogenesis although the antigen inducing the process remains unknown. CASE REPORT: A 50-year-old male patient suffered from acute hemiballism. Neuroimaging showed an infarction of right temporal insular cortex. Neurosonology and MR-Angiography revealed bilateral long-distant subtotal stenosis of the common carotid artery and left-sided occlusion of the subclavian artery. Positive hepatitis B serology with active viral replication was found. In the absence of other vasculitis or inflammation markers, Takayasu's arteritis was diagnosed and steroid therapy was started. CONCLUSIONS: Unilateral insular lesions may lead to transient hemiballistic movements which could be the result of decreased inhibitory output of the insula to basal ganglia. The hepatitis B virus possibly contains a surface antigen inducing a specific cellular immune response leading to Takayasu's arteritis.

Anti-Inflammatory Agents↗
PubMed2002

Reduced progression of early carotid atherosclerosis after antibiotic treatment and Chlamydia pneumoniae seropositivity.

BACKGROUND: Chlamydia pneumoniae (Cp) infection has been associated with atherosclerosis, and a beneficial effect of antibiotic therapy on future cardiovascular events was described. METHODS AND RESULTS: We evaluated the effect of roxithromycin therapy (150 mg twice daily for 30 days) on the progression of the intima-to-media thickness (IMT) of the common carotid artery using duplex ultrasonography in a prospective and randomized trial with a follow-up of 2 years in 272 consecutive patients with ischemic stroke aged over 55 years in whom the first IMT measurement and Cp testing (IgG and IgA) were performed at least 3 years before the roxithromycin treatment. Cp IgG antibodies (> or =1:64) were initially found in 123 (45%) patients and IgA antibodies (> or =1:16) in 112 (41%) patients. During the 3 years before antibiotic therapy, Cp-positive patients showed an enhanced IMT progression, even after adjustment for other cardiovascular risk factors (0.12 [95% CI, 0.11 to 0.14] versus 0.07 [0.05 to 0.09] mm/year; P<0.005). The 62 Cp-positive patients given roxithromycin showed a significantly decreased IMT progression after 2 years compared with the Cp-positive patients without therapy (0.07 [0.045 to 0.095] versus 0.11 [0.088 to 0.132] mm/year; P<0.01). No significant difference in the occurrence of future cardiovascular events was found between both groups during follow-up. No change of IMT was observed in Cp-negative patients given roxithromycin (n=74) compared with those without therapy (0.06 [0.03 to 0.09] versus 0.07 [0.05 to 0.09] mm/year). CONCLUSIONS: Our findings suggest a positive impact of antibiotic therapy on early atherosclerosis progression in Cp-seropositive patients with cerebrovascular disease.

Aged↗
PubMed2002

Prognostic relevance of early serial C-reactive protein measurements after first ischemic stroke.

BACKGROUND AND PURPOSE: Recent studies described an association between elevated levels of C-reactive protein (CRP) and outcome after ischemic stroke. We investigated the impact of early serial CRP measurements in hyperacute ischemic stroke on long-term outcome. METHODS: One hundred twenty-seven consecutive patients without thrombolysis with a first ischemic stroke no more than 12 hours after symptom onset were examined. Serial CRP measurements were done at admission (CRP 1), within 24 hours (CRP 2), and within 48 hours (CRP 3) after symptom onset. In addition to several cerebrovascular risk factors, the 1-year outcome and the lesion volumes of initial diffusion-weighted images were determined. RESULTS: The CRP concentration increased significantly during the first 48 hours after symptom onset (CRP 1, 0.86 mg/dL [95% CI, 0.69 to 1.02]; CRP 2, 1.22 mg/dL [95% CI, 0.88 to 1.55]; CRP 3, 1.75 mg/dL [95% CI, 1.25 to 2.25]; P=0.003). Multiple logistic regression analysis identified Barthel Index score at admission and CRP 2 and 3 as independent predictors of an unfavorable outcome. Kaplan-Meier analysis revealed a significantly higher rate of end point events (adjusted odds ratio, 3.9 [95% CI, 1.4 to 10.7]; P=0.008) only in patients with elevated CRP 2 concentrations. CONCLUSIONS: The CRP level measured within 12 hours after symptom onset of an acute ischemic stroke is not independently related to long-term prognosis. In contrast, a CRP increase between 12 and 24 hours after symptom onset predicts an unfavorable outcome and is associated with an increased incidence of cerebrovascular and cardiovascular events.

Aged↗