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W Müllges

Publications and source records attributed to W Müllges.

36 records · Page 2Linked to original sources
PubMed1996

Eyeball pressure testing in the evaluation of serious bradyarrhythmias in Guillain-Barré syndrome.

OBJECTIVE: To investigate the usefulness of eyeball pressure testing (EP) as an indicator for impending serious bradyarrhythmias in patients with Guillain-Barré syndrome (GBS) and its relationship to motor disability. BACKGROUND: Autonomic dysfunction is a common complication in GBS and accounts for a significant number of deaths. Serious bradyarrhythmias are thought to occur only in severe cases but are difficult to predict. METHODS/DESIGN: In 13 consecutive patients with GBS aged 29 to 70 years, 156 EP (6 to 19 per patient) were done serially for up to 1 year. Bilateral moderate pressure was manually applied and sustained for 25 seconds or until abnormal bradycardia developed, defined as heart rate below 40 beats per minute. Disability was graded by a score from 0 to 5 (DS). RESULTS: Four of 13 patients (DS 2/2/3-4/5) showed abnormal sensitivity to EP at least once. In two of them, vagal overreactivity could be demonstrated repeatedly, which gradually resolved within 4 and 10 days. In one patient with a rapid progressive course requiring early cardiopulmonary resuscitation, a highly abnormal EP could be recorded until 1 day after heart arrest. Another patient (DS 3-4) with abnormal EP required cardiac pacing twice because of significant bradycardia. The only other event necessitating pacing occurred in a severely disabled patient (DS 5-4) who never showed abnormal EP. CONCLUSIONS: Vagal overreactivity could be demonstrated in approximately 30% of our patients. It was not restricted to severe motor impairment and was also present in mild-to-moderately disabled patients. In this regard, EP may be a simple and useful bedside test to indicate an increased risk of developing serious bradyarrhythmias in patients with GBS.

Adult↗
PubMed1993

[Is chronic dermato- or polymyositis misdiagnosed as "weakness of old age"?].

Two women, aged 72 (case 1) and 77 (case 2) were referred for neurological diagnosis because of progressive muscular weakness, for 4 and 18 months, respectively, which had finally led to dysphagia and required mechanical ventilation. The cause of the disease in case 1 was classical dermatomyositis. Creatinine kinase concentration, never previously measured, was 950 U/l. In case 2 there was polymyositis, previously not considered as she had a diabetic polyneuropathy and muscle enzyme concentration was normal. In both cases the correct diagnosis was speedily confirmed by electromyography and muscle biopsy. Immunosuppressive treatment was largely successful in reversing the symptoms (case 1: initially 500 mg methylprednisolone daily, reduced to 50 mg daily within 6 weeks; case 2: 500 mg methylprednisolone daily for 1 week, then 100 mg daily plus 150 mg azathioprine with maintenance dosage of 20 mg glucocorticoid daily).--These two cases demonstrate that, particularly in the elderly, dermatomyositis and polymyositis should be considered in the differential diagnosis of progressive general weakness.

Aged↗
PubMed1992

Non-invasive diagnosis of internal carotid artery dissections.

Arteriography is thought to be mandatory for the diagnosis of internal carotid artery (ICA) dissection. With the introduction of transcranial Doppler sonography (TCD) and magnetic resonance imaging (MRI), however, this is no longer the case. In 13 consecutive patients with ICA dissections the diagnosis was made by means of non-invasive tests including extracranial and transcranial Doppler sonography, contrast enhanced computed tomography (ceCT), and, in five patients, MRI. Intra-arterial digital subtraction angiography used as the gold standard in all cases was confirmative. Extracranial and transcranial ultrasound findings indicative of the diagnosis could be identified. MRI directly demonstrated the intramural haematoma and the false lumen of the dissected artery. These non-invasive techniques also allowed for repetitive follow up examinations. They were, however, unable to demonstrate false aneurysms in the chronic state. Results show that the diagnosis of carotid dissection can be made by means of cerebrovascular ultrasound and MRI.

Adult↗
PubMed1992

Noninvasive assessment of intracranial fistulas and other small arteriovenous malformations.

Twenty patients in whom the diagnosis of an intracranial arteriovenous malformation was suspected either by the history and clinical findings or by abnormal periorbital Doppler flow are discussed. Sixteen patients had only minor complaints or inconclusive signs or were clinically asymptomatic; 4 others presented with the syndrome of a carotid cavernous fistula. Patients were further examined by means of transcranial Doppler sonography, computed tomographic scanning, and cerebral angiography. In 17 patients, the diagnosis of an arteriovenous malformation could be established by transcranial Doppler sonography and could be confirmed by angiography. Transcranial Doppler sonography gave false negative results in 1 and false positive results in 2 patients. Our findings demonstrate the usefulness of modern ultrasound techniques in the assessment of small or even occult intracranial arteriovenous shunts before subjecting patients to more invasive procedures.

Adolescent↗
PubMed1991

Patterns of brain infarctions in internal carotid artery dissections.

In 15 patients with internal carotid artery (ICA) dissections, patterns of brain infarctions visible on CT were categorized according to a pathogenetically oriented classification system. This differentiated ischemic brain damage due to low flow from thromboembolic infarctions. Simultaneously, cerebral hemodynamic reserve was evaluated by means of both CO2-dependent vasomotor reactivity and HMPAO- and 99mTc-RBC-SPECT. Six out of 11 patients with ischemic infarctions had the territorial type of brain lesion, suggesting distal embolism. Five patients revealed the pattern of hemodynamically induced low-flow infarctions. Cerebral hemodynamic reserve was significantly decreased only in these latter patients. In ICA dissections the frequencies of hemodynamically and thromboembolically induced brain infarctions is approximately equal. This finding suggests that only half of the patients with symptoms of symptomatic dissections had brain emboli, whereas in the other half the dissections lead to a low-flow effect in terminal supply areas which is so severe that non-embolic brain infarctions occur. This differentiation can help decide whether antithrombotic or hemodynamic treatment should be given.

Adult↗
PubMed1991

Infarctions and non-invasive diagnosis in moyamoya disease: two case reports.

An 31-year-old female and a 32-year-old male had clinical signs and angiographical confirmation of adult Moyamoya disease (MMD). Bilateral carotid siphon (C1), middle cerebral artery (M1), and anterior cerebral artery (A1) stenoses were diagnosed by means of transcranial Doppler sonography (TCD) and visualized during angio Magnetic Resonance Imaging (angio-MRI). In the woman, a 'rete mirabile' of dilated and tortuous lenticulostriate arteries could be visualized during proton weighted and T1-weighted MRI sequences. CO2-dependent vasomotor reactivity was bilaterally reduced and completely exhausted in the territory of right middle cerebral artery in both patients. Cerebral perfusion reserve, defined as the ratio of cerebral blood flow (CBF) to cerebral blood volume (CBV) was assessed by SPECT, and was found to be dramatically reduced in the anterior region of the male patient. Both patients had bilateral small subcortical infarctions in the corona radiata. TCD and MRI are important noninvasive techniques for a preliminary diagnosis of Moyamoya disease. Infarctions in Moyamoya disease may be hemodynamically produced low-flow infarctions.

Adult↗
PubMed1991

[Dissections of the internal carotid artery--new diagnostic and pathogenetic aspects].

Initial and follow-up investigations were done systematically in 15 cases of internal carotid artery (ICA) dissections by means of angiography, computerized tomography, Magnetic Resonance Imaging, extracranial and transcranial Doppler sonography, as well as B-mode imaging. Cerebral hemodynamic reserve was evaluated by means of both SPECT and CO2-dependent vasomotor reactivity. The findings are focussed on two major issues: Do modern diagnostic tools permit to make the diagnosis of ICA dissection without angiographical proof? What is the pathogenesis of brain infarctions due to ICA dissections? Our findings demonstrate that the diagnosis of carotid artery dissection can reliably be done noninvasively by means of ultrasound techniques and MRI. These methods also allow for frequent follow-up investigations without any inconvenience for the patient. Embolic brain infarctions caused by carotid artery dissections are equally frequent as low flow induced lesions. Acute and follow-up findings suggest that surgical intervention is contraindicated in the acute phase, but may be considered for chronic pseudoaneurysms. Initial anticoagulation with high dose heparin is safe and seems to be efficacious. In certain cases, subsequent cumarine therapy may be indicated for a maximum of six months. Measures improving hemodynamics, e. g. induced hypertension, are reasonable, as long as the vasomotor reserve is exhausted.

Carotid Artery Diseases↗
PubMed1991

[Immunotherapy of chronic Guillain-Barré syndrome with high dose IgG and cyclosporin A. Case report, review of the literature and perspectives].

We report about the three-year treatment of a patient with chronic relapsing Guillain-Barré syndrome (GBS), who, simultaneously, suffered from benign gammopathy. A casual relationship between the two diseases could not be proven, since specific antimyeline antibodies could not be found. Five severe bouts of the disease occurred during the observation period, only the first two relapses, however, showed improvement with cortisone treatment, while the latter did not so. High dosages of 7S-immunoglobuline, by contrast, led to a rapid improvement during each of the subsequent relapses. The additional therapy with ciclosporine A kept the patient free from neurological deficits for more than six months now. The mechanisms of various immunological therapeutic approaches are discussed, particularly as an alternative to plasmapheresis. Our observation, as well as theoretical considerations, suggest the aforementioned immunological treatment being promising in chronic GBS.

Aged↗
PubMed1991

[Anticoagulation in acute cerebral infarct. Benefits, risks, therapeutic failures].

We studied 2 groups of ischemic stroke patients who received therapeutic heparinization during the acute phase in order to prevent thromboembolic reinfarction. 530 patients were studied retrospectively (Group B) and 127 prospectively (Group A). Doses of 24,000-38,000 IE/24 h of heparin were given i.v., resulting in a partial thromboplastin time 2-3 times that of normal controls. Three patients from Group A suffered a massive intracranial hemorrhage. All of them had a large infarction (greater than 5 cm in diameter). They had been given anticoagulants within the first 12 h. Two of them presented with uncontrollable hypertension (systolic BP up to 240 mm Hg). Ischemic reinfarction during the first two weeks occurred in 2.3% and 2.4% of subgroups, respectively. This was less than would have been expected from the literature (approx. 14-15%). Features of these patients were 1.) insufficient heparin dosage, 2.) progression of hemodynamically relevant internal carotid artery lesions leading to critical low-flow or 3.) embolization of a floating thrombus from the internal carotid artery in the middle cerebral artery. It appears that therapeutic heparinization reduces the rate of reinfarction within the acute phase of ischemic strokes. This type of treatment should, however, be confined to patients with an embolic stroke mechanism. Careful surveillance of blood pressure and PTT are prerequisites. Anticoagulation should be avoided in patients with massive infarctions (greater than 5 cm in diameter) or uncontrollable hypertension.

Cerebral Infarction↗
PubMed1986

The human sinus nodal electrogram: techniques and clinical results of intra-atrial recordings in patients with and without sick sinus syndrome.

An intra-atrial recording technique previously employed in animal experiments was successfully used to record SNP from the anatomic sinus nodal region of the high right atrium in 29 out of 41 patients (71%) thus examined. Due to the low amplitudes (microvolt range, 40 to 120 microV, mean 79 +/- 20 microV), these potentials were discernible only on high amplification (A = 10(4) to 10(6)), but with a conventional electrode catheter. Against the background of a gradual diastolic depolarization (0.6 to 3.5 microV/msec, mean 1.9 +/- 0.71 msec), SNP stood out distinctly from the subsequent abrupt atrial depolarization. In four patients with SSS, first- and second-degree sinoatrial blocks, respectively, were recorded. SACT were measured both directly and indirectly, and the results were compared in all 18 patients without SSS and in 11 patients with SSS. Although the recordings were not made simultaneously, the paired values for the patients without SSS correlated well (r = 0.890, p less than 0.001), whereas no correlation was found in the patients with SSS (r = 0.163, p = 0.316). In spite of unresolved questions, direct recording of SNP appears to be of potential value in evaluating patients with SSS.

Adult↗
PubMed1984

Frequency and significance of left and right ventricular late potentials after myocardial infarction in man.

Left and right heart catheterization was conducted on 45 patients with a history of myocardial infarction in order to detect so-called ventricular late potentials by means of endocardiac mapping. The endocardiac signals were amplified 100 to 10,000 times at a low noise level using bipolar electrode catheters. The signals were stored unfiltered and visualized directly on an oscilloscope. Consistently recurring late potentials were recorded after QRS complexes in 32 patients (71%). They ranged in amplitude from 50 to 780 microV, while the coupling intervals were measured in the range of 80 to 620 ms from the beginning of the QRS complex to the beginning of the late potential. In some patients, the intracardially registered and/or Holter-monitored ventricular ectopic beats occurred with a delay, corresponding to the delayed occurrence of the ventricular late potentials.

Adult↗
PubMed1983

[Late potentials--endocardial lead following myocardial infarct].

In 27 patients with myocardial infarction, late potentials were sought by means of diagnostic heart catheterization with endocardial left and right ventricular mapping. Signals of late potentials were amplified between 100 and 10,000 times at low noise level using bipolar electrode catheters. Late potentials were recorded reproducibly in 19 patients (70%). Their amplitudes ranged from 50 to 600 microV. The coupling interval in each individual patient was constant and in the total group ranged between 100 and 520 ms. There were no differences of amplitude, form, and coupling interval in patients with and without ventricular tachycardia. In conclusion, late potentials can be found by endocardial mapping in the majority of patients after myocardial infarction. Their clinical relevance, however, has not yet been sufficiently investigated.

Adult↗
PubMedDate not supplied

Cerebral microembolus generation in different extracorporeal circulation systems.

Microemboli generated during extracorporeal circulation (ECC) are likely to induce neurological sequelae. This study examines whether the choice of a distinct type of ECC can reduce intracerebral emboli counts. Middle cerebral artery blood flow during coronary artery bypass grafting was monitored continuously by transcranial Doppler ultrasound in 45 patients. The ECC systems used were a roller pump (n = 16), a centrifugal pump (n = 18) and a combination of centrifugal pump and heparin-coated ECC system (n = 11). Patients' characteristics as well as surgical and anesthesiological procedure did not differ between the groups. Total counts did not differ significantly between the three groups. Intraoperative events in individual patients may lead to massive embolus generation overcoming positive properties of a distinct ECC system.

Aged↗
PubMedDate not supplied

Left cerebral hemi-neglect following carotid TEA: diagnostic, pathogenetic and therapeutic considerations.

OBJECTIVE: This paper describes the first case report in the literature of a hemi-neglect following carotid desobliteration. The disorder is explained in detail and diagnostic as well as pathogenetic aspects are discussed in depth. SUBJECT: Hemi-neglect syndrome is thought to be a rare complication after carotid-desobliteration. It describes a neuropsychological disorder which can affect motor, sensory and visual modalities, either singly or in combination. The diagnostic approach is rather simple but requires thorough clinical assessment. It can be caused by embolic or hemodynamic reasons; the clinical findings in either case are highlighted and discussed in detail. CONCLUSIONS: Pre-operative diagnostic evaluation and perioperative management of patients with ICA-stenosis should be undertaken in close co-operation between surgeons and neurologists. This way, the risk of developing neurological complications (i.e. neglect) after surgery can be estimated in the individual case. In high risk cases, indication for surgery should be seen critically.

Aged↗