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Gaul C, Dietrich W, Tomandl B, Neundörfer B, Erbguth FJ. Aortic dissection presenting with transient global amnesia-like symptoms. Neurology 2004; 63:2442-3. [PMID: 15623727 DOI: 10.1212/01.wnl.0000148581.00912.1a] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Graf M, Ecker D, Horowski R, Kramer B, Riederer P, Gerlach M, Hager C, Ludolph AC, Becker G, Osterhage J, Jost WH, Schrank B, Stein C, Kostopulos P, Lubik S, Wekwerth K, Dengler R, Troeger M, Wuerz A, Hoge A, Schrader C, Schimke N, Krampfl K, Petri S, Zierz S, Eger K, Neudecker S, Traufeller K, Sievert M, Neundörfer B, Hecht M. High dose vitamin E therapy in amyotrophic lateral sclerosis as add-on therapy to riluzole: results of a placebo-controlled double-blind study. J Neural Transm (Vienna) 2004; 112:649-60. [PMID: 15517433 DOI: 10.1007/s00702-004-0220-1] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2004] [Accepted: 07/31/2004] [Indexed: 10/26/2022]
Abstract
UNLABELLED Increasing evidence has suggested that oxidative stress may be involved in the pathogenesis of amyotrophic lateral sclerosis (ALS). The antioxidant vitamin E (alpha-tocopherol) has been shown to slow down the onset and progression of the paralysis in transgenic mice expressing a mutation in the superoxide dismutase gene found in certain forms of familial ALS. The current study, a double blind, placebo-controlled, randomised, stratified, parallel-group clinical trial, was designed to determine whether vitamin E (5000 mg per day) may be efficacious in slowing down disease progression when added to riluzole. METHODS 160 patients in 6 German centres with either probable or definite ALS (according to the El Escorial Criteria) and a disease duration of less than 5 years, treated with riluzole, were included in this study and were randomly assigned to receive either alpha-tocopherol (5000 mg per day) or placebo for 18 months. The Primary outcome measure was survival, calculating time to death, tracheostomy or permanent assisted ventilation, according to the WFN-Criteria of clinical trials. Secondary outcome measures were the rate of deterioration of function assessed by the modified Norris limb and bulbar scales, manual muscle testing (BMRC), spasticity scale, ventilatory function and the Sickness Impact Profile (SIP ALS/19). Patients were assessed at entry and every 4 months thereafter during the study period until month 16 and at a final visit at month 18. Vitamin E samples were taken for compliance check and Quality Control of the trial. For Safety, a physical examination was performed at baseline and then every visit until the treatment discontinuation at month 18. Height and weight were recorded at baseline and weight alone at the follow-up visits. A neurological examination as well as vital signs (heart rate and blood pressure), an ECG and VEP's were recorded at each visit. Furthermore, spontaneously reported adverse experiences and serious adverse events were documented and standard laboratory tests including liver function tests performed. For Statistical Analysis, the population to be considered for the primary outcome measure was an "intent-to-treat" (ITT) population which included all randomised patients who had received at least one treatment dose (n = 160 patients). For the secondary outcome measures, a two way analysis of variance was performed on a patient population that included all randomised patients who had at least one assessment after inclusion. RESULTS Concerning the primary endpoint, no significant difference between placebo and treatment group could be detected either with the stratified Logrank or the Wilcoxon test. The functional assessments showed a marginal trend in favour of vitamin E, without reaching significance. CONCLUSION Neither the primary nor the secondary outcome measures could determine whether a megadose of vitamin E is efficacious in slowing disease progression in ALS as an add-on therapy to riluzol. Larger or longer studies might be needed. However, administration of this megadose does not seem to have any significant side effects in this patient population.
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Schüttler M, Neundörfer B, Kohl D. Anosmie als alleiniges Residuum einer Herpes-simplex-Virus-Enzephalitis. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-818188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Maihöfner C, Handwerker H, Neundörfer B, Birklein F. Misslokalisationen während taktiler Stimulation bei Patienten mit Komplex-Regionalem Schmerzsyndrom. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Neundörfer B. Autonomic Neuropathies. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-832108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hammen T, Tomandl B, Neundörfer B, Stefan H, Single H. Voxel MR Spectroscopy of Hippocampal Structures in Healthy Adults at 1.5 Tesla – How Stable are the Results? KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-832002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Maihöfner C, Handwerker HO, Birklein F, Neundörfer B. Functional Imaging in Complex-Regional Pain Syndromes. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-832084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kirchner A, Birklein F, Stefan H, Neundörfer B. Vagus Nerve Stimulation – New Insight into the Antinociceptive Effect. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-832045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Heckmann JG, Weber M, Jünemann AG, Neundörfer B, Mardin CY. Laser scanning tomography of the optic nerve vs CSF opening pressure in idiopathic intracranial hypertension. Neurology 2004; 62:1221-3. [PMID: 15079033 DOI: 10.1212/wnl.62.7.1221] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors investigated 17 patients with idiopathic intracranial hypertension (IIH), correlating laser scanning tomography of the optic nerve with CSF opening pressure. The decrease in papilla volume and papilla height showed a linear correlation with the opening pressure of the CSF (r = 0.59, p < 0.001; r = 0.63, p < 0.001). If the CSF opening pressure is higher than 20 cm water, an increase of 5 cm water CSF pressure corresponds to a papilla volume increase of 0.95 mm3 as well as a papilla height increase of 0.34 mm.
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Handschu R, Fateh-Moghadam S, Klotz E, Schmid A, Stemper B, Heckmann JG, Huk WJ, Neundörfer B, Tomandl BF. Multimodale Computertomographie beim akuten Hirninfarkt. DER NERVENARZT 2004; 75:564-76. [PMID: 15257380 DOI: 10.1007/s00115-003-1617-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Computed tomography (CT) is the standard method of brain imaging in acute stroke. To an experienced examiner, nonenhanced CT will exclude hemorrhage and may indicate early ischemic signs. Reliable description of an ischemic area and the underlying vascular disease is not possible in the acute phase but is possible, particularly within the first hours, when therapeutic decisions on matters such as systemic thrombolysis are to be made. For such rapid decision-making, imaging must provide more information. Novel, contrast-enhanced CT techniques can provide this information. Perfusion CT (CTP) can show brain perfusion, allowing one to distinguish between reversible and irreversible damage in an ischemic area. Also, CT angiography (CTA) can detect occlusion or stenosis in the relevant vasculature. Using a modern, multislice CT scanner, it is now possible to combine these modalities of imaging. In a fast protocol for emergency evaluation, all three methods can be performed and evaluated to provide the crucial information within 15 min. In the first 102 patients examined within 6 h of symptom onset using this protocol, multimodal CT contributed substantially to therapeutic decisions, even though there are some limitations in these methods.
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Lang CJ, Heidenreich SP, Fahlbusch R, Neundörfer B. [Primary loss of consciousness and amnesia in subarachnoid hemorrhage--a quantitative study]. ACTA ACUST UNITED AC 2004; 65:18-24. [PMID: 14981572 DOI: 10.1055/s-2004-44884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Subarachnoid hemorrhages (SAH) being sudden events affecting the brain in a rather wide-spread fashion are apt to induce loss of consciousness (LOC) and amnesia. The aim of the present study was to collect data on their frequency and extent. To this end we examined 48 patients at a mean of one year post-onset. Two thirds of them reported anterograde and an additional 17% retrograde amnesia; in 40% LOC (median 6 minutes) was observed. The durations were extremely skewed towards shorter times with a median of 2.7 days for anterograde and 1.3 days for retrograde amnesia who--with a single exception--were markedly shorter than anterograde amnesia. Summing up, a significant proportion of all SAH suffered LOC and amnesia occurred in the majority of cases. SAH therefore are events which with respect to LOC and amnesia bear some resemblance with closed head injuries. Exact observation and history taking may disclose important data on their severity and possible sequelae.
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Hecht MJ, Birklein F, Hilz MJ, Neundörfer B, Winterholler M. Botulinumtoxin B in sehr geringer Dosis zur Behandlung der axillären Hyperhidrose. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-823157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Marthol H, Werner D, Neundörfer B, Daniel WG, Hilz MJ. Externe Gegenpulsation hat keinen Einfluss auf die zerebrale Autoregulation. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-823155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Heckmann JG, Stadter M, Dütsch M, Handschu R, Rauch C, Neundörfer B. Einweisung von Nicht-Schlaganfallpatienten auf eine Stroke Unit. Dtsch Med Wochenschr 2004; 129:731-5. [PMID: 15042487 DOI: 10.1055/s-2004-821377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Stroke care in Germany has substantially improved during the last decade. One column of modern stroke care is the institution of stroke unit which allows rapid diagnosis and treatment. The aspect of admission of nonstroke patients to a stroke unit is poorly evaluated. The aim of this study is to evaluate the number of patients who are admitted to a national stroke unit but do not suffer from stroke. Furthermore, we related the proportion of nonstroke referrals to the different referral modes. PATIENT AND METHODS Observational study recording all suspected stroke referrals with regard to final diagnosis and type of referral during a 12-month period (1.8.2002-31.7.2003). RESULTS 462 patients were admitted by 4 routes: 74 by paramedics or by self-presentation, 138 by emergency physicians, 144 by primary care doctors, and 106 were transferred from other hospitals. 88 patients (19 %) finally revealed no acute stroke. The most common nonstroke diagnoses were seizure (20 %), dissociative disorders (14 %), cranial nerve disorders (11 %), hypoglycaemia (8 %) and transient global amnesia (7 %). There was no significant difference among the proportion of nonstroke patients referred by ambulance paramedics and self-presentation (15 %), emergency physicians (21 %), primary care doctors (15 %) and interhospital transfer (24 %) [p = 0.222, X (2)-test according to Pearson]. CONCLUSION Due to the fact that a number of clinical neurological conditions mimic acute stroke, misdiagnosis of stroke is common. We advocate that all stroke patients are seen early in the course of the disease by a neurologist. An alternative could be that in stroke units of internal medicine hospitals patients are seen by a consulting neurologist. Alternatively, telemedicine might be used and the neurologist on duty of a neurological stroke unit could be consulted.
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Probst-Cousin S, Acker T, Epplen JT, Bergmann M, Plate KH, Neundörfer B, Heuss D. Spinocerebellar ataxia type 2 with glial cell cytoplasmic inclusions. J Neurol Neurosurg Psychiatry 2004; 75:503-5. [PMID: 14966177 PMCID: PMC1738943 DOI: 10.1136/jnnp.2003.011825] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Glial cell cytoplasmic inclusions were identified in a case of spinocerebellar ataxia type 2. These have not been reported before. The inclusions were found in low frequency in the dentate nucleus, cerebellar white matter, pontine transverse fibres, and the inferior olivary nucleus. They were of variable size and shape and expressed ubiquitin, thus resembling glial cytoplasmic inclusions in multiple system atrophy. However, their immunohistochemical profile was different as they did not show immunoreactivity for either tau protein or alpha-synuclein. There was no evidence of expanded polyglutamine tracts in these inclusions, which also failed to label with silver stains. As in many other neurodegenerative diseases, in spinocerebellar ataxia type 2 there may be pathogenic contributions of glial cells other than the common astrogliotic response to neuronal damage.
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Probst-Cousin S, Neundörfer B, Heuß D. Hypoxie-induzierbare Faktoren in der Pathogenese vaskulitischer neuromuskulärer Erkrankungen. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Handschu R, Schmid A, Heckmann J, Tröscher-Weber R, Huk W, Neundörfer B, Tomandl B. Multimodales CT als Entscheidungshilfe für sofortige Therapieentscheidungen beim akuten Schlaganfall - Erfahrungen mit einem zeitkritischen Untersuchungsalgorithmus. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Heckmann J, Bleh C, Dütsch M, Lang C, Neundörfer B. Verbessert problem-orientierter Unterricht mit praktischen Übungen den Kenntnisstand der Studenten im Neurologie-Ausbildungsabschnitt des Praktischen Jahres? AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-832948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Scibor M, Heckmann J, Neundörfer B, Erbguth F, Handschu R. Probleme und Möglichkeiten der Datenübertragung - bei high-level Echtzeit-Videoübertragung zur teleneurologischen Konsultation. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Leuschner T, Neundörfer B, Heuß D. Survivin in der Pathogenese der vaskulitischen Neuropathie. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Dütsch M, Burger M, Dörfler C, Neundörfer B, Hilz M. Der Eiswassertest zeigt eine linkshemisphärische Kontrolle parasympathischer autonomer Modulation bei Patienten mit lakunären Hirninfarkten. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Stemper B, Leis S, Strauß S, Peters A, Platsch G, Neundörfer B, Heckmann J. FDG PET - wichtige Rolle bei der Diagnose der PNP? AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gaul C, Heckmann JG, Bremer J, Wasmeier G, Huk WJ, Schräder R, Neundörfer B, Nixdorff U. Thrombus am Sideris-Okkludersystem nach 6 Jahren. Dtsch Med Wochenschr 2004; 129:87-90. [PMID: 14724782 DOI: 10.1055/s-2004-816287] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HISTORY AND CLINICAL FINDINGS A 61-year-old man was admitted to hospital because of right-sided hypaesthesia. Additionally he reported a brief speech disturbance some weeks before. Neurological examination indicated right-sided sensomotoric hemiparesis and left-sided upper quadrant anopia. 6 years ago recurrent transient ischaemic attacks (TIA) was diagnosed caused by paradoxical embolism through a persistent foramen ovale (PFO). The PFO was closed with a 45 mm Sideris button occluder device. After this, he reported no symptoms of cerebral ischaemia and he did not take any antiplatelet therapy. INVESTIGATIONS Transesophageal echocardiography (TEE) showed a left atrial thrombus attached to the occluder. Cerebral computed tomography revealed infarction in regions supplied by the right posterior cerebral artery and left media cerebral artery. As additional risk factor for thrombosis a heterozygous factor V Leiden mutation was diagnosed. DIAGNOSIS Multiple cerebral infarctions caused by a thrombus attached to an occluder system 6 years after interventional closure of persistent foramen ovale in a patient with heterozygous factor V Leiden mutation. TREATMENT AND COURSE The patient was anticoagulated (phenprocoumon) and the thrombus gradually dissolved. CONCLUSION A thrombosis on a Sideris occluder device may cause cerebral infarctions even years after transcatheter closure of a PFO.
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Abstract
A 76-year old woman was admitted because of severe gait ataxia and dysarthric speech that had worsened over the last 24 h. The patient was initially suspected of having repeated transitory ischemic attacks (TIAs) as her daughter reported a similar episode that had happened 3 weeks prior to admission. The onset of spontaneous twisting, choreoathetotic movements of both hands and arms and worsening of symptoms one hour after admission together with a history of lithium therapy lead to the correct diagnosis and appropriate treatment.
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Heckmann JG, Stemper B, Ringwald J, Nixdorff U, Neundörfer B. Economy class stroke syndrome. Cerebrovasc Dis 2003; 17:88. [PMID: 14534384 DOI: 10.1159/000073908] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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