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Berger K, Weltermann B, Kolominsky-Rabas P, Meves S, Heuschmann P, Böhner J, Neundörfer B, Hense HW, Büttner T. [The reliability of stroke scales. The german version of NIHSS, ESS and Rankin scales]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 1999; 67:81-93. [PMID: 10093781 DOI: 10.1055/s-2007-993985] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aim of the study was the translation of three frequently used stroke scales ("National Institutes of Health Stroke Scale" NIHSS, "European Stroke Scale" ESS and "Rankin Scale") into German and the analysis of the interrater reliability of the respective German versions. The translation process followed the protocol of the Medical Outcomes Trust (Boston) and included two independent forward, one backward translation and a consensus conference for the German versions. Interrater reliability was assessed using the weighted kappa statistic. For this study 43 patients with an ischemic stroke determined by computed tomography or magnetic resonance imaging were recruited from two university hospitals. Excluded were patients with an intracerebral hemorrhage or TIA. The interrater reliability of the three German versions was substantial to excellent. Mean Kappa for the NIHSS was 0.80, for the ESS 0.79 and 0.76 for the Rankin Scale using simple weights in the analysis. Additional analysis revealed the influence of preselected weights on the results of the kappa statistic. The use of German versions of frequently used stroke scales can reduce bias that is introduced by different levels of knowledge of the English language and thus improve the standardised assessment of neurological deficits in stroke.
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Heckmann JG, Lang CJ, Neundörfer B. Comment on the paper: Batchelor TT, Platten M, Palmer-Toy DE, Hunter GJ, Lev MH, Dalmau J, Hochberg FH: Chorea as a paraneoplastic complication of Hodgkin's disease. Journal of Neuro-Oncology 36: 185-190, 1998. J Neurooncol 1999; 41:95-6. [PMID: 10222428 DOI: 10.1023/a:1006110127226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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203
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Neundörfer B. [Therapy of polyneuropathies]. Dtsch Med Wochenschr 1998; 123:1553-5. [PMID: 9893682 DOI: 10.1055/s-2007-1023889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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204
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205
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Neundörfer B, Reinhardt F. [Polyneuropathies from solvents]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 1998; 66:539-44. [PMID: 9922926 DOI: 10.1055/s-2007-995296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Polyneuropathy is a clinically diagnosed disorder. The diagnostic features consist mainly of subjective complaints about distally marked paresthesia or dysaesthesia, pain and motor disturbances like cramps. Neurological examination typically shows weak or absent tendon reflexes (early signs: weak or absent Achilles tendon reflexes), distally marked disturbances of sensitivity (early sign: reduced sense of vibration), atrophic paresis, cranial nerve impairment and disturbances of the autonomic nervous system. Results of additionally performed electrophysiological examinations (nerve conduction studies, vibratometry and thermotesting) contribute to the diagnosis. Polyneuropathy is undoubtedly induced by carbon disulfite, ethylene glycol, n-hexane and methyl-n-butylketone, triorthocresyl phosphate and solvent mixtures. Induction of polyneuropathy is doubtful with the following substances: tetrachloride, trichlorethylene, styrene, toluene. Additional impairment of the central nervous system is often indicated by clinical findings of brisk patellar tendon reflexes or the occurrence of Babinski's sign.
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206
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Druschky A, Erbguth F, Strauss R, Helm G, Heckmann J, Neundörfer B. Central nervous system involvement in thrombotic thrombocytopenic purpura. Eur Neurol 1998; 40:220-4. [PMID: 9813405 DOI: 10.1159/000007983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Thrombotic thrombocytopenic purpura (TTP) is an uncommon multisystem disease characterized by microangiopathic hemolytic anemia, thrombocytopenic purpura, fluctuating neurologic dysfunctions, renal disease, and fever. Delayed diagnosis and treatment may lead to a high mortality rate that can be as great as 90%. We describe 7 patients in whom CNS involvement was the first clinical manifestation of TTP. Despite early diagnosis and treatment, 3 patients died because of multiple system organ failure. Four patients recovered completely. In patients with focal neurologic disorders in whom infectious CNS diseases were excluded TTP should be considered in the differential diagnosis.
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Abstract
A review of all published cases of iatrogenic Creutzfeldt-Jakob disease (CJD) via dural (N=71) and corneal (N=4) transplants is given. All but three of the dural cases were obviously due to a commercial product recalled in 1996. Two of the corneal grafts were taken from patients who had died of sporadic CJD. These cases differed from CJD due to human growth hormone injections and the new variant. Instead. they were akin to sporadic cases, but memory loss, disorders of higher cerebral functions and extrapyramidal signs were fewer, while cerebellar abnormalities were more frequent. Progressive dysarthria and gait disorder/gait ataxia were prominent signs during the early stages, myocloni the most salient feature later. A nonperiodic EEG did not contradict the diagnosis. Using current diagnostic criteria the disease was underdiagnosed ante mortem. Utmost care is needed in selecting, harvesting and handling dural and corneal grafts to avoid inadvertent transmission of CJD.
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Hilz MJ, Dütsch M, Neundörfer B. [Autonomic disorders in polyneuropathies]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1998; 93:533-40. [PMID: 9792019 DOI: 10.1007/bf03042662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many polyneuropathies manifest autonomic disturbances. Diabetic neuropathy, the most frequent neuropathy in the western world, serves as model of the symptomatology of autonomic disturbances. DIABETIC NEUROPATHY Clinical symptoms comprise pupillary and cardiovascular dysfunction such as orthostatic hypotonia and syncopes, thermoregulatory, gastrointestinal symptoms, disturbances in urogenital and respiratory function and unawareness of hypoglycemia. OTHER NEUROPATHIES This article also describes autonomic symptoms in alcoholic neuropathy, in Guillain-Barré syndrome, in paraneoplastic polyneuropathies, in toxic neuropathies, in acute and subacute autonomic neuropathy, in amyloidosis, in porphyria, in familiar dysautonomia, in HIV infection and in botulism.
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Hilz MJ, Axelrod FB, Hermann K, Haertl U, Duetsch M, Neundörfer B. Normative values of vibratory perception in 530 children, juveniles and adults aged 3-79 years. J Neurol Sci 1998; 159:219-25. [PMID: 9741411 DOI: 10.1016/s0022-510x(98)00177-4] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Impaired vibratory perception is an early and frequent finding in various neuropathies. Quantitative vibratory threshold assessment refines the diagnosis of neuropathies but is based on psychophysical techniques requiring patient cooperation. Large, age and sex matched normative data bases are needed to better identify abnormal vibratory perception. In this study vibratory perception was tested at the second metacarpal bone and above the first metatarsal bone of 530 children, juveniles and adults aged 3.3-79.2 years. Thresholds assessed with a 128 Hz graded Rydel-Seiffer tuning fork, TF, were compared to three Vibrameter values, the vibration perception thresholds, VPT, determined with increasing vibration stimuli, the vibration disappearance threshold, VDT, determined with decreasing supraliminal stimuli, and the vibration threshold VT which equals the mean of VPT and VDT. The influence of gender, age, body height, weight and skin temperature at the tested site on thresholds was studied. Retest reliability was tested in 73 children aged 3.3-6.9 years and in 20 volunteers aged 5.2-66.1 years who were also tested for the influence of pretest skin warming on thresholds and for differences between results of the left and right body side. TF, VPT, VDT, VT were closely correlated with each other (Spearman: -0.67<Rs<-0.47; P<0.01). The skin temperature, body side, weight and height did not influence thresholds. In adults, thresholds increased with age and were higher in men above the age of 50 than in women of the same age. Thresholds at the feet were higher than at the hands (Wilcoxon: P<0.001). Retest reliability was high and did not depend on the retest interval. The study provides important normative data for the widespread use of quantitative vibration testing.
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Heckmann JG, Böhmer K, Druschky A, Winterholler M, Neundörfer B. Guillain-Barré syndrome in association with focal segmental glomerulosclerosis. Eur Neurol 1998; 40:114-5. [PMID: 9776633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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212
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Heckmann JG, Stefan H, Groh MJ, Winterholler M, Neundörfer B. [A rare cause of peracute vision loss: pseudotumor cerebri. Case report of course with recurrence after decompression of the optic nerve]. DER NERVENARZT 1998; 69:702-6. [PMID: 9757423 DOI: 10.1007/s001150050332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In primary pseudotumor cerebri (PTC) intracranial pressure is elevated by so far unknown mechanisms. There is a wide range of clinical courses. Therapy is controversial. We present a case of PTC with acute visual loss. After optic nerve sheath decompression a relapse occurred. A 30-year old female patient experienced visual loss within 48 h accompanied by headache and slight neck stiffness. Visual acuity was 1/50 in the right eye; in the left eye just hand movements and light were perceived. Fundoscopy revealed a 9 dptr. prominent optic disc bilaterally. After optic nerve sheath decompression (ONSD) she improved, but underwent a relapse after 3 months. Twenty-four-hour measurement of intracranial pressure revealed elevated values. As a consequence ventriculo-peritoneal shunting was performed, leading to prominent improvement. Primary PTC can cause acute visual loss. If conservative treatment fails, different surgical procedures should be considered.
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213
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Muhr-Becker D, Ziegler AG, Druschky A, Wolfram G, Haslbeck M, Neundörfer B, Standl E, Schnell O. Evidence for specific autoimmunity against sympathetic and parasympathetic nervous tissues in Type 1 diabetes mellitus and the relation to cardiac autonomic dysfunction. Diabet Med 1998; 15:467-72. [PMID: 9632120 DOI: 10.1002/(sici)1096-9136(199806)15:6<467::aid-dia621>3.0.co;2-q] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is growing evidence for the involvement of immunological factors in the pathogenesis of cardiac autonomic dysfunction in Type 1 diabetes mellitus (DM). To evaluate the presence of autoantibodies against autonomic nervous tissues and their relationship with tests of autonomic function, 64 newly diagnosed and 142 long duration Type 1 DM patients were investigated for sympathetic and parasympathetic ganglia (CF-SG and CF-PSG) autoantibodies with a complement-fixing indirect immunofluorescence technique. Five cardiac reflex tests were performed to assess autonomic function. Fifty-seven patients with neurological diseases other than diabetic neuropathy and 131 healthy control subjects were also tested for CF-SG and CF-PSG autoantibodies. CF-SG autoantibodies were observed in 47 (23%) and CF-PSG autoantibodies in 21 (10%) of 206 Type 1 DM patients (p < 0.001). In contrast, these autoantibodies were detected in 3 (5%) and 1 (2%) of patients with non-diabetic neurological diseases and 3 (2%) and 4 (3%) of control subjects (p < 0.01, p < 0.05, p < 0.0001, p < 0.05 vs Type 1 DM patients). All except two Type 1 DM patients with CF-PSG autoantibodies also presented with CF-SG autoantibodies. In diabetic patients with long duration, CF-SG autoantibodies were more frequent in patients with ECG-based cardiac autonomic neuropathy (CAN; > or =2 of 5 cardiac reflex tests abnormal) compared to patients without CAN although this did not reach statistical significance (29% vs 17%, p = 0.06). However, 4 (80%) of 5 newly diagnosed and 23 (32%) of 73 established Type 1 DM patients with abnormalities in heart rate variation during deep breathing and/or standing from lying presented with CF-SG autoantibodies compared to 12 (25%) of 58 newly diagnosed (p < 0.05) and 7 (11%) of 63 established Type 1 DM patients (p < 0.01), in whom both tests were normal. The results suggest that autoimmune factors contribute to the pathogenesis of cardiac autonomic dysfunction in Type 1 DM and that autoantibodies against sympathetic and parasympathetic nervous tissues are relatively specific for Type 1 DM.
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Heckmann JG, Bockhorn J, Stolte M, Druschky A, Neundörfer B. An instructive false diagnosis: steroid-induced complete remission of a CNS tumor--probably lymphoma. Neurosurg Rev 1998; 21:48-51. [PMID: 9584286 DOI: 10.1007/bf01111485] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In recent years the incidence of primary cerebral lymphomas has increased. Diagnosis by imaging techniques (CCT, angiography, MRT) and stereotactic biopsy are considered as reliable diagnostic tools. Therapeutically a combination of radio-, steroid- and chemotherapy is recommended. We report a case of space-occupying CNS lesion in which the radiopaque enhancing process completely disappeared after biopsy and steroid therapy. A year later the tumor recurred on the other side and again regressed after steroid therapy. The first biopsy showed signs of a papillar tumor, so a choroid plexus papilloma was suspected. On examination of the treatment history, however, this diagnosis had to be revised. A primary CNS lymphoma seems most probable. The phenomenon of a tumor remission under steroid administration and the problems related to the differential diagnosis are discussed.
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215
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Riedl B, Nischik M, Birklein F, Neundörfer B, Handwerker HO. Spatial extension of sudomotor axon reflex sweating in human skin. JOURNAL OF THE AUTONOMIC NERVOUS SYSTEM 1998; 69:83-8. [PMID: 9696262 DOI: 10.1016/s0165-1838(98)00016-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Acetylcholine (ACh) applied to human skin is known to elicit a sweat response, which consists of a direct muscarinergic (M3) activation of sweat glands and a nicotinic axon reflex response from sudomotor terminals. To visualize the extent of axon reflex sweating after ACh-iontophoresis, iodine starch staining was used. Iontophoresis was performed under occlusion at the peroneal aspects of the lower leg and the center of the foot dorsum of healthy volunteers (n = 10). Ten minutes after stimulation, the area of dark blue staining was recorded by a video camera. Control experiments were performed with saline, histamine, pilocarpine and nicotine iontophoresis. The stained area was measured and the maximum and minimum distance of its boundary from the edge of the iontophoresis probe was determined (maximum/minimum radius). Sizes of stained areas and maximum radii were significantly greater on the lower leg compared to the foot (P < 0.01). The median sizes of the stained areas on the leg were 14.6 cm2 and on the foot dorsum 8.0 cm2. The respective median maximum radii were 3.1 cm on the leg and 2.3 cm on the foot dorsum (median minimum, leg 1.1 cm, foot 0.8 cm). These results match microneurographic findings of innervation territories of sympathetic efferent units. Area sizes of stained skin showed a close correlation between both stimulation sites (R = 0.96, P < 0.01), i.e. the sizes of sweat responses on leg and foot show a constant relation (foot/leg = 0.57) in spite of their great interindividual variability. This novel technique of establishing sweat responses provides information on the size of sudomotor innervation territories and may be useful for clinical studies in patients with suspected impairment of sympathetic functions.
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216
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Heckmann JG, Hilz MJ, Katalinic A, Marthol H, Mück-Weymann M, Neundörfer B. Myogenic cerebrovascular autoregulation in migraine measured by stress transcranial Doppler sonography. Cephalalgia 1998; 18:133-7. [PMID: 9595205 DOI: 10.1046/j.1468-2982.1998.1803133.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Transcranial Doppler sonography (TCD) studies may help to elucidate the nature and role of vascular abnormalities in migraine. Our aim in this study was to evaluate cerebrovascular autoregulative response in migraine patients with and without aura to blood pressure increase using stress TCD. PATIENTS AND METHODS Using transcranial Doppler ultrasound at rest and during ergometer stress (stress TCD), we studied the changes in mean flow velocities and resistance index (RI) in relation to physical stress in the middle cerebral artery. Fifteen migraine patients without aura, 15 migraine patients with aura, and 15 healthy control subjects were examined. Patients suffered from predominantly unilateral headache and were studied during an attack-free period. The Pourcelot's RI as a measure of cerebrovascular reactivity was calculated by dividing the difference between systolic and diastolic velocity by the systolic velocity. RESULTS None of the subgroups showed any difference during ergometer exercise with regard to blood pressure, endtidal CO2, heart rate, or mean flow velocity. In all subgroups, sufficient physical stress was achieved. With respect to RI change, migraine patients without aura and healthy controls did not differ (p > 0.05). However, the RI change of migraine patients with aura was significantly lower than the RI change of migraine patients without aura or healthy subjects (p > 0.05). The discrimination analysis showed in addition that RI change (absolute and as a percentage) and mean flow velocity change (as a percentage) could be used as diagnostic variables to detect patients with aura symptoms. CONCLUSION Differences exist in cerebrovascular reactivity in migraine patients with aura that may contribute to the neurologic disturbances in these patients during attack. We propose that there is disorder of myogenic cerebrovascular autoregulation in migraine patients with aura during headache-free intervals.
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217
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Birklein F, Riedl B, Claus D, Neundörfer B. Pattern of autonomic dysfunction in time course of complex regional pain syndrome. Clin Auton Res 1998; 8:79-85. [PMID: 9613797 DOI: 10.1007/bf02267817] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The objective of the present investigation was to describe and localize autonomic dysfunction in acute and chronic stages of complex regional pain syndrome (CRPS). Patients were investigated twice: the first investigation was performed as soon as diagnosis was established during the acute stage of CRPS and the second investigation was performed about 2 years later. Twenty-one patients completed the follow-up investigation. The median duration of CRPS was 5 (range 2-21) weeks at first investigation and 94 weeks (22-148) at follow-up. Skin temperature was recorded by thermography, sudomotor function was assessed by thermoregulatory sweat test (TST) and quantitative sudomotor axon reflex test (QSART). Skin temperature was warmer on the affected side at the first investigation (P < 0.001) and colder at follow-up (P < 0.02) compared with the contralateral limb. Sudomotor output was enhanced after both TST (P < 0.005) and QSART (P < 0.05) at the first investigation on the affected side. However, at follow-up, sweating after TST was still increased (P < 0.04) while QSART responses were not different between the affected and unaffected limbs. As compared to controls there was no statistically significant difference, neither in skin temperature nor sweating, neither on the affected nor on the unaffected side. In conclusion, the present investigation proved that vasomotor and sudomotor control are substantially altered in CRPS. In the acute stage vasomotor control is decreased in the affected limb whereas sudomotor function is enhanced. This may be the result of disturbances of thermoregulation, but different secondary peripheral mechanisms, concerning vasomotor and sudomotor function, contribute to clinical presentation of CRPS and affect autonomic function at all stages of CRPS.
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218
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Heckmann JG, Mück-Weymann M, Katalinic A, Hilz MJ, Claus D, Neundörfer B. [Transcranial Doppler exercise test in patients with chronic tension headache]. DER NERVENARZT 1998; 69:131-6. [PMID: 9551457 DOI: 10.1007/s001150050249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the etiopathology of tension type headache, vascular and autonomic disorders are discussed. Fifteen patients with chronic tension type headache according to the criteria of the IHS were investigated using the TCD-ergometer-test--a method used to evaluate the myogenic mechanism of cerebrovascular autoregulation--and the results were compared with the findings in fifteen healthy control subjects. The patients' Mean Flow Velocity (TAVmean) and Resistance Index (RI) at rest and after exercise were significantly decreased (p < 0.05). During exercise they normalized. The patients' endtidal pCO2 at rest and during exercise was significantly lower than the corresponding values of the control group (p < 0.05). Regarding blood pressure elevation and heart rate increase during exercise both groups did not differ significantly (p > 0.05). These findings suggest that patients with tension type headache have a diminished vascular tone in the cerebral vessels at rest which is normalised during exercise. The reduced endtidal pCO2 is considered as a physiological response to increase vascular tone via metabolic mechanism of cerebrovascular autoregulation. In conclusion it is suggested that therapeutic procedures which activate sympathetic autonomic nervous function to train cerebral vessels should be more carefully considered.
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219
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Heckmann JG, Niedermeier W, Neundörfer B. [Indications for acetazolamide in neurology]. Internist (Berl) 1998; 39:221. [PMID: 9556741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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220
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Neundörfer B, Hilz MJ. Ludwig Robert Müller (1870-1962)--a pioneer of autonomic nervous system research. Clin Auton Res 1998; 8:1-5. [PMID: 9532414 DOI: 10.1007/bf02267597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ludwig Robert Müller, MD, professor of internal medicine, born in 1870 in Augsburg, Bavaria, studied medicine from 1890 to 1893 in various European cities and specialized in pathology and bacteriology. In 1895, he joined A. Strümpell, one of Germany's outstanding internists and neurologists, in Erlangen, Germany. Henceforth, Müller focused on the autonomic nervous system. In his 1898 Habilitation, a thesis required to join the academic faculty, which he entitled Anatomy and pathology of the lower spinal cord, he presented studies on the autonomic innervation of the bladder and colon. Based on animal studies, he continued to publish essential findings on the autonomic innervation of heart, lungs, and gastrointestinal tract. Müller was the first to report afferent pathways from internal organs to the brain. His book The vegetative nervous system was first published in 1920. In 1931, he wrote the book Lebensnerven und Lebenstriebe (Life nerves and life instincts). Many of his papers dealt with the regulation of thirst, hunger and sleep. He was Chairman of Internal Medicine in Würzburg, Germany, from 1914 to 1920, and also in Erlangen as Strümpell's successor from 1920 to 1936. The broad scope of Müller's publications makes him one of the important pioneers of autonomic nervous system research.
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221
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Reinhardt F, Erbguth F, Neundörfer B. [Invasive therapeutic strategies in the acute phase of ischemic arterial cerebral infarct]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1998; 93:27-33. [PMID: 9505076 DOI: 10.1007/bf03045037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Currently to an increasing extent aggressive therapeutic approaches in ischemic stroke are discussed. These approaches include intraarterial and systemic thrombolysis to reduce infarction size and also decompressive surgical measures to prevent from fatal consequences of elevated intracranial pressure. This report gives an overview over these strategies. Their specific values are discussed. STRATEGIES In acute vertebrobasilar artery occlusion an attempt of intraarterial thrombolysis is indicated because of the mostly poor prognosis of large brainstem infarction. Acute artery occlusion in carotid territory has a better prognosis, so that the indication of intraarterial thrombolysis has to be regarded more critically. In view of recent reports systemic rt-PA-thrombolysis seems to be justified in well defined cases independently from site of occlusion. At present there is no longer doubt about the benefit of decompressive surgery in space occupying cerebellar stroke. The value of surgery in malignant brain infarction in carotid territory is not clear due to date. Further randomised studies are necessary to learn more about benefit, risks and required proceedings in space occupying supratentorial infarction. CONCLUSIONS A well defined group of patients suffering from ischemic stroke seems to benefit from aggressive therapeutic approaches in ischemic stroke. Concerning the selection of patients and management of those approaches a close cooperation with an experienced center is required.
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Heckmann J, Holbach L, Huk W, Druschky A, Wigand M, Neundörfer B. Unifocal eosinophilic granuloma (Langerhans cell histiocytosis) of the supratemporal orbital bone in an adult. Neuroophthalmology 1998. [DOI: 10.1076/noph.19.1.49.3694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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223
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Winterholler M, Erbguth F, Neundörfer B. [The use of alternative medicine by multiple sclerosis patients--patient characteristics and patterns of use]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 1997; 65:555-61. [PMID: 9451568 DOI: 10.1055/s-2007-996363] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
UNLABELLED The use of alternative medicine is growing in all Western countries. Little is known about the modalities and patterns of use of alternative medicine by patients suffering from multiple sclerosis. PATIENTS AND METHODS We analysed an anonymous questionnaire that was sent to and answered by 129 former inpatients who had multiple sclerosis diagnosed by typical clinical and laboratory findings. RESULTS 82 of 129 patients (63.6%) have been using alternative therapies. They were treated with a total of 87 different alternative healing methods or substances. Some patients used up to 9 different methods. The mean duration of the alternative treatment was 2.6 (0-20) years. Most patients used homoeopathy (n = 35), herbs (29 different substances, 32 users), different relaxation methods like yoga (n = 38) and various diets (n = 21). The most important motivation to look for alternative medicine was the aim to participate actively in the healing process. Most patients thought that there was some positive effect from the alternative treatment but did not inform their general practitioner or neurologist about it. DISCUSSION Like in other chronic diseases many MS-patients use alternative medicine. The experiences of these treatments forms part of the patient's coping with the disease.
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Heub D, Neundörfer B. Light-microscopic study of the beta 1 integrin subunit in human skeletal muscle. Clin Neuropathol 1997; 16:319-27. [PMID: 9401799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The beta 1 integrin subunit is identical with the CD29 antigen, which is found at the surface of leukocytes. Integrins are involved in cell-cell and cell-matrix adhesion, mediate neuronal attachment and neurite outgrowth in response to extracellular matrix proteins in cell culture systems. A few analyses of beta 1 integrin subunit have been done on developing and regenerating skeletal muscle in animals; but cell culture systems and animal models differ in some respects from human skeletal muscle in situ. The expression of a beta 1 integrin subunit variant in human skeletal muscle was reported merely by Western blot analysis. Our present study, performed with immunohistochemical procedures, attempts to demonstrate the expression of the beta 1 integrin subunit in developing, normal adult, and diseased human skeletal muscles. The results demonstrated that the beta 1 integrin subunit is expressed in developing, normal adult, regenerating, and denervated human skeletal muscle. In developing muscle, the beta 1 integrin subunit was observed in muscle cells at least from 12 to 16 weeks of gestation. In muscular dystrophy and inflammatory myopathy the beta 1 integrin subunit staining occurs in basophilic muscle fibers. Furthermore, the beta 1 integrin subunit is expressed in mature fast twitch type 2 fibers, and in denervated myocytes in neurogenic muscular atrophy. On serial sections, the beta 1 integrin subunit, N-CAM (neural cell adhesion molecule) and vimentin are expressed in identical muscle fibers. However, in mature fast twitch type 2 fibers the beta 1 integrin subunit is expressed exclusively and in neurogenic muscular atrophy vimentin expression is weak. In conclusion, the beta 1 integrin subunit, in human skeletal muscles, probably plays a role in the growth morphology and innervation of developing, regenerating, and denervated myocytes. Furthermore, the observation that the beta 1 integrin subunit is enriched in mature fast twitch type 2 fibers indicates that the beta 1 integrin subunits may play a role in transducing mechanical forces to extracellular matrix proteins.
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Birklein F, Claus D, Riedl B, Neundörfer B, Handwerker HO. Effects of cutaneous histamine application in patients with sympathetic reflex dystrophy. Muscle Nerve 1997; 20:1389-95. [PMID: 9342155 DOI: 10.1002/(sici)1097-4598(199711)20:11<1389::aid-mus6>3.0.co;2-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Thirty-six patients suffering from acute reflex sympathetic dystrophy (RSD) were examined in order to evaluate nociceptive C-fibers. Axon reflex vasodilatation was induced by iontophoresis of histamine and recorded (laser Doppler flux). The strength of concomitant sensation was rated on a visual analogue scale, and the quality was characterized as itching or burning pain. Skin temperature was recorded by infrared thermography. The results were compared with investigations of unaffected limbs of patients and volunteers. The histamine-induced sensation on the symptomatic side was more often burning pain than itching (P < 0.001), and skin temperature was increased on the affected limb (P < 0.001). Axon reflex vasodilatation and the strength of sensations were unaltered. In conclusion, this study rules out a significant deterioration of afferent C-fibers in RSD, but gives evidence of sensitization of nociceptive function. This nociceptive sensitization has to be taken into consideration for effective treatment of RSD.
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