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Felfela K, Jooshani N, Möhwald K, Huppert D, Becker-Bense S, Schöberl F, Schniepp R, Filippopulos F, Dieterich M, Wuehr M, Zwergal A. Evaluation of a multimodal diagnostic algorithm for prediction of cognitive impairment in elderly patients with dizziness. J Neurol 2024:10.1007/s00415-024-12403-3. [PMID: 38702563 DOI: 10.1007/s00415-024-12403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The current diagnostic workup for chronic dizziness in elderly patients often neglects neuropsychological assessment, thus missing a relevant proportion of patients, who perceive dizziness as a subjective chief complaint of a concomitant cognitive impairment. This study aimed to establish risk prediction models for cognitive impairment in chronic dizzy patients based on data sources routinely collected in a dizziness center. METHODS One hundred patients (age: 74.7 ± 7.1 years, 41.0% women) with chronic dizziness were prospectively characterized by (1) neuro-otological testing, (2) quantitative gait assessment, (3) graduation of focal brain atrophy and white matter lesion load, and (4) cognitive screening (MoCA). A linear regression model was trained to predict patients' total MoCA score based on 16 clinical features derived from demographics, vestibular testing, gait analysis, and imaging scales. Additionally, we trained a binary logistic regression model on the same data sources to identify those patients with a cognitive impairment (i.e., MoCA < 25). RESULTS The linear regression model explained almost half of the variance of patients' total MoCA score (R2 = 0.49; mean absolute error: 1.7). The most important risk-predictors of cognitive impairment were age (β = - 0.75), pathological Romberg's sign (β = - 1.05), normal caloric test results (β = - 0.8), slower timed-up-and-go test (β = - 0.67), frontal (β = - 0.6) and temporal (β = - 0.54) brain atrophy. The binary classification yielded an area under the curve of 0.84 (95% CI 0.70-0.98) in distinguishing between cognitively normal and impaired patients. CONCLUSIONS The need for cognitive testing in patients with chronic dizziness can be efficiently approximated by available data sources from routine diagnostic workup in a dizziness center.
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Affiliation(s)
- K Felfela
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - N Jooshani
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - K Möhwald
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - D Huppert
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - S Becker-Bense
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - F Schöberl
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - R Schniepp
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - F Filippopulos
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - M Dieterich
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Cluster for Systems Neurology, SyNergy, Munich, Germany
| | - M Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - A Zwergal
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
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Masouris I, Wischmann J, Schniepp R, Müller R, Fuhry L, Hamann GF, Trumm C, Liebig T, Kellert L, Schöberl F. Basilar artery occlusion: drip-and-ship versus direct-to-center for mechanical thrombectomy within the Neurovascular Network of Southwest Bavaria (NEVAS). J Neurol 2024; 271:1885-1892. [PMID: 38095722 DOI: 10.1007/s00415-023-12126-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Recent clinical trials revealed a substantial clinical benefit for mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO). While urban areas are sufficiently covered with comprehensive stroke centers and MT expertise, rural areas lack such resources. Structured telemedical stroke networks offer rural hospitals instant consultation by stroke experts, enabling swift administration of intravenous thrombolysis (IVT) on-site and transportation for MT. For BAO patients, data on performance and clinical outcomes in telemedical stroke networks are lacking. METHODS We retrospectively analyzed data from patients with acute BAO eligible for MT: those treated directly in our comprehensive stroke center (direct-to-center/DC) and those treated in rural hospitals that were telemedically consulted by the Neurovascular Network of Southwest Bavaria (NEVAS) and transferred to our center for MT (drip-and-ship, DS). Key time intervals, stroke management performance and functional outcome after 90 days were compared. RESULTS Baseline characteristics, including premorbid status and stroke severity, were comparable. Time from symptom onset to IVT was identical in both groups (118 min). There was a delay of 180 min until recanalization in DS patients, mainly due to patient transport for MT. Procedural treatment time intervals, success of recanalization and complications were comparable. Clinical outcome at 3 months follow-up of DS patients was not inferior to DC patients. CONCLUSION We show for the first time that patients with BAO in rural areas benefit from a structured telemedicine network such as NEVAS, regarding both on-site processing and drip-and-ship for MT. Clinical outcomes are comparable among DS and DC patients.
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Affiliation(s)
- Ilias Masouris
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany.
| | - J Wischmann
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - R Schniepp
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - R Müller
- Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Guenzburg, Günzburg, Germany
| | - L Fuhry
- Department of Neurology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - G F Hamann
- Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Guenzburg, Günzburg, Germany
| | - C Trumm
- Institute of Neuroradiology, LMU University Hospital, LMU, Munich, Germany
| | - T Liebig
- Institute of Neuroradiology, LMU University Hospital, LMU, Munich, Germany
| | - L Kellert
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - F Schöberl
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
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Bücklein V, Blumenberg V, Ackermann J, Frölich L, Winkelmann M, Schmidt C, Rejeski K, Ruzicka M, Müller N, von Baumgarten L, Schöberl F, Hildebrandt M, Humpe A, Kunz W, Hoster E, von Bergwelt M, Subklewe M. EXTRANODAL DISEASE IS ASSOCIATED WITH SHORTER PROGRESSION‐FREE SURVIVAL AFTER CD19‐CAR T‐CELL THERAPY FOR RELAPSED/REFRACTORY DIFFUSE LARGE B‐CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.183_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- V. Bücklein
- University Hospital LMU Munich Department of Medicine III Munich Germany
| | - V. Blumenberg
- University Hospital LMU Munich Department of Medicine III Munich Germany
| | - J. Ackermann
- University Hospital LMU Munich Department of Medicine III Munich Germany
| | - L. Frölich
- University Hospital LMU Munich Department of Medicine III Munich Germany
| | - M. Winkelmann
- University Hospital LMU Munich Department of Radiology Munich Germany
| | - C. Schmidt
- University Hospital LMU Munich Department of Medicine III Munich Germany
| | - K. Rejeski
- University Hospital LMU Munich Department of Medicine III Munich Germany
| | - M. Ruzicka
- University Hospital LMU Munich Department of Medicine III Munich Germany
| | - N. Müller
- University Hospital LMU Munich Department of Medicine III Munich Germany
| | - L. von Baumgarten
- University Hospital LMU Munich Department of Neurosurgery Munich Germany
| | - F. Schöberl
- University Hospital LMU Munich Department of Neurology Munich Germany
| | - M. Hildebrandt
- University Hospital LMU Munich Department of Transfusion Medicine Munich Germany
| | - A. Humpe
- University Hospital LMU Munich Department of Transfusion Medicine Munich Germany
| | - W. Kunz
- University Hospital LMU Munich Department of Radiology Munich Germany
| | - E. Hoster
- LMU Munich Institute for Medical Information Processing, Biometry, and Epidemiology Munich Germany
| | - M. von Bergwelt
- University Hospital LMU Munich Department of Medicine III Munich Germany
| | - M. Subklewe
- University Hospital LMU Munich Department of Medicine III Munich Germany
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Grosch M, Schöberl F, Levin J, Bötzel K, Dieterich M, Zwergal A. FV16 [18F]FDG-PET imaging of supraspinal locomotor control in Parkinson’s disease. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Selge C, Kümpfel T, Havla J, Schöberl F, Danek A, Reilich P. [Seronegative myasthenic syndrome?]. Nervenarzt 2020; 91:150-152. [PMID: 31535177 DOI: 10.1007/s00115-019-00810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- C Selge
- Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland.
| | - T Kümpfel
- Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
| | - J Havla
- Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
| | - F Schöberl
- Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
| | - A Danek
- Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
| | - P Reilich
- Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
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Zwergal A, Schöberl F, Möhwald K, Höglinger G, Brandt T, Dieterich M. P22. Long-term course of progression of clinical ocular motor signs in progressive supranuclear palsy. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zwergal A, Irving S, Trapp C, Pradhan C, Dieterich M, Brandt T, Schöberl F. P 144 Longer-term spatial navigation deficits in transient global amnesia – a follow-up study. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schöberl F, Csanadi E, Eren O, Dieterich M, Kümpfel T. NMOSD triggered by yellow fever vaccination – An unusual clinical presentation with segmental painful erythema. Mult Scler Relat Disord 2017; 11:43-44. [DOI: 10.1016/j.msard.2016.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 11/25/2016] [Indexed: 11/25/2022]
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Schöberl F, Eren OE, Wollenweber FA, Kraus T, Kellert L. [Sporadic Cerebral Amyloid Angiopathy: An Overview with Clinical Cases]. Fortschr Neurol Psychiatr 2016; 84:534-41. [PMID: 27607067 DOI: 10.1055/s-0042-109537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sporadic cerebral amyloid angiopathy (CAA) is a cerebral small vessel disease in the elderly. Neuropathologically, it is characterized by deposition of amyloid-ß (Aß) in the wall of small to medium-sized arteries, capillaries and venules of the cerebral cortex and leptomeninges. Over the last years it was recognized as an important cause of spontaneous intracerebral hemorrhage and cognitive deficits in the elderly. The clinical and radiological manifestations are diverse ranging from acute onset focal neurological deficits due to intracerebral lobar hemorrhage to subacute progressive cognitive impairment due to Aß-mediated inflammation confluent subcortical edema. The wide clinico-radiological spectrum of CAA is a major challenge for the neurologist and stroke physician. This review provides a structured and detailed look at recent developments in CAA, and is illustrated with case studies.
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Affiliation(s)
- F Schöberl
- Neurologische Klinik und Poliklinik & Deutsches Schwindel- und Gleichgewichtszentrum DSGZ, Klinikum der Universität München
| | - O E Eren
- Neurologische Klinik und Poliklinik & Deutsches Schwindel- und Gleichgewichtszentrum DSGZ, Klinikum der Universität München
| | - F A Wollenweber
- Institut für Schlaganfall- und Demenzforschung, Klinikum der Universität München
| | - T Kraus
- Zentrum für Neuropathologie und Prionforschung, Klinikum der Universität München
| | - L Kellert
- Neurologische Klinik und Poliklinik & Deutsches Schwindel- und Gleichgewichtszentrum DSGZ, Klinikum der Universität München
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Zwergal A, Schöberl F, Patzig M, Forbrig R, Brandt T, Dieterich M. EPV 20. Vascular encephalopathy is a major risk factor for poor vestibular compensation. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Schniepp R, Wuehr M, Schöberl F, Zwergal A. Erfassung motorisch-kognitiver Interaktionen bei Demenzerkrankungen im klinischen Alltag. Fortschr Neurol Psychiatr 2016; 84:469-79. [DOI: 10.1055/s-0042-110651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- R. Schniepp
- Klinik und Poliklinik für Neurologie, Campus Großhadern, Ludwig-Maximilians-Universität, München
| | - M. Wuehr
- Deutsches Zentrum für Schwindel und Gleichgewichtsstörungen (DSGZ), Campus Großhadern, Ludwig-Maximilians-Universität, München
| | - F. Schöberl
- Klinik und Poliklinik für Neurologie, Campus Großhadern, Ludwig-Maximilians-Universität, München
| | - A. Zwergal
- Klinik und Poliklinik für Neurologie, Campus Großhadern, Ludwig-Maximilians-Universität, München
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Feil K, Böttcher N, Guri F, Krafczyk S, Schöberl F, Zwergal A, Strupp M. Long-term course of orthostatic tremor in serial posturographic measurement. Parkinsonism Relat Disord 2015; 21:905-10. [PMID: 26071126 DOI: 10.1016/j.parkreldis.2015.05.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 11/17/2022]
Affiliation(s)
- K Feil
- Department of Neurology, University Hospital Munich, Campus Grosshadern, Munich, Germany; German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany.
| | - N Böttcher
- Department of Neurology, University Hospital Munich, Campus Grosshadern, Munich, Germany; German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany.
| | - F Guri
- Department of Neurology, University Hospital Munich, Campus Grosshadern, Munich, Germany.
| | - S Krafczyk
- Department of Neurology, University Hospital Munich, Campus Grosshadern, Munich, Germany; German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany.
| | - F Schöberl
- Department of Neurology, University Hospital Munich, Campus Grosshadern, Munich, Germany; German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany.
| | - A Zwergal
- Department of Neurology, University Hospital Munich, Campus Grosshadern, Munich, Germany; German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany.
| | - M Strupp
- Department of Neurology, University Hospital Munich, Campus Grosshadern, Munich, Germany; German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany.
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Schöberl F, Xiong G, Feil K, Bartenstein P, Fougere CL, Brandt T, Jahn K, Strupp M, Dieterich M, Zwergal A. V12. [18F]-FDG-PET imaging of the cerebral orthostatic tremor network during stance. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schöberl F, Kugler G, Kohlbecher S, Werner P, Xiong G, la Fougere C, Schneider E, Brandt T, Dieterich M, Jahn K, Zwergal A. Hirnaktivierung während realer 3D-Navigation. KLIN NEUROPHYSIOL 2014. [DOI: 10.1055/s-0034-1371204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schöberl F, Zwergal A, Engmann J, Kugler G, Kohlbecher S, Xiong G, Brandt T, Dieterich M, Schneider E, LaFougère C, Jahn K. Unterschiedliche Navigationsstrategien von Frauen und Männern in realer Umgebung und ihre Korrelate im Hirnaktivierungsmuster. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zwergal A, Schöberl F, Kugler G, Kohlbecher S, Engler J, Xiong G, Brandt T, Dieterich M, Dichgans M, Bürger K, Schneider E, la Fougere C, Jahn K. Spatial orientation deficits in mild cognitive impairment. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zwergal A, Xiong G, Schlichtiger J, Schöberl F, Strupp M, Jahn K, Dieterich M, Bartenstein P, la Fougère C. Altersabhängigkeit der zentralen vestibulären Kompensation - Erkenntnisse einer vergleichenden mikroPET-Verhaltensstudie im Rattenmodell. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Flamm D, Schöberl F, Uematsu H. A peculiar relation between mass and energy with respect to the Schrödinger equation. Phys Rev D Part Fields 1987; 36:2176-2177. [PMID: 9958417 DOI: 10.1103/physrevd.36.2176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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