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Celik E, Goertz L, Ozpeynirci Y, Schlamann M, Dorn F, Lehnen N, Siebert E, Liebig T, Kabbasch C. Comparative assessment of woven endobridge embolization and standard coil occlusion for the treatment of ruptured basilar tip aneurysms. Neuroradiology 2023; 65:765-773. [PMID: 36460785 DOI: 10.1007/s00234-022-03096-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Endovascular coil occlusion represents the standard treatment for basilar tip aneurysms. Recently, this role has been rivalled by intrasaccular flow disruptors across numerous centres. We retrospectively compared WEB embolization and coiling for the treatment of ruptured basilar tip aneurysms. METHODS Patients treated with WEB or coiling at four neurovascular centres were reviewed. Procedure-related complications, clinical outcome, and angiographic results were retrospectively compared. RESULTS The study included 23 patients treated with the WEB (aneurysm size: 6.6 ± 1.9 mm) and 56 by coiling (aneurysm size: 6.7 ± 2.5 mm). Stent-assistance was more often necessary with coiling than with WEB embolization (32% vs. 4%, p = 0.009). A modified Rankin scale score ≤ 2 at discharge had 21 (37.5%) patients in the coiling group and 12 (52.2%) in the WEB group (p = 0.235). Immediate complete and adequate occlusion rates were 52% for the WEB and 87% for coiling. At short-term follow-up, these rates were 87% for the WEB and 72% for coiling, respectively. There was no delayed aneurysm re-bleeding during follow-up. CONCLUSION Both coiling and WEB seem to prevent rebleeding in ruptured BTA aneurysms. WEB embolization required less frequently stent-support than coiling, potentially advantageous for SAH patients to avoid anti-platelet therapy in the light of concomitant procedures like ventricular drainage.
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Affiliation(s)
- Erkan Celik
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany.
| | - Lukas Goertz
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Yigit Ozpeynirci
- Department of Neuroradiology, Ludwig's Maximilian University Munich, Munich, Germany
| | - Marc Schlamann
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Nils Lehnen
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, University Hospital of Berlin (Charité), Berlin, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Ludwig's Maximilian University Munich, Munich, Germany
| | - Christoph Kabbasch
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
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Paech D, Lehnen N, Lakghomi A, Schievelkamp A, Gronemann C, Bode FJ, Radbruch A, Dorn F. School of Thrombectomy-A 3-Step Approach to Perform Acute Stroke Treatment with Simulator Training and Virtual Supervision by Remote Streaming Support (RESS). Clin Neuroradiol 2022; 33:529-535. [PMID: 36520188 PMCID: PMC9753868 DOI: 10.1007/s00062-022-01242-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/29/2022] [Accepted: 09/26/2022] [Indexed: 12/23/2022]
Abstract
As the number of neurointerventional procedures continues to increase, so does the need for well-trained neurointerventionalists. The purpose of this work was to establish and assess a systematic 3‑step approach to perform acute stroke treatment including simulator training and virtual supervision by remote streaming support (RESS). Five trainees (four men, one women) who have completed the 3‑step approach have answered an 11-item questionnaire (5-point Likert scale) in order to evaluate training step 1 (simulator). Furthermore, all trainees and one supervisor (female) answered a standardized questionnaire following the initial 15 consecutive thrombectomies for each trainee, corresponding to a total of 75 thrombectomies. The simulator training yielded learning benefits and confidence gain to perform MT on patients. The RESS approach facilitated the translation during the first independently performed thrombectomies on patients. In summary, the presented 3‑step approach increases the level of safety, as reported by the trainees and supervisor in this study and may enable an accelerated training of neurointerventionalists.
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Affiliation(s)
- Daniel Paech
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Nils Lehnen
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Asadeh Lakghomi
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Arndt Schievelkamp
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christian Gronemann
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Felix J. Bode
- grid.15090.3d0000 0000 8786 803XClinic for Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Radbruch
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Franziska Dorn
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Schmeel FC, Enkirch SJ, Luetkens JA, Faron A, Lehnen N, Sprinkart AM, Schmeel LC, Radbruch A, Attenberger U, Kukuk GM, Mürtz P. Diagnostic Accuracy of Quantitative Imaging Biomarkers in the Differentiation of Benign and Malignant Vertebral Lesions : Combination of Diffusion-Weighted and Proton Density Fat Fraction Spine MRI. Clin Neuroradiol 2021; 31:1059-1070. [PMID: 33787957 PMCID: PMC8648653 DOI: 10.1007/s00062-021-01009-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose To compare and combine the diagnostic performance of the apparent diffusion coefficient (ADC) derived from diffusion-weighted imaging (DWI) and proton density fat fraction (PDFF) derived from chemical-shift encoding (CSE)-based water-fat magnetic resonance imaging (MRI) for distinguishing benign and malignant vertebral bone marrow lesions (VBML). Methods A total of 55 consecutive patients with 53 benign (traumatic, inflammatory and primary) and 36 malignant (metastatic and hematologic) previously untreated VBMLs were prospectively enrolled in this IRB-approved study and underwent sagittal DWI (single-shot spin-echo echo-planar with multi-slice short TI inversion recovery fat suppression) and CSE-based MRI (gradient-echo 6‑point modified Dixon) in addition to routine clinical spine MRI at 1.5 T or 3.0 T. Diagnostic reference standard was established according to histopathology or imaging follow-up. The ADC = ADC (0, 800) and PDFF = fat / (water + fat) were calculated voxel-wise and examined for differences between benign and malignant lesions. Results The ADC and PDFF values of malignant lesions were significantly lower compared to benign lesions (mean ADC 861 × 10−6 mm2/s vs. 1323 × 10−6 mm2/s, p < 0.001; mean PDFF 3.1% vs. 28.2%, p < 0.001). The areas under the curve (AUC) and diagnostic accuracies were 0.847 (p < 0.001) and 85.4% (cut-off at 1084.4 × 10−6 mm2/s) for ADC and 0.940 (p < 0.001) and 89.9% for PDFF (cut-off at 7.8%), respectively. The combined use of ADC and PDFF improved the diagnostic accuracy to 96.6% (malignancy if ADC ≤ 1118.2 × 10−6 mm2/s and PDFF ≤ 20.0%, otherwise benign). Conclusion Quantitative evaluation of both ADC and PDFF was useful in differentiating benign VBMLs from malignancy. The combination of ADC and PDFF improved the diagnostic performance and yielded high diagnostic accuracy for the differentiation of benign and malignant VBMLs.
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Affiliation(s)
- Frederic Carsten Schmeel
- Department of Neuroradiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. .,Research Group Clinical Neuroimaging, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany.
| | - Simon Jonas Enkirch
- Department of Neuroradiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian Alexander Luetkens
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Anton Faron
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Nils Lehnen
- Department of Neuroradiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Research Group Clinical Neuroimaging, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Alois Martin Sprinkart
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Leonard Christopher Schmeel
- Department of Radiotherapy and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Research Group Clinical Neuroimaging, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Ulrike Attenberger
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Guido Matthias Kukuk
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.,Department of Radiology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Petra Mürtz
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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Rosmalen JGM, Burton C, Carson A, Cosci F, Frostholm L, Lehnen N, Olde Hartman TC, Rask CU, Rymaszewska J, Stone J, Tak LM, Witthöft M, Löwe B. The European Training Network ETUDE (Encompassing Training in fUnctional Disorders across Europe): a new research and training program of the EURONET-SOMA network recruiting 15 early stage researchers. J Psychosom Res 2021; 141:110345. [PMID: 33385705 DOI: 10.1016/j.jpsychores.2020.110345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Affiliation(s)
- J G M Rosmalen
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Dimence Group, Deventer, the Netherlands.
| | - C Burton
- University of Sheffield, Sheffield, UK
| | - A Carson
- University of Edinburgh, Edinburgh, UK
| | - F Cosci
- University of Florence, Florence, Italy
| | | | - N Lehnen
- Technical University Munich, Munich, Germany
| | | | - C U Rask
- Aarhus University Hospital, Aarhus, Denmark
| | | | - J Stone
- University of Edinburgh, Edinburgh, UK
| | - L M Tak
- Dimence Group, Deventer, the Netherlands
| | - M Witthöft
- Johannes Gutenberg-University, Mainz, Germany
| | - B Löwe
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lehnen N, Henningsen P, Ramaioli C, Glasauer S. An experimental litmus test of the emerging hypothesis that persistent physical symptoms can be explained as perceptual dysregulation. J Psychosom Res 2018; 114:15-17. [PMID: 30314573 DOI: 10.1016/j.jpsychores.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/16/2018] [Indexed: 12/20/2022]
Affiliation(s)
- N Lehnen
- Technical University of Munich, University Hospital rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy & Brandenburg Technical University, Institute of Medical Technology, Germany.
| | - P Henningsen
- Technical University of Munich, University Hospital rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Germany
| | - C Ramaioli
- Brandenburg Technical University, Institute of Medical Technology & Technical University of Munich, University Hospital rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Germany
| | - S Glasauer
- Brandenburg Technical University, Institute of Medical Technology, Germany
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Luis L, Lehnen N, Muñoz E, de Carvalho M, Schneider E, Valls-Solé J, Costa J. Anticompensatory quick eye movements after head impulses: A peripheral vestibular sign in spontaneous nystagmus. J Vestib Res 2016; 25:267-71. [PMID: 26890428 DOI: 10.3233/ves-160566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Differentiating central from peripheral origins of spontaneous nystagmus (SN) is challenging. Looking for a simple sign of peripheral disease with the video Head Impulsive Test we noticed anti-compensatory eye movements (AQEM) in patients with peripheral etiologies of spontaneous nystagmus (SN). Here we assess the diagnostic accuracy of AQEM in differentiating peripheral from central vestibular disorders. METHODS We recorded the eye movements in response to horizontal head impulses in a group of 43 consecutive patients with acute vestibular syndrome (12 with central, 31 with peripheral disorders), 5 patients after acute vestibular neurectomy (positive controls) and 39 healthy subjects (negative controls). AQEM were defined as quick eye movements (peak velocity above 50°/s) in the direction of the head movement. RESULTS All patients with peripheral disorders and positive controls had AQEM (latency 231 ± 53 ms, amplitude 3.4 ± 1.4°, velocity 166 ± 55°/s) when their head was moved to the opposite side of the lesion. Central patients did not have AQEM. AQEM occurrence rate was higher in peripheral patients with contralesional (74 ± 4%, mean ± SD) in comparison to ipsilesional (1 ± 4%) impulses (p< 0.001). Overall diagnostic accuracy for differentiating central from peripheral patients was 96% (95% CI for AUC ROC curve: 0.90 to 1.0) for VOR gain and 100% (95% CI: 1.0 to 1.0) for AQEM occurrence rate. CONCLUSIONS These results suggest that AQEM are a sign of vestibular imbalance in a peripheral deficit. In addition to VOR gain they should be added to the evaluation of the head impulse test.
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Affiliation(s)
- L Luis
- Health Sciences Institute, Portuguese Catholic University, Lisbon, Portugal.,Translational Clinical Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal.,Otolaryngology Unit, Hospital de Cascais, Cascais, Portugal
| | - N Lehnen
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Germany.,Department of Neurology, Munich University Hospital, Germany
| | - E Muñoz
- EMG and Motor Control Unit, Neurology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Spain
| | - M de Carvalho
- Translational Clinical Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal
| | - E Schneider
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Germany.,Institute for Clinical Neurosciences, Munich University Hospital, Germany.,Institute of Medical Technology, Brandenburg University of Technology, Cottbus-Senftenberg, Germany
| | - J Valls-Solé
- EMG and Motor Control Unit, Neurology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Spain
| | - J Costa
- Translational Clinical Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal.,EMG and Motor Control Unit, Neurology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Spain
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Sağlam M, Lehnen N. Gaze stabilization in chronic vestibular-loss and in cerebellar ataxia: interactions of feedforward and sensory feedback mechanisms. J Vestib Res 2015; 24:425-31. [PMID: 25564085 DOI: 10.3233/ves-140538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
During gaze shifts, humans can use visual, vestibular, and proprioceptive feedback, as well as feedforward mechanisms, for stabilization against active and passive head movements. The contributions of feedforward and sensory feedback control, and the role of the cerebellum, are still under debate. To quantify these contributions, we increased the head moment of inertia in three groups (ten healthy, five chronic vestibular-loss and nine cerebellar-ataxia patients) while they performed large gaze shifts to flashed targets in darkness. This induces undesired head oscillations. Consequently, both active (desired) and passive (undesired) head movements had to be compensated for to stabilize gaze. All groups compensated for active and passive head movements, vestibular-loss patients less than the other groups (P < 0.001, passive/active compensatory gains: vestibular-loss 0.23 ± 0.09/0.43 ± 0.12, healthy 0.80 ± 0.17/0.83 ± 0.15, cerebellar-ataxia 0.68 ± 0.17/0.77 ± 0.30, mean ± SD). The compensation gain ratio against passive and active movements was smaller than one in vestibular-loss patients (0.54 ± 0.10, P=0.001). Healthy and cerebellar-ataxia patients did not differ in active and passive compensation. In summary, vestibular-loss patients can better stabilize gaze against active than against passive head movements. Therefore, feedforward mechanisms substantially contribute to gaze stabilization. Proprioception alone is not sufficient (gain 0.2). Stabilization against active and passive head movements was not impaired in our cerebellar ataxia patients.
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Affiliation(s)
- M Sağlam
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany
| | - N Lehnen
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany Department of Neurology, Munich University Hospital, Munich, Germany
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Ramaioli C, Colagiorgio P, Sağlam M, Heuser F, Schneider E, Ramat S, Lehnen N. Covert saccades improve dynamic visual stability in bilateral vestibular dysfunction. KLIN NEUROPHYSIOL 2014. [DOI: 10.1055/s-0034-1371226] [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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Saglam M, Glasauer S, Lehnen N. Über die Feedforward Kontrolle der Blickstabilisierung während Auge-Kopf-Bewegungen. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337286] [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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Schneider E, Lehnen N, Bartl K, Bardins S, Kohlbecher S, Glasauer S, Jahn K. Zentral oder peripher? Schwindelursachen auf der Spur mit dem video-basierten Kopfimpulstest. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301511] [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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Lehnen N, Bartl K, Bardins S, Kohlbecher S, Glasauer S, Jahn K, Schneider E. Der video-basierte Kopfimpulstest zur Quantifizierung peripher-vestibulärer Funktion bei Kindern und Jugendlichen. KLIN NEUROPHYSIOL 2011. [DOI: 10.1055/s-0031-1272766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Lehnen N, Rettinger N, Jahn K, Danek A. Deviation of the subjective visual vertical (SVV) in anterior cerebral artery infarction. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1250919] [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: 10/19/2022]
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Lehnen N. Mehr als nur Reflexe – Die Rolle des vestibulären Systems während aktiver Blickbewegungen. KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0029-1216048] [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: 10/21/2022]
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Lehnen N, Büttner U, Glasauer S. Vestibuläre Kontrolle von Willkürbewegungen – Systemanalyse und Modellbildung. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976398] [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: 10/21/2022]
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Lehnen N, Büttner U, Glasauer S. Willkürbewegung des Kopfes: vestibuläre Rückkopplung und Kleinhirn. Akt Neurol 2007. [DOI: 10.1055/s-2007-987459] [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: 10/21/2022]
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Wagner J, Lehnen N, Rettinger N, Karch C, Büttner U, Glasauer S, Brandt T, Strupp M. Downbeat nystagmus caused by a paramedian ponto-medullary lesion. Akt Neurol 2007. [DOI: 10.1055/s-2007-988062] [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: 10/21/2022]
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Affiliation(s)
- R Kalla
- Department of Neurology, University of Munich, Germany
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