[Recurrent alternating cranial nerve paralysis as an unusual type of polyneuropathy predilection]. / Rezidivierende alternierende Hirnnervenparesen als ungewöhnlicher Prädilektionstyp einer Polyneuropathie

A case is described where relapsing alternating cerebral nerve pareses were frequently observed in the course of twelve years. The neurogenic character of the pareses could be demonstrated by electromyography. The extremities examined also showed signs of subclinical changes of the peripheral nervous system. The results of examinations suggest that the patient has an idiopathic form of polyneuropathy, the clinical manifestation of which is restricted to the cerebral nervous system. The literature on relapsing cerebral nerve pareses is discussed briefly.

[The clinical value of the orbicularis oculi reflex in combination with auditory evoked brain stem potentials in the diagnosis of disease processes in the cerebellopontile angle and brain stem]. / Der klinische Wert des Orbicularis oculi-Refexes in Kombination mit akustisch evozierten Hirnstammpotentialen bei der Diagnose von Krankheits-prozessen im Kleinhirnbrückenwinkel und im Hirnstamm.

The results of the Orbicularis oculi reflex (OOR) and the anditory evoked brain stem potential (a. e. BSP) supplement each other in the furnished information in lesions of the central and lower brain stem. The a. e. BSP permits quite a reliable localisation in the brain stem and in the cerebellopontile angle. the OOR moreover helps to discover disturbances in the N. facialis and the N. trigeminus. In intracanalicularly situated acousticus neurinomas lacking a. e. BSP the pathologically changed reflex response of the OOR indicates the process in the internal auditory canal.

[Nephrotic syndrome after treatment with penicillamine in Wilson's disease]. / Nephrotisches Syndrom nach Penizillamintherapie beim Morbus Wilson

In a 33-year-old man with Wilson's disease a nephrotic syndrome appeared as a severe complication under penicillamine therapy. Under strong observation and exact controls of protein in the urine, leucocytes, differential blood picture and thrombocytes after interruption of the medication and retrogression of the side-effects a retarding new stabilisation of penicillamine can take place. Other side-effects of penicillamine observed as well as control measures under a long-term treatment with penicillamine are briefly discussed.

[The auditory evoked brain stem potential andits value for clinical diagnosis]. / Das akustisch evozierte Hirnstammpotential und sein Wert für die klinische Diagnostik.

Auditory evoked brain stem potentials (seven waves within the first 10 milliseconds after the stimulus) obtained from the intercalated nuclei within the auditory pathway by averaging are suitable for a functional diagnosis of the brain stem. Disorders affecting the auditory pathway (direct or indirect tumour pressure or infiltrates, demyelinisation processes, traumatic brain stem injuries, ischemia) from the acoustic nerve through the cochlear nuclei, the superior olivary nuclei, the nuclei of the lateral lemnisci, the inferior collicular nuclei, to the medial geniculate bodies can be identified and used for the topical diagnosis.

[Thermographic studies with fluid crystals in peripheral nerve damage]. / Thermografische Untersuchungen mit Flüssigkristallen bei peripheren Nervenschädigungen.

Common peripheral neurogenic lesion in various locations and of different origins were examined thermographically and the results were compared with those obtained by clinical and electromyographic methods. Lesions in the regions of the N. ulnaris and N. medianus can, except in the case of carpal tunnel syndrome, be identified without difficulty by thermography. The results obtained in the case of paresis of the radialis are non-specific, and thermographic examination of radicular lesions are also sometimes ambiguous. Damage in the plexus-brachialis and root region yield impressive results which, however, are not particularly useful.

Cerebrovascular disease assessed by color-flow and power Doppler ultrasonography. Comparison with digital subtraction angiography in internal carotid artery stenosis.

BACKGROUND AND PURPOSE: An understanding of carotid atherosclerosis is important to further our knowledge regarding the etiology of cerebral ischemia, and therefore it is necessary to accurately visualize carotid stenosis. The purpose of the present study was to compare different imaging techniques to determine their advantages and disadvantages in the diagnosis and quantification of middle- and high-grade internal carotid artery stenosis. In particular, we were interested in evaluating the effectiveness of the new ultrasound technique power Doppler. METHODS: Fifty-four patients with greater than 50% extracranial internal carotid artery stenosis, as determined by continuous-wave Doppler, were recruited prospectively to serve as subjects. All subjects were examined with color-flow Doppler, power Doppler, and digital subtraction angiography to enable visualization of carotid stenosis and plaque surface morphology. RESULTS: Thirty-four middle-grade stenoses (50% to 69%), 32 high-grade stenoses (70% to 99%), and 7 complete occlusions of the internal carotid artery were diagnosed with the use of digital subtraction angiography. Power Doppler visualized stenosis significantly more frequently and accurately than color-flow Doppler. Color-flow Doppler tended to overestimate and underestimate in patients with both middle- and high-grade stenosis. Power Doppler was superior to both color-flow Doppler and angiography with regard to differentiation of plaque surface morphology. CONCLUSIONS: This study demonstrates that power Doppler is an important, noninvasive imaging technique that has several advantages over color-flow Doppler in diagnosing carotid artery stenosis and visualizing plaque surface. Power Doppler, used in concert with other ultrasound techniques, should enable a more accurate detection and treatment of cerebrovascular disease.

Power Doppler--a new tool for transcranial duplex assessment of intracranial vasculature.

The present study was undertaken to assess the clinical use of power Doppler (PD) as a new tool for transcranial vessel imaging. Power Doppler displays the integrated power of the Doppler signal instead of the Doppler frequency shift used in the conventional color flow Doppler (CFD) technique. Twenty-one patients were evaluated who had intracranial malformations or arterial stenoses [4 middle cerebral artery (MCA) stenoses, 2 intracranial carotid stenoses, 7 arteriovenous malformations (AVM), 5 intracranial carotid aneurysms, 3 Moya-Moya syndromes]. The PD results were compared with those obtained from CFD and digital subtraction angiography (DSA). Power Doppler was able to visualize 3 of 4 MCA stenoses with greater morphological detail than CFD, whereas PD and CFD were equally effective in diagnosing carotid stenoses. All AVMs were visualized using PD as well as CFD, but again PD revealed more morphological details, in a manner similar to DSA. Power Doppler was also superior to CFD in imaging intracerebral aneurysms and pathological collateralization associated with Moya-Moya syndromes. It is evident from these data that PD permits reliable and detailed transcranial imaging and therefore is a superior method for visualizing intracerebral vascular malformations and arterial stenoses.

[Prepontine epidural hemorrhage]. / Präpontine epidurale Blutung.

Extradural haematomas of the clivus represent a rare event and occur almost only in infancy. The case of a haematoma promptly operated upon via a transdural cerebellopontine angle approach is described for the first time. The mechanism of injury is discussed.

Ictal and interictal ECD-SPECT for focus localization in epilepsy.

Forty-one ECD (Technetium-99m-ethyl cysteinate dimer) SPECT investigations were undertaken in the course of a presurgical diagnostic work-up in 23 patients with pharmacoresistant focal epilepsy. In 21 patients, both an ictal and interictal SPECT were conducted. In the patients receiving ictal SPECT the tracer was injected between 7 and 30 s after the seizure onset. Of the interictal SPECTs 17 of 23 showed focal hypoperfusion which was consistent in 17 cases (74%) with the area of the electrophysiological focus (EF) and 6 patients had a normal interictal SPECT. Of the ictal SPECTs 18 of 21 (86%) showed regional hyperperfusion, 18 of them in the same location as the EF. Ictal SPECT showed a hypoperfusion similar to that in interictal SPECT in another 3 patients. In these cases seizure duration was short (28-54 s), so that the tracer reached the brain postictally. Our results show that ictal ECD-SPECT is an effective method for demonstrating an epileptogenic focus. Possible reasons for false-negative ictal SPECT results are discussed.