[Operationalization and feasibility of the early rehabilitation index ("lower-saxony early rehabilitation index")]. / Versuch einer Operationalisierung und praxisorientierten Erweiterung des Frühreha-Indexes ("niedersächsischer Frühreha-Index").

This paper suggests an operationalization of the items of the early rehabilitation Barthel-index (ERBI). In addition, it presents a modification of this instrument, called lower-saxony ERBI (lsERBI). In order to validate the lsERBI, it has been used in 273 neurological rehabilitants. Findings suggest that the lsERBI has a higher specificity but lower sensitivity than the conventional ERBI. Inter-rater-reliability was high (r=0.84). Further studies are welcome to validate the lsERBI.

[Clinical aspects and prognosis following severe craniocerebral trauma]. / Klinik und Prognose nach schwerem Schädel-Hirn-Trauma.

The practical employment of diagnostic and therapeutic management in the early stage of head-injured patients depends on the precise assessment of the clinical course. In a retrospective study of 39 patients with severe head injury the prognostic value of clinical and methodical (instrument) parameters was analysed and compared with results of 28 international studies. As findings of this study the factors "age", "motoric response", "pupillary light reaction" and "type of intracranial lesion" were combined with the highest precision of outcome prediction. On the other hand, signs originating from the autonomic nervous system were not useful to predict the clinical course. The duration of post-traumatic coma was not appropriate to give an early view of the development of disease. The high value of neurological state in combination with neuroradiological and neurophysiological investigations in the early posttraumatic period of severe head injury is emphasised.

Outcome prediction in comatose patients: significance of reflex eye movement analysis.

An analysis of oculocephalic response and vestibuloocular reflex (VOR) in 81 patients with coma from various causes showed the importance of reflex eye movements for outcome prediction. Compared with oculocephalic response testing, VOR analysis provided more evidence and allowed more precise study of ocular motility in comatose patients. In 25 patients (31%) without conclusive or with absent oculocephalic response, a preserved VOR could be seen. The results indicated that in all cases with preserved VOR response (independent of the cause of coma) the assumption of a good outcome is justified and was correct in a maximum of 67%. The unpredictability in the other cases was largely due to non-neurological factors. Ninety two per cent of the patients with abolished reflex eye movements died. The combination of absent VOR and abolished pupillary light reaction allows prediction of negative outcome in 100% and shows the paramount importance of these two brainstem reflexes.

Local intraarterial fibrinolysis in acute vertebrobasilar occlusion. Technical developments and recent results.

Local intraarterial fibrinolytic therapy (LIF) in patients with acute vertebrobasilar occlusion (AVBO) is a rational and if successful a life saving treatment. The recent progress in this field is determined by the use of microcatheters for superselective basilar artery catheterisation and a "short time, highdose" regimen using 750.000 IU Urokinase in not more than two h. Two out of 7 patients died and 1 did not improve to a better than a locked-in-state. Four patients however survived with excellent outcome.

[Clinical manifestations of rabies in the human. Case report and review]. / Klinische Manifestation der Tollwut beim Menschen. Kasuistischer Beitrag und Ubersicht.

Clinical symptoms and course in a 28 year old woman who suffered from rabies are reported. Neurophysiological and neuropathological findings in this patient, who died 21 days after developing initial symptoms, are presented in more detail. This disease appears to be rare in Central Europe. It can be treated effectively only by means of early detection and a special vaccination programme. Late recognition of lyssa specific symptoms in non-vaccinated patients is invariably associated with a fatal outcome. A review of current knowledge concerning rabies research is presented.