[Telemedical prenotification in acute stroke treatment : Experiences from the Stroke Angel initiative from 2004 until the present]. / Telemedizinische Voranmeldung in der akuten Schlaganfallversorgung : Erfahrungen der Stroke-Angel-Initiative von 2004 bis heute.

OBJECTIVE: The Stroke Angel initiative investigates the implementation of telemedicine for improvement of preclinical communication between emergency medical services (EMS) and stroke units in cases of acute stroke. MATERIAL AND METHODS: Stroke Angel is a technical system for the telemedical prenotification of patients in cases of suspected stroke at a stroke unit by the EMS. Within the framework of an observational study, the team has been investigating the effects of the system on door-to-computed tomography (CT) and door-to-needle times as well as the lysis rate in the neighboring regions of Rhön-Grabfeld and Bad Kissingen since 2005. RESULTS: The system supports the acute treatment of neurological emergencies and functions as a catalyst for the interlinking of medical institutions in the region as well as for communication between emergency physicians/EMS and hospital physicians. The use of a computer-based data collection enables a continuous improvement process leading to an acceleration of internal clinical procedures and an increase of the lysis rate with the mortality rate staying constant. CONCLUSION: Telemedicine is applicable in the preclinical care of acute stroke and, thanks to the computer-based data collection, leads to an increase in process transparency, which helps to improve the internal clinical processes in and around a stroke unit.

[Home-based telerehabilitation after stroke]. / Telerehabilitation nach Schlaganfall im häuslichen Umfeld.

The use of modern information and telecommunication technologies enables telerehabilitation of neurological deficits in the domestic environment. The current state of studies on rehabilitative teletherapy for improvement of motor function and mobility deficits due to stroke is reviewed. Two neurolinguistic proof of concept studies investigating the efficacy of online interactive telespeech therapy are reported, which compared virtual screen to screen interactive telerehabilitation of aphasia after stroke and dysarthrophonia in Parkinson's disease to conventional face to face rehabilitation. The results of the studies indicate that the neurological rehabilitation of motor and communicative deficits in the domestic environment of patients by means of teletherapy is just as efficient as conventional rehabilitation. Under home-based telerehabilitation patient transfer becomes unnecessary. Rehabilitative Teletherapy is a posthospital component of a cross-sector supply chain for patients with handicaps or impairments due to stroke and other neurological diseases.

Incidence and predictors of chronic headache attributed to whiplash injury.

We identified clinical, demographic and psychological predictive factors that may contribute to the development of chronic headache associated with mild to moderate whiplash injury [Quebec Task Force (QTF) ≤ II] and determined the incidence of this chronic pain state. Patients were recruited prospectively from six participating accident and emergency departments. While 4.6% of patients developed chronic headache attributed to whiplash injury according to the International Classification of Headache Disorders, 2nd edn criteria, 15.2% of patients complained about headache lasting > 42 days (QTF criteria). Predictive factors were pre-existing facial pain [odds ratio (OR) 9.7, 95% confidence interval (CI) 2.1, 10.4; P = 0.017], lack of confidence to recover completely (OR 5.5, 95% CI 2.0, 13.2; P = 0.005), sore throat (OR 5.0, 95% CI 1.5, 8.9; P = 0.013), medication overuse (OR 4.2, 95% CI 1.4, 12.3; P = 0.009), high Neck Disability Index (OR 4.0, 95% CI 1.3, 12.6; P = 0.019), hopelessness/anxiety (OR 3.8, 95% CI 1.3, 8.7; P = 0.024), and depression (OR 3.3, 95% CI 1.2, 9.4; P = 0.024). The lack of a control group limits the conclusions that can be drawn from this study. Identified predictors closely resemble those found in chronic primary headache disorders.

Myopathy in two siblings with nephropathic cystinosis.

Nephropathic cystinosis is a hereditary disorder characterized by a specific defect in the transport of cystine across the lysosomal membrane, leading to an accumulation of protein-free cystine in tissues, including conjunctiva, liver, bone marrow and kidney. Renal transplantation is necessary because of renal failure. With improved life-expectancy, neurological complications have been reported, including cases of distal myopathy diagnosed ante- and post-mortem. We report on two further rare cases of two siblings suffering from cystinosis who developed a predominantly distal myopathy, proven electrophysiologically and on biopsy during life. The reported clinical picture of a distal atrophy resembling a neurogenic disease, confirms a picture apparently typical in cystinosis. Possible effects of cysteamine therapy on the course of the myopathy are discussed. Copyright 1998 Lippincott Williams & Wilkins

Multiple intracerebral metastases of a 17-year-old girl with previously diagnosed neurofibromatosis type I.

We report a case of a 17-year-old girl with multiple intracerebral tumors. Previously, a neurofibroma in the posterior mediastinum and neurofibromatosis had been diagnosed. She developed a spastic tetraparesis with a prominent hemiparesis of the right side within several weeks. On admission we found clinical signs of elevated intracranial pressure. Cranial CT and MRI scans showed multiple space-occupying intracerebral tumors, thought to be multiple meningeoma. The patient was referred to the neurosurgical department, where two of the intracerebral tumors were excised. The histological examination revealed metastases of a neurosarcoma.

Presumed pharmacologically induced change from upbeat- to downbeat nystagmus in a patient with Wernicke's encephalopathy.

A case of Wernicke's encephalopathy due to proven thiamine deficiency suffering from upbeat nystagmus (UN) changing to downbeat nystagmus (DN) after a latency of 1 year is presented. The case was also notable for the finding of positive oligoclonal bands in the CSF. The underlying pathophysiological mechanisms and a possible effect of baclofen treatment are discussed.

The computer-vibromyography as a biometric progress in studying muscle function.

Muscular vibrations were recorded from different relaxed and contracted skeletal muscles in human subjects, with the use of a piezo-electric device. Simultaneous wire-EMG recordings were performed. Spectral analysis of the acceleration curves (vibromyograms) disclosed muscle and function dependent compound frequency patterns. We suggest that the activity of motor units including the action of central reflex loops and oscillatory driving is mainly responsible for the muscular vibrations. Other sources are discussed. Computer-Vibromyography as a mechanical ensemble measurement supplements bioelectric EMG techniques and classical tremor analysis and provides further insights into the function of muscle and motor-system.

Prospective PC-interactive pressure algesimetry of post-traumatic neck pain after whiplash injury.

Cervical pain is a prominent symptom in both acute whiplash injury and late whiplash syndrome. However, no systematic analysis of post-traumatic pain development covering several weeks has yet been performed in whiplash patients. It was the aim of the present study to analyse the duration and course of post-traumatic muscle pain due to whiplash injury in a prospective follow-up examination with short investigation intervals. A recovery of initially increased muscle pain after whiplash injury within 1 month was hypothesized. Pressure pain of the splenius and trapezius muscles was recorded using PC-interactive pressure algesimetry. Whiplash patients were investigated during the acute injury stage and after 3, 4, and 6 weeks and compared with matched controls. We found significantly increased pressure pain of the splenius and trapezius muscles in the acute stage of whiplash injury. After 4 weeks patients' scores of pain parameters were comparable to those of healthy control subjects. Within the patient group the first changes of pressure pain were observed within 3 (splenius) and 4 weeks (trapezius). For most patients the recovery dynamics lasted 4-6 weeks. A minority of patients did not show any improvement after 6 weeks. The present study shows that the dynamics of pressure pain due to whiplash injury can be quantified by means of PC-interactive pressure algesimetry. Our results confirm the clinical experience that the acute post-traumatic cervical syndrome normally subsides within weeks.

[Familial cavernous malformations of the central nervous system. A clinical and genetic study of 15 German families]. / Familiäre Kavernome des Zentralnervensystems. Eine klinische und genetische Studie an 15 deutsche Familien.

In 1928, Hugo Friedrich Kufs reported on a family with cerebral, retinal, and cutaneous cavernous malformations. Since then, more than 300 families with inherited cavernous malformations have been reported. Genetic studies showed three loci, on chromosomes 7q21-q22 (with the gene CCM1), 7p15-p13 (CCM2), and 3q25.2-q27 (CCM3). The gene product of CCM1 is Krit 1 (Krev interaction trapped 1), a protein interacting with angiogenesis by various mechanisms. Recently, CCM2 has also been identified; its product is a protein which might have a function similar to that of Krit 1. However, the CCM3 gene has still not been found. In this study, we present clinical and genetic findings on 15 German families.

[Motor intention potential. Electrophysiologic objectization of a single intended movement]. / Das motorische Intentionspotential. Elektrophysiologische Objektivierung einer alleinigen Bewegungsabsicht.

Autocorrelation of the EEG was used to registrate a potential from the intact human scalp during intended, but not executed movements (dorsalflexion of the right hallux, imaginated in equal time intervals). This "Motor Intention Potential" (MIP) is a possible electrophysiological sign of the otherwise purely introspectively experienced intention of a voluntary movement and the cortex of the frontal lobes is suspected to be its origin. The average maximum amplitude height is 6 microV, and the potential shows a continuous decrease from the frontal to occipital region. The duration of MIP is in the range of seconds. Methodological questions are discussed, and the MIP is differentiated from other event-, movement- and imagination-related potentials. An attempt is made to place the motor intention potential in the context of existing movement theories.

Malignant pheochromocytoma with progressive paraparesis in von Hippel-Lindau disease.

Pheochromocytomas are a feature of the von Hippel-Lindau disease spectrum, a multisystem disorder of autosomal dominant inheritance. Pheochromocytomas are, however, observed during life with a lower frequency than other features of this disease, such as retinal angiomas, haemangioblastomas of the CNS, and renal carcinomas. We present the highly unusual case of a patient who required an emergency operation for an intradural extramedullary thoracic tumour which was clinically suggestive initially of neurinoma. We present evidence from NMR, histological and isotope scan investigations of this being a pheochromocytoma metastasis and of an additional right-sided paraganglioma at the same height. A detailed history revealed that this patient had suffered from four other pheochromocytomas and two other paragangliomas, in addition to retinal angiomatosis of von Hippel-Lindau disease. This case is extraordinary due to (i) the unusual site of the metastasis, (ii) the neurological requirement for an emergency operation of pheochromocytoma, (iii) metastasis of pheochromocytoma in von Hippel-Lindau disease (only eight previous cases), and (iv) the number of recurrent pheochromocytomas. It clearly demonstrates the necessity for frequent and life-long follow-up in von Hippel-Lindau disease.

["Paralysis cruciata"--a rare brain stem lesion syndrome after cervical vertebrae trauma]. / "Paralysis cruciata"--ein seltenes Hirnstammläsionssyndrom nach HWS-Trauma.

Bell's cruciate paralysis with severe paresis or paralysis of the upper extremities and no or minimal paresis of the lower extremities represents a rare lesion of the pyramidal decussation of the lower brain-stem. MRI may show a hypointense lesion on T1-weighted imaging. Prognosis in this syndrome is dependent on the extent of involvement of surrounding brain-stem-structures, as described in three different cases.

[Frequency analytic EEG study on the topic of temporal function disorders in transsexuality]. / Frequenzanalytische EEG-Untersuchung zur Frage temporaler Funktionsstörungen bei Transsexualität.

A high rate of (temporal) EEG abnormalities within the group of transsexual patients has been previously described. These reports however were based on visual EEG analyses, which were not sufficiently statistically supported. It therefore seemed necessary to test this observations by utilizing quantitative frequency EEG analysis by using a larger group of transsexuals (n = 33). Fourier transformed data were recordings from T3-A1, T3-P3, T5-Cz, 01-Cz. The power of the delta-, theta-, alpha, and beta-bands were calculated as the percent of the total power (1,00-30,00 Hz). Different ratios of the absolute power values were computed. No significant differences of frequency-band related power, global power or power ratios between patients and normal subjects were found. There was also no separation on the basis of the genotypic sex of the subjects (Mann-Whitney-test). However 7 EEG's (21%) of the transsexual patients showed according to our interpretation temporo-parietal abnormalities.