[Interdisciplinary interaction for vascular diseases of the eye. Neurological differential diagnosis]. / Interdisziplinäre Interaktion bei vaskulären Erkrankungen des Auges. Neurologische Differenzialdiagnostik.

BACKGROUND: Vascular diseases of the eye are common and may be indicative of cerebrovascular diseases. OBJECTIVE: The aim was to describe the significance of neurological evaluation in patients with vascular diseases of the eye. METHODS: A selective literature research using PubMed was performed taking personal experiences as well as recommendations of international and national guidelines into consideration. RESULTS: Patients with transient blindness (amaurosis fugax) have a 4-fold higher risk of stroke during the year following onset of optical symptoms. These patients should be treated with platelet antiaggregants, such as 100 mg/day acetylsalicylic acid (ASS). Patients with > 70 % stenosis of the ipsilateral internal carotid artery should be evaluated for carotid endarterectomy. Colloidal solutions should not be used in patients with cerebrovascular diseases. Avoiding nocturnal blood pressure drop may help to prevent anterior ischemic optical neuropathy in patients with carotid artery disease. Patients with ocular ischemic syndrome often have severe stenosis or occlusion of the internal carotid artery. Duplex ultrasound is the most important diagnostic test. CONCLUSION: Vascular diseases of the eye are frequently associated with cerebrovascular disease. A comprehensive vascular evaluation can contribute to prevention of stroke.

Neural substrates of good and poor recovery after hemiplegic stroke: a serial PET study.

In this study, we used positron emission tomography (PET) at two different time points to study the temporal evolution of reorganization in patients with good and those without motor recovery from hemiplegia after the occurrence of a stroke. Ten hemiplegic patients with a first subcortical stroke and five healthy control subjects were scanned during passive and active movements at an interval of 8 weeks. PET1 was performed 22.8 ± 7.8 days after the index stroke. At PET2, 8 weeks later, patients were dichotomized to either good recovery or no recovery according to the upper extremity motor component of the Fugl-Meyer score. Increases of regional cerebral blood flow (rCBF) and comparison between groups at PET1 and PET2 were assessed using statistical parametric mapping. At PET 1, activation was found bilaterally in the inferior parietal cortex. Eight weeks later, patients with good recovery showed maximum activation in the contralateral primary somatosensory cortex and overactivation of the contralateral inferior parietal cortex. Patients with poor recovery showed bilateral activation with a maximum in the somatosensory cortex. Studies correlating activation patterns with quality of recovery may identify the neuroanatomical substrates that subserve improved motor function. Such studies may also guide the development of more effective rehabilitative interventions after the occurrence of stroke.

Cognitive performance in elderly patients undergoing carotid endarterectomy or carotid artery stenting: a twelve-month follow-up study.

BACKGROUND: It is still a matter of debate if and to what extent carotid endarterectomy (CEA) and carotid artery stenting (CAS) impair cognitive functioning in the elderly. METHODS: We conducted a nonrandomized clinical trial on subjects with asymptomatic carotid artery stenosis comparing CEA (n = 28; 24 males and 4 females; 72.6 +/- 5.8 years old) with CAS (n = 29; 17 males and 12 females; 75.1 +/- 5.7 years old). Cognition, mood and functional status were evaluated by a broad spectrum of tests performed on the day prior to carotid reopening as well as 3 and 12 months after. RESULTS: No significant differences in scores on cognitive tests including the Babcock story recall test and Rey's auditory verbal learning test (memory), category naming test (verbal fluency), trail-making test parts A and B (attention and executive function) and controlled oral word association test (executive functioning) were observed 3 and 12 months after carotid reopening independent of the technique used. Only scores on the copy drawing test (visuospatial and constructional abilities) slightly but significantly (p < 0.05) worsened in the CAS group 12 months after the intervention. No significant differences between the CEA and CAS groups were detected regarding mood and functional status after 3 and 12 months. CONCLUSIONS: CEA and CAS seem to be safe procedures in elderly patients in terms of cognitive, mood and functional status in the short and long term. CAS might be preferred for the shorter hospital stay, but further studies with a larger number of old and oldest old subjects with a longer follow-up are needed to better understand the cost-effectiveness of both treatments.

Oxidative LDL modification is increased in vascular dementia and is inversely associated with cognitive performance.

It is not known whether the association between increased plasma homocysteine (Hcy) associated with LDL modification and propensity for LDL uptake by macrophages in cardiovascular disease patients holds true in vascular dementia (VaD). Plasma from 83 subjects diagnosed with Alzheimer's disease (AD), VaD, mild cognitive impairment (MCI) and from controls was analysed to examine (1) whether LDL isolated from the plasma of VaD is biochemically and functionally distinct from that isolated from AD, MCI or controls; and (2) whether such biomarkers of LDL phenotype are related to plasma folate levels, Hcy levels and/or to disease severity. Folate and vitamin B6 levels were significantly lower in VaD subjects than in controls. VaD-LDL showed increased protein carbonyl content (p < 0.05) and was more susceptible to scavenging by macrophages (p < 0.05) than AD- or control-LDL. Patients from the VaD cohort were more prevalent in the lowest tertile for HDL:LDL and the upper tertile for LDL oxidation; the combined parameters of HDL cholesterol, LDL oxidation and scavenging by macrophages show 87% sensitivity towards VaD detection. The association between folate deficiency, LDL modification and dysfunction in VaD but not in AD may provide a novel biomarker assessment to discriminate between the diseases.

Up-conversion fluorescence: noncoherent excitation by sunlight.

We demonstrate up-conversion of noncoherent sunlight realized by ultralow excitation intensity. The bimolecular up-conversion process in our systems relies on the presence of a metastable triplet excited state, and thus has dramatically different photophysical characteristics relative to the other known methods for photon up-conversion (two-photon absorption, parametric processes, second harmonic generation, sequential multiphoton absorption, etc.).

Band-gap engineering of metal oxides for dye-sensitized solar cells.

Mixed oxides Ti(1-x)Zr(x)O2 with 0 < x < or = 0.2 were synthesized by means of thermal hydrolysis for use in dye-sensitized solar cells. The lattice parameter d is observed to increase linearly with Zr content x. The band gap of the mixed oxides was measured to increase by up to 0.2 eV. The respective shift of the conduction band edge leads to an increase of the open circuit voltage (V(OC)) by up to 0.1 V. Among others, temperature-dependent measurements of V(OC) clearly identify the correlation between band edge shift and change in V(OC).

Diffusion properties of dye molecules in nanoporous TiO2 networks.

The adsorption of ruthenium-dye molecules out of ethanol solution onto TiO2 particles of nanoporous TiO2 films was used to study the molecules' diffusion through these layers by means of optical absorption spectrometry. Dependent on pore size, porosity, and particle size, effective diffusion constants as low as D(eff) = 4 x 10(-9) cm2/s were deduced from the uptake curves by applying a simple model for combined diffusion and adsorption. These diffusion constants for diffusion through the nanoporous network are up to 3 orders of magnitude lower than in bulk ethanol and are discussed with respect to the properties of the nanoporous material.

Analysis of electrotonic coupling in patterned neuronal networks.

Microcontact printing of laminin is known as an efficient approach for guiding neuronal cell migration and neurite outgrowth on artificial surfaces. In the present study, ultrathin (approximately 250 microm) brain stem slices of Sprague-Dawley rats (E15-E18) were cultured on laminin-patterned substrates, such that neuronal cells migrating out of the slices formed grid-shaped neuronal networks along the geometry defined by the pattern. The interconnections between neighbouring pairs of neurons within these artificial networks were assessed electrophysiologically by double patch-clamp recordings and optically by microinjection of fluorescent dyes. Both functional and electrotonic synapses were detected. Based on the recorded data and simulations in PSpice, an electrical model for electrotonically coupled cells was derived. In this model the neuritic pathway is described as a cylindric cable, and gap junctions are represented by an ohmic resistor. Applying this model in the data analysis, the average inner radius of neurites could be determined to be approximately 0.1 microm. In addition, evidence was found for a correlation between the path-width of the applied pattern and the diameter of neurites growing along these paths.

Diffusion-limited transport of I- 3 through nanoporous TiO2-polymer gel networks.

Tri-iodide transport in a polymer gel electrolyte embedded in nanoporous TiO(2) networks and its diffusion limits are investigated by means of current-voltage (I-V) characteristics of simple Pt-gel-Pt sandwich devices with a thin porous TiO(2) layer sintered directly onto one of the Pt electrodes. At voltages between 0.2 and 0.7 V, the I-V curves of such devices show the typical plateau of diffusion-limited redox reactions, in this case I(-)/I(3) (-), at the platinum electrodes. From the dependence of the limiting current density on layer thickness, the diffusion constants D(bulk) and D(p,eff) of tri-iodide in the bulk polymer gel and through a polymer gel penetrated TiO(2) network, respectively, have been found to be D(bulk)=3.2(+/-0.2)x10(-6) cm(2)/s and D(p,eff)=1.5(+/-0.1)x10(-6) cm(2)/s. Temperature-dependent measurements show diffusion in the gel to be activated by about 0.16 eV. The results are discussed in comparison to diffusion in liquid electrolytes as well as with respect to the implications for dye-sensitized solar cell devices.

A functional MRI study of three motor tasks in the evaluation of stroke recovery.

Functional brain imaging studies have provided insights into the processes related to motor recovery after stroke. The comparative value of different motor activation tasks for probing these processes has received limited study. We hypothesized that different hand motor tasks would activate the brain differently in controls, and that this would affect control-patient comparisons. Functional magnetic resonance imaging (MRI) was used to evaluate nine control subjects and seven patients with good recovery after a left hemisphere hemiparetic stroke. The volume of activated brain in bilateral sensorimotor cortex and four other motor regions was compared during each of three tasks performed by the right hand: index-finger tapping, four-finger tapping, and squeezing. In control subjects, activation in left sensorimotor cortex was found to be significantly larger during squeezing as compared with index-finger tapping. When comparing control subjects with stroke patients, patients showed a larger volume of activation in right sensorimotor cortex during index-finger tapping but not with four-finger tapping or squeezing. In addition, patients also showed a trend toward larger activation volume than controls within left supplementary motor area during index-finger tapping but not during the other tasks. Motion artifact was more common with squeezing than with the tapping tasks. The choice of hand motor tasks used during brain mapping can influence findings in control subjects as well as the differences identified between controls and stroke patients. The results may be useful for future studies of motor recovery after stroke.

Compensatory visual field training for patients with hemianopia after stroke.

Twenty-one patients with hemianopia received 4 weeks of compensatory visual field training. Detection of and reaction time to visual stimuli were measured with eyes fixating (condition A) and with use of exploratory eye movements (condition B) before and after training. Twenty-three healthy individuals served as control subjects for measurements of parameters during both conditions. Patients with hemianopia to either side showed a marked improvement of detection and reaction time during condition B, but minimum or no change during condition A. Improvements were maintained 8 months after training. Activity of daily living skills also improved in all patients. The size of scotoma on computerized perimetry, in contrast, remained unchanged. Training improved detection of and reaction to visual stimuli without restitution of the visual field defect.

Arm training induced brain plasticity in stroke studied with serial positron emission tomography.

We used serial positron emission tomography (PET) to study training-induced brain plasticity after severe hemiparetic stroke. Ten patients were randomized to either task-oriented arm training or to a control group and scanned before and after 22.6 +/- 1.6 days of treatment using passive movements as an activation paradigm. Increases of regional cerebral blood flow (rCBF) were assessed using statistical parametric mapping (SPM99). Before treatment, all stroke patients revealed bilateral activation of the inferior parietal cortex (IPC). After task-oriented arm training, activation was found bilaterally in IPC and premotor cortex, but also in the contralateral sensorimotor cortex (SMC). The control group only showed weak activation of the ipsilateral IPC. After treatment, the training group revealed relatively more activation bilaterally in IPC, premotor areas, and in the contralateral SMC. Five normal subjects showed no statistical significant differences between two separate PET studies. In this group of patients, task-oriented arm training induced functional brain reorganization in bilateral sensory and motor systems.

Evolution of functional reorganization in hemiplegic stroke: a serial positron emission tomographic activation study.

We used serial positron emission tomography (PET) to study the evolution of functional brain activity within 12 weeks after a first subcortical stroke. Six hemiplegic stroke patients and three normal subjects were scanned twice (PET 1 and PET 2) by using passive elbow movements as an activation paradigm. Increases of regional cerebral blood flow comparing passive movements and rest and differences of regional cerebral blood flow between PET 1 and PET 2 in patients and normal subjects were assessed by using statistical parametric mapping. In controls, activation was found in the contralateral sensorimotor cortex, supplementary motor area, and bilaterally in the inferior parietal cortex with no differences between PET 1 and PET 2. In stroke patients, at PET 1, activation was observed in the bilateral inferior parietal cortex, contralateral sensorimotor cortex, and ipsilateral dorsolateral prefrontal cortex, supplementary motor area, and cingulate cortex. At PET 2, significant increases of regional cerebral blood flow were found in the contralateral sensorimotor cortex and bilateral inferior parietal cortex. A region that was activated at PET 2 only was found in the ipsilateral premotor area. Recovery from hemiplegia is accompanied by changes of brain activation in sensory and motor systems. These alterations of cerebral activity may be critical for the restoration of motor function.

Reorganization of sensory and motor systems in hemiplegic stroke patients. A positron emission tomography study.

BACKGROUND AND PURPOSE: Cortical reorganization of motor systems has been found in recovered stroke patients. Reorganization in nonrecovered hemiplegic stroke patients early after stroke, however, is less well described. We used positron emission tomography to study the functional reorganization of motor and sensory systems in hemiplegic stroke patients before motor recovery. METHODS: Regional cerebral blood flow (rCBF) was measured in 6 hemiplegic stroke patients with a single, subcortical infarct and 3 normal subjects with the [(15)O]H(2)O injection technique. Brain activation was achieved by passive elbow movements driven by a torque motor. Increases of rCBF comparing passive movements and rest were assessed with statistical parametric mapping. Significant differences were defined at P<0.01. RESULTS: In normal subjects, significant increases of rCBF were found in the contralateral sensorimotor cortex, supplementary motor area, cingulate cortex, and bilaterally in the inferior parietal cortex. In stroke patients, significant activation was observed bilaterally in the inferior parietal cortex and in the contralateral sensorimotor cortex, ipsilateral prefrontal cortex, supplementary motor area, and cingulate cortex. Significantly larger increases of rCBF in patients compared with normal subjects were found bilaterally in the sensorimotor cortex, stronger in the ipsilateral, unaffected hemisphere, and in both parietal lobes, including the ipsilateral precuneus. CONCLUSIONS: Passive movements in hemiplegic stroke patients before clinical recovery elicit some of the brain activation patterns that have been described during active movements after substantial motor recovery. Changes of cerebral activation in sensory and motor systems occur early after stroke and may be a first step toward restoration of motor function after stroke.

Increased plasma levels of lipid hydroperoxides in patients with ischemic stroke.

A large body of experimental research indicates that the generation of free radicals leading to oxidative stress plays a role in the pathogenesis of ischemic brain injury, but evidence in humans is limited. We examined plasma levels of lipid hydroperoxides (measured as cholesteryl ester hydroperoxides, CEOOH) and ascorbic acid in 32 patients with cortical stroke, as compared with 13 patients with lacunar infarct. Patients with cortical stroke had significantly increased levels of CEOOH, which peaked on Day 5 after the ictus. Small decreases in ascorbic acid concentrations were not significant. There was a significant positive correlation of CEOOH with the NIH stroke scale, and a significant negative correlation with the Glasgow coma scale. Concentrations of CEOOH were significantly higher in patients with total anterior cerebral syndrome as compared with patients with partial anterior cerebral syndrome or posterior cerebral syndrome. Stroke volumes computed from CT or MRI scans were significantly correlated with plasma CEOOH levels. These findings implicate oxidative stress in ischemic brain injury in humans and suggest that measurements of CEOOH in plasma may be useful both prognostically as well as in monitoring therapeutic interventions.

Quantitative assessment of mirror movements after stroke.

BACKGROUND AND PURPOSE: Mirror movements (MM) are involuntary synchronous movements of one limb during voluntary unilateral movements of the opposite limb. We measured MM in stroke and control subjects and evaluated whether MM after stroke are related to motor function. METHODS: Twenty-three patients and 16 control subjects were studied. A computerized dynamometer was used during two squeezing tasks to measure intended movements from the active hand as well as MM from the opposite hand. Motor deficits were measured with the arm motor component of the Fugl-Meyer scale. RESULTS: During paretic hand squeezing, MM in the unaffected hand were detected in 70% (repetitive squeeze) to 78% (sustained squeeze) of stroke patients. For both tasks, this was significantly (P < 0.05) greater than the incidence of MM in the paretic hand or in either hand of control subjects (17% to 44%), except when compared with the incidence of MM in the dominant hand of control subjects (56%; P = 0.17). The incidence of MM in the paretic hand was not significantly different from that seen in either hand of control subjects. Patients with MM in the unaffected hand had significantly greater motor deficit than patients without MM. Patients with MM in the paretic hand had significantly better motor function than patients without MM. CONCLUSIONS: Simultaneously recording motor performances of both hands provides precise information to characterize MM. MM in the unaffected hand and in the paretic hand are associated with different degrees of motor deficit after stroke. Evaluation of MM may be useful for studying mechanisms of stroke recovery.

Recovery following lateral medullary infarction.

Lateral medullary infarction (LMI) has a well-defined clinical syndrome and vascular pathology. The functional outcome and degree of disability of patients with LMI, however, have not been as well investigated. We followed 18 consecutive patients with LMI during inpatient stroke rehabilitation. Thirteen patients were followed after discharge from the hospital over a mean time of 1 year. The degree of disability on admission and discharge from the hospital, and at follow-up was assessed using the motor component of the Functional Independence Measurement (FIM-motor). All patients were discharged home. During inpatient rehabilitation, the functional performance of all patients improved substantially from FIM-motor 50.9 +/- 13.0 (mean +/- SD) on admission to 76.9 +/- 10.5 at discharge. Patients with lower FIM-motor scores on admission had more functional improvement from admission to discharge than those with higher FIM-motor scores on admission. Patients with disease of the posterior inferior cerebellar artery showed significantly less functional improvement than patients with disease of the vertebral artery or no identified vascular pathology in the posterior circulation. In the follow-up group, the FIM-motor scores further improved to 84.6 +/- 8.4, indicating nearly full functional independence. Eighty-five percent were totally independent with ambulation. Five of seven previously working patients returned to work. Patients with LMI have few functional deficits after completion of inpatient rehabilitation, continue to improve functionally after discharge, and often resume their previous activities.

A functional MRI study of subjects recovered from hemiparetic stroke.

BACKGROUND AND PURPOSE: Stroke recovery mechanisms remain incompletely understood, particularly for subjects with cortical stroke, in whom limited data are available. We used functional magnetic resonance imaging to compare brain activations in normal controls and subjects who recovered from hemiparetic stroke. METHODS: Functional magnetic resonance imaging was performed in ten stroke subjects with good recovery, five with deep, and five with cortical infarcts. Brain activation was achieved by index finger-tapping. Statistical parametric activation maps were obtained using a t test and a threshold of P < .001. In five bilateral motor regions, the volume of activated brain for each stroke subject was compared with the distribution of activation volumes among nine controls. RESULTS: Control subjects activated several motor regions. During recovered hand finger-tapping, stroke subjects activated the same regions as controls, often in a larger brain volume. In the unaffected hemisphere, sensorimotor cortex activation was increased in six of nine stroke subjects compared with controls. Cerebellar hemisphere contralateral and premotor cortex ipsilateral to this region, as well as supplementary motor areas, also had increased activation. In the stroke hemisphere, activation exceeding controls was uncommon, except that three of five cortical strokes showed peri-infarct activation foci. During unaffected hand finger-tapping, increased activation by stroke subjects compared with controls was uncommon; however, decreased activation was seen in unaffected sensorimotor cortex, suggesting that this region's responsiveness increased to the ipsilateral hand and decreased to contralateral hand movements. Use of a different threshold for defining activation (P < .01) did not change the overall findings (kappa = .75). CONCLUSIONS: Recovered finger-tapping by stroke subjects activated the same motor regions as controls but to a larger extent, particularly in the unaffected hemisphere. Increased reliance on these motor areas may represent an important component of motor recovery. Functional magnetic resonance imaging studies of subjects who recovered from stroke provide evidence for several processes that may be related to restoration of neurologic function.