[Neurological and psychiatric expert assessment of post-COVID syndrome]. / Neurologisch-psychiatrische Begutachtung des Post-COVID-Syndroms.

Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to a multiorgan disease and subsequently to very different clinical manifestations of coronavirus disease 2019 (COVID-19). In addition to acute symptoms, the long-term complaints in the context of the infection, known as long or post-COVID syndrome, are increasingly attracting attention. With respect to social insurance systems, expert opinions of such problems will become more and more important, whereby neurological and psychiatric symptoms are the most frequent complaints. In addition to the legal principles of the medico-legal assessment with a focus on statutory accident insurance, this overview article discusses the principles of expert assessment and presents landmarks for the expert opinion of the most frequent neurological and psychiatric symptoms occurring in the context of post-COVID syndrome.

[Ability to drive with cerebrovascular diseases : Position paper of the German societies DGNB, DGN, DGNC, DGNR, DSG and GNP]. / Fahreignung bei Hirngefäßerkrankungen : Positionspapier der DGNB, DGN, DGNC, DGNR, DSG und GNP.

The regulations for ability to drive with cerebrovascular diseases in the German Driving License Regulations (Fahrerlaubnisverordnung, FeV) and German Guidelines for the Evaluation of Driving Ability of the Federal Highway Research Institute (BASt) are not up to date with the current medical knowledge and are not consistent with comparable regulations regarding cardiovascular diseases. This is particularly true for the assessment of future risks for a sudden loss of control during driving. The present position paper of six medical and neuropsychological societies in Germany presents the current conditions for the assessment of driving ability of patients a cerebrovascular diesease and recommends an estimation of the ability to drive founded on the current state of scientific knowledge. It addresses the following: 1. Physical and mental functional limitations and the possibilities for compensation, which if necessary enable a fitness to drive under conditions or within limits, including the importance of behavioral or personality changes and cognitive deficiencies that interfere with safety. 2. The potential danger due to a sudden loss of control as a result of a transient ischemic attack (TIA) new stroke event, or another cardiovascular event while driving. A summary in the form of a table provides physicians and expert assessors with assistance for the most important cerebrovascular diseases.

[Guideline "Legal evaluation after closed brain injury in adulthood"]. / Leitlinie "Begutachtung nach gedecktem Schädel-Hirntrauma im Erwachsenenalter".

In 2005 and 2013, the "Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung" (German Society for Neuroscientific Evaluation) together with other societies developed and consented guidelines fort the legal evaluation of patients with closed head injuries and published them trough the National Working Group of Scientific Medical Societies and in this journal. Five years later, a revision was necessary, this was developed on the higher S2 k level of consent through a Delphi conference.

[Principles of evaluating driving ability for neurological and psychiatric diseases]. / Grundlagen der Fahreignungsbeurteilung bei neurologischen und psychischen Erkrankungen.

If attending physicians and psychologists recognize restricted or a lack of driving ability they are obliged to inform their patients appropriately. In Germany the legal basis for assessing driving ability is the "Fahrerlaubnis-Verordnung" (FeV, driving licence act), supplemented by guidelines for evaluating driving ability. In each individual case it has to be clarified whether and to what extent permanent or paroxysmally occurring disorders affect driving ability and whether lack of insight ability or personality defects are a threat to driving safety. In addition, it has to be considered whether compensation opportunities exist that enable restricted driving ability. If an expert opinion is requested by the driving licence authority in Germany the medical expert must have a specific qualification and should not be the attending physician.

[The German guideline "legal evaluation after closed head injury"]. / Die leitlinie "begutachtung nach gedecktem schädel-hirntrauma".

In 2005, the "Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung" (German Society for Neuroscientific Legal Evaluation) together with other Societies published a guideline for the legal evaluation of patients with closed head injuries. Meanwhile, not only scientific progress in imaging techniques but also in other fields such as neuropsychology has necessitated a revision, which is presented here. In the mean time, the handling of guidelines has been systematised in Germany so that a registration with the Cooperation of German Medical Learned Societies is applied for and publication in the German Guideline Registry is expected.

[Expert opinions in German statutory accident insurance]. / Begutachtung von Unfallfolgen in der gesetzlichen Unfallversicherung.

German statutory accident insurance covers employees and trainees against occupational accidents, employers bear the inherent charges. Expert opinion is obtained, in particular, for discussing causality questions and for rating accidental health disorders. Causality has to be estimated based on the "theory of essential condition", health disorders have to be substantiated without any reasonable doubt. Reduction in earning capacity due to an accident may not consider the individual kind of occupation and has to be rated by an abstract approach.

[Assessment of psychological consequences of trauma]. / Begutachtung psychischer Unfallfolgen.

After accidents psychological consequences are often asserted. This may be due to the traumatic experience itself, the experience of severe physical injury or to the experience of a traumatic hospital treatment. The pivotal point of the medicolegal assessment is the evidence of primary mental or physical damage that has to be documented beyond a reasonable doubt in all areas of law. A medicolegal assessment in five steps is proposed.

[Revision of DEGUM ultrasound criteria for grading internal carotid artery stenoses and transfer to NASCET measurement]. / Ultraschallkriterien zur Graduierung von Stenosen der A. carotis interna - Revision der DEGUM-Kriterien und Transfer in NASCET-Stenosierungsgrade.

Since 1986, German ultrasound criteria for grading carotid stenosis have followed the local diameter reduction percentage consistent with the definition used in the European Carotid Surgery Trial (ECST) definition. To overcome the confusion caused by the coexisting grading method used in the North American Symptomatic Carotid Endarterectomy Trial (NASCET), a German interdisciplinary council on carotid artery stenosis has recommended the implementation of the NASCET grading system (distal diameter reduction percentage) as the standard. The multi-parametric German "DEGUM ultrasound criteria" consisting of combined Doppler and imaging criteria have consequently been revised and transferred to the NASCET definition. In addition, a novel differentiation between main (primary) and additional (secondary) criteria has been proposed. When these ultrasound criteria are combined, vascular sonography allows reliable grading of carotid disease.

[Symptom validity tests in psychiatric assessment: a critical review]. / Kritische Bestandsaufname zum Einsatz von Beschwerdenvalidierungstests in der psychiatrischen Begutachtung.

Neuropsychological symptom validity testing is increasingly used even in psychiatric expert assessment. Low scores on symptom validity tests can only demonstrate exaggerated symptoms. However, symptom validity tests do not address the question of whether the result is intentionally produced or motivated by internal incentives. Therefore, symptom validity tests cannot differentiate between malingering and somatoform disorder. Test results have to be considered carefully in the medicolegal context and require thorough clinical assessment.

[Avoidable mistakes in neurological expert testimony]. / Vermeidbare Fehler bei neurologischen Begutachtungen.

A physician thinking in the usual diagnostic/therapeutic fashion is faced with numerous pitfalls when presenting expert opinions as a medical advisor in courts of law. The main source of errors in assessment is the lack of understanding of differences and peculiarities of terminology and how health disturbances are rated in the various legal fields. Additionally, there are major problems with different valuations of evidence in the "causative chain" and how to estimate the influence of previous health disturbances. Finally, it is important to avoid formal mistakes in the formulation of expert opinions and to avoid creating confusion in presentation, role conflicts, and conflicts of interest.

[Acute therapy of stroke. With these basic measures prognosis can be improved]. / Akuttherapie des Schlaganfalls. Mit diesen Basismassnahmen verbessern Sie die Prognose.

Up until a few years ago, the acute management of stroke generated a massive sense of nihilism. Since then, things have changed drastically. In the first place, systemic thrombolysis for infarctions in the anterior cerebral circulation is now approved in Germany--although a number of questions still remain unanswered. In the second place, the consequences of a stroke can be effectively mitigated by the rapid application of apparently commonplace "basic measures". These include the maintenance of a "high/normal" blood pressure, control of respiratory function with aspiration prophylaxis, securement of normal glycemia, optimization of cardiac output and microcirculation, lowering of elevated temperatures, and relief of increased intracerebral pressure, if necessary via a craniotomy. As required by the stroke unit concept--which is now widely established--rapid referral of the patient, and interdisciplinary management by an experienced team is of decisive importance for the prognosis.

[Stroke management in a stroke unit with rural catchment area]. / Schlaganfallversorgung in einer Stroke Unit mit ländlichem Einzugsgebiet.

The experiences of a rural stroke unit since 1997 are reported. A special referral concept was developed with the emergency services and hospitals of the region. As a result, 35% of patients arrived in the stroke unit within 3 hours after onset of stroke symptoms. This corresponds with the data from larger cities. The major peculiarity of the Günzburg Stroke Unit is that, after emergency diagnostic and therapeutic procedures, 41% of the patients with mainly internistic problems were transferred to another regional hospital and only 40% were admitted to the inpatient stroke unit. Moreover, among these were an above-average proportion of patients with intracerebral hemorrhage (24% of the inpatients in 1998), and complete acute treatment and rehabilitation were carried out in the same hospital according to an integrative treatment concept. Since 1997, the average hospitalization duration decreased from 11.4 days to 5.9 days and the number of patients per month increased to an average of 22.3. The total hospitalization duration--including inpatient rehabilitation--was 33.9 days. All in all, a comparably good stroke treatment thus is possible outside urban regions.