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1.
Sci Rep ; 14(1): 12486, 2024 05 31.
Artículo en Inglés | MEDLINE | ID: mdl-38816506

RESUMEN

Affections of the central nervous system (CNS) rarely occur in Lyme neuroborreliosis (LNB). CNS manifestations can have residual neurological symptoms despite antibiotic treatment. We explored the spectrum of CNS affections in patients with LNB in a tertiary care center in a region endemic for Lyme borreliosis. We retrospectively included patients treated at a tertiary care center from January 2020-December 2021 fulfilling the case criteria for LNB as stated in the current German guideline on LNB. Clinical data, cerebrospinal fluid (CSF) findings and MRI imaging were collected. We included 35 patients with LNB, 24 with early manifestations and 11 with CNS-LNB. CNS-LNB patients had encephalomyelitis (n = 6) or cerebral vasculitis (n = 5). Patients with early LNB and CNS-LNB differed regarding albumin CSF/serum quotient and total protein in CSF. Duration from onset of symptoms until diagnosis was statistically significantly longer in patients with encephalomyelitis. MRI findings were heterogeneous and showed longitudinal extensive myelitis, perimedullar leptomeningeal enhancement, pontomesencephalic lesions or cerebral vasculitis. CNS-LNB can present with a variety of clinical syndromes and MRI changes. No clear pattern of MRI findings in CNS-LNB could be identified. The role of MRI consists in ruling out other causes of neurological symptoms.


Asunto(s)
Neuroborreliosis de Lyme , Imagen por Resonancia Magnética , Humanos , Neuroborreliosis de Lyme/diagnóstico por imagen , Neuroborreliosis de Lyme/líquido cefalorraquídeo , Neuroborreliosis de Lyme/diagnóstico , Imagen por Resonancia Magnética/métodos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Anciano , Sistema Nervioso Central/diagnóstico por imagen , Sistema Nervioso Central/patología , Encefalomielitis/diagnóstico por imagen , Encefalomielitis/líquido cefalorraquídeo , Adulto Joven , Vasculitis del Sistema Nervioso Central/diagnóstico por imagen
2.
Nervenarzt ; 92(6): 593-601, 2021 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-34046722

RESUMEN

BACKGROUND AND OBJECTIVE: Telemedical stroke networks improve stroke care and provide access to time-dependent acute stroke treatment in predominantly rural regions. The aim is a presentation of data on its utility and regional distribution. METHODS: The working group on telemedical stroke care of the German Stroke Society performed a survey study among all telestroke networks. RESULTS: Currently, 22 telemedical stroke networks including 43 centers (per network: median 1.5, interquartile range, IQR, 1-3) as well as 225 cooperating hospitals (per network: median 9, IQR 4-17) operate in Germany and contribute to acute stroke care delivery to 48 million people. In 2018, 38,211 teleconsultations (per network: median 1340, IQR 319-2758) were performed. The thrombolysis rate was 14.1% (95% confidence interval 13.6-14.7%) and transfer for thrombectomy was initiated in 7.9% (95% confidence interval 7.5-8.4%) of ischemic stroke patients. Financial reimbursement differs regionally with compensation for telemedical stroke care in only three federal states. CONCLUSION: Telemedical stroke care is utilized in about 1 out of 10 stroke patients in Germany. Telemedical stroke networks achieve similar rates of thrombolysis and transfer for thrombectomy compared with neurological stroke units and contribute to stroke care in rural regions. Standardization of network structures, financial assurance and uniform quality measurements may further strengthen the importance of telestroke networks in the future.


Asunto(s)
Consulta Remota , Accidente Cerebrovascular , Telemedicina , Alemania , Humanos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia , Terapia Trombolítica
3.
Ticks Tick Borne Dis ; 11(6): 101512, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32993932

RESUMEN

We report on a pregnant patient who contracted tick-borne encephalitis (TBE) during her second trimester in an endemic region in Southern Germany. The patient presented with typical symptoms including fever and headache, and TBE infection was confirmed by positive blood and cerebrospinal fluid (CSF) testing. During acute infection there was no evidence of pregnancy complications, and the mother recovered well. We performed a clinical follow-up examination of both mother and child eight months after the diagnosis of TBE, which revealed no signs of sequelae. This case study presents rare evidence of TBE infection during pregnancy and may provide guidance for both physicians as well as mothers-to-be dealing with TBE.


Asunto(s)
Virus de la Encefalitis Transmitidos por Garrapatas/aislamiento & purificación , Encefalitis Transmitida por Garrapatas/diagnóstico , Complicaciones del Embarazo/diagnóstico , Enfermedad Aguda , Adulto , Anticuerpos Antivirales/análisis , Preescolar , Encefalitis Transmitida por Garrapatas/etiología , Encefalitis Transmitida por Garrapatas/transmisión , Femenino , Alemania , Humanos , Transmisión Vertical de Enfermedad Infecciosa , Embarazo , Complicaciones del Embarazo/etiología , Segundo Trimestre del Embarazo , Resultado del Tratamiento , Adulto Joven
4.
Neurol Res Pract ; 1: 26, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-33324892

RESUMEN

INTRODUCTION: Comprehensive treatment of Herpes-simplex-virus-encephalitis (HSVE) remains a major clinical challenge. The current therapy gold standard is aciclovir, a drug that inhibits viral replication. Despite antiviral treatment, mortality remains around 20% and a majority of survivors suffer from severe disability. Experimental research and recent retrospective clinical observations suggest a favourable therapy response to adjuvant dexamethasone. Currently there is no randomized clinical trial evidence, however, to support the routine use of adjuvant corticosteroid treatment in HSVE. METHODS: The German trial of Aciclovir and Corticosteroids in Herpes-simplex-virus-Encephalitis (GACHE) studied the effect of adjuvant dexamethasone versus placebo on top of standard aciclovir treatment in adult patients aged 18 up to 85 years with proven HSVE in German academic centers of Neurology in a randomized and double blind fashion. The trial was open from November 2007 to December 2012. The initially planned sample size was 372 patients with the option to increase to up to 450 patients after the second interim analysis. The primary endpoint was a binary functional outcome after 6 months assessed using the modified Rankin scale (mRS 0-2 vs. 3-6). Secondary endpoints included mortality after 6 and 12 months, functional outcome after 6 months measured with the Glasgow outcome scale (GOS), functional outcome after 12 months measured with mRS and GOS, quality of life as measured with the EuroQol 5D instrument after 6 and 12 months, neuropsychological testing after 6 months, cranial magnetic resonance imaging findings after 6 months, seizures up to day of discharge or at the latest at day 30, and after 6 and 12 months. RESULTS: The trial was stopped prematurely for slow recruitment after 41 patients had been randomized, 21 of them treated with dexamethasone and 20 with placebo. No difference was observed in the primary endpoint. In the full analysis set (n = 19 in each group), 12 patients in each treatment arm achieved a mRS of 0-2. Similarly, we did not observe significant differences in the secondary endpoints (GOS, mRS, quality of life, neuropsychological testing). CONCLUSION: GACHE being prematurely terminated demonstrated challenges encountered performing randomized, placebo-controlled trials in rare life threatening neurological diseases. Based upon our trial results the use of adjuvant steroids in addition to antiviral treatment remains experimental and is at the decision of the individual treating physician. Unfortunately, the small number of study participants does not allow firm conclusions. TRIAL REGISTRATION: EudraCT-Nr. 2005-003201-81.

6.
Minerva Anestesiol ; 77(3): 371-4, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21364501

RESUMEN

Development of space-occupying edema in patients with severe Herpes simplex virus encephalitis is a major factor for high morbidity and mortality. Conventional intracranial pressure-lowering modalities are limited and more aggressive treatment options for such patients have rarely been described. This article reports on a HIV-positive patient with Herpes simplex type 2 encephalitis and elevated intracranial pressure refractory to medical therapy. Induced moderate hypothermia of 33 °C resulted in fast and sustained control of intracranial pressure. After three months, the patient had a fairly good functional outcome with a Glasgow Outcome Scale score of 4.


Asunto(s)
Encefalitis por Herpes Simple/terapia , Hipotermia Inducida , Encéfalo/patología , Edema Encefálico/etiología , Edema Encefálico/patología , Edema Encefálico/fisiopatología , Imagen de Difusión por Resonancia Magnética , Encefalitis por Herpes Simple/patología , Escala de Consecuencias de Glasgow , Infecciones por VIH/complicaciones , Humanos , Hipertensión Intracraneal/etiología , Hipertensión Intracraneal/terapia , Presión Intracraneal/fisiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Convulsiones/etiología
8.
Ger Med Sci ; 8: Doc14, 2010 Jun 28.
Artículo en Inglés, Alemán | MEDLINE | ID: mdl-20628653

RESUMEN

Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1(st) revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the "German Instrument for Methodological Guideline Appraisal" of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.


Asunto(s)
Continuidad de la Atención al Paciente/normas , Cuidados Críticos/normas , Servicios Médicos de Urgencia/normas , Grupo de Atención al Paciente/normas , Sepsis , Estudios de Seguimiento , Alemania , Humanos , Sepsis/diagnóstico , Sepsis/prevención & control , Sepsis/terapia
9.
Anaesthesist ; 59(4): 347-70, 2010 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-20414762
10.
J Neurol Neurosurg Psychiatry ; 81(1): 105-8, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20019227

RESUMEN

BACKGROUND: Intraventricular fibrinolysis (IVF) through bilateral external ventricular drains (EVD) may provide better access of the thrombolytic agent to the intraventricular clot, potentially influencing clot clearance and outcome. METHODS: Patients with spontaneous ganglionic intracerebral haemorrhage (ICH)<40 cm(3) and intraventricular haemorrhage (IVH) with acute hydrocephalus have been treated with IVF. The decision for placement of one or two EVDs has been left to the discretion of the treating physician. CT volumetry, the effects on cerebrospinal fluid (CSF) circulation and outcome at 3 months have been analysed for patients with one (group I, n = 13) or two EVDs (group II, n = 14). RESULTS: No difference was found in clot resolution between the two groups (clot half life 2.1 (SD 1.2) vs 2.4 (1.3) days). A separate analysis of the third and fourth ventricle clearance was similar (1.6 (0.6) versus 1.8 (0.8) days), indicating no difference in reconstitution of CSF circulation. A trend towards a longer EVD duration and higher infection rate was found in the bilateral EVD group. No difference was found in outcome at 3 months. CONCLUSIONS: Our results do not support the use of bilateral EVDs for IVF in patients with severe IVH.


Asunto(s)
Hemorragia Cerebral/terapia , Derivaciones del Líquido Cefalorraquídeo , Fibrinolíticos/uso terapéutico , Hemorragia Cerebral/tratamiento farmacológico , Hemorragia Cerebral/cirugía , Derivaciones del Líquido Cefalorraquídeo/métodos , Drenaje , Fibrinolíticos/administración & dosificación , Hematoma/terapia , Humanos , Inyecciones Intraventriculares , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
11.
Nervenarzt ; 79(12): 1369-70, 1372-4, 1376, 2008 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-18626618

RESUMEN

Most cases of intraventricular hemorrhage (IVH) occur secondary to spontaneous intracerebral or subarachnoid hemorrhage. The main concern is development of hydrocephalus, which is related to a poor prognosis. Over the last years, several treatment options for IVH have been introduced, but prospective data regarding the efficacy of those therapies (external ventricular drainage, intraventricular fibrinolysis, lumbar drainage, endoscopic hematoma evacuation) do not yet exist. This review focuses on combined therapy using an external ventricular drain and intraventricular fibrinolysis with r-TPA for IVH-associated initial occlusive hydrocephalus. Moreover, a continuing treatment strategy for persistent malresorptive communicating hydrocephalus using lumbar drainage is described.


Asunto(s)
Hidrocefalia/terapia , Hemorragias Intracraneales/terapia , Drenaje , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiología , Hemorragias Intracraneales/diagnóstico , Hemorragias Intracraneales/etiología , Pronóstico , Punción Espinal , Terapia Trombolítica , Tomografía Computarizada por Rayos X , Ventriculostomía
12.
Eur J Neurol ; 15(4): 342-9, 2008 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-18312407

RESUMEN

Over the recent years, fibrinolytic agents have been tested for intraventricular clot fibrinolysis (IVF). Compared with patients who did not receive IVF, administration of rt-PA induces rapid resorption of intraventricular blood and normalization of cerebrospinal fluid (CSF) circulation resulting in a reduced 30-day mortality and beneficial short-term outcome after 3 months. Our objective was to analyze possible influences of IVF on the long-term outcome after 12 months. Based on a prospective data base, patients with ganglionic supratentorial hematoma with additional intraventricular hemorrhage and occlusive hydrocephalus (n = 135) were isolated. Twenty-seven patients received IVF. To design a case-control study, we carefully matched 22 controls without IVF with regard to hematoma volume, Graeb score, Glasgow Coma Scale on admission and age (five patients remained unmatchable). We determined clinical and imaging parameters by reviewing the medical records and CT scans of all included patients. Outcome after 12 months was evaluated using the modified Rankin scale (mRS). One multivariate regression analysis was performed to determine predisposing factors for outcome. IVF significantly reduced Graeb score during treatment (eight on admission, three after IVF, one prior to discharge in the treated group versus 8/6/2 in patients without IVF). In patients with IVF requirement, a second external ventricular drainage (EVD) and a ventriculoperitoneal (VP) shunt were reduced (P = 0.08) and the incidence of a lumbar drainage was significantly higher (P < 0.01), whilst the overall time of extra-corporal CSF drainage was comparable. EVD associated complications were equal in both groups. Overall long-term outcome was poor but no significant differences were found between patients with and without IVF (mRS 4-6: 12/22 (54%) in patients with and 13/22 (59%) in patients without IVF; P = 0.81). The five excluded patients with IVF were similar to the 22 included ones with respect to imaging findings and outcome. The multivariate analysis revealed age and baseline hematoma volume, but not IVF to significantly impact the outcome. In accordance with previous studies, IVF hastened clot lysis and reduced the need for repeated EVD exchanges and permanent shunting. However, despite these advantages, IVF did not influence long-term outcome after 12 months. The results of the prospective randomized trial (Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage) need to be awaited.


Asunto(s)
Hemorragia de los Ganglios Basales/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Terapia Trombolítica/métodos , Activador de Tejido Plasminógeno/uso terapéutico , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intraventriculares/métodos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
13.
Eur J Neurol ; 15(3): 214-8, 2008 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-18215154

RESUMEN

We report here a 27-year-old woman who presented with encephalitis of unknown origin. Magnetic resonance imaging (MRI) of the brain revealed leukoencephalopathy, cerebrospinal fluid showed signs of inflammation. Serum and brain biopsy tissue was tested positive for hepatitis C virus (HCV). Neuropathological investigation supported the hypothesis of viral encephalitis. C3, C4 and cryoglobulins as well as cerebral MR-angiography were normal. Neurological complications of HCV infection other than hepatic encephalopathy are generally attributed to parainfectious phenomena. This is the first case of HCV-RNA detection in vivo in human brain in literature and it raises the possibility that HCV is able to induce encephalitis caused by neurotrophism. This is supported by the fact that there is a growing body of literature on HCV-induced cerebral dysfunction and laboratory findings indicating HCV neuroinvasion.


Asunto(s)
Encéfalo/virología , Encefalitis/patología , Encefalitis/virología , Hepacivirus/genética , ARN/aislamiento & purificación , Adulto , Femenino , Hepacivirus/aislamiento & purificación , Humanos , Imagen por Resonancia Magnética , Espectroscopía de Resonancia Magnética/métodos
14.
Eur J Neurol ; 14(11): 1251-5, 2007 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-17956445

RESUMEN

Since genetic analysis of the GFAP gene for the diagnosis of adult Alexander disease (AD) has been established in 2001, several cases of both sporadic and familial cases of AD have been described. Except for one patient, all subjects revealed glial fibrillary acidic protein (GFAP) mutations, and clinical progression of symptoms, mainly bulbar and pseudobulbar, were moderate. Here we report on a patient with acute onset of vegetative symptoms, rapid progression, and death within 2 months. Although histology and final magnetic resonance imaging (MRI) were characteristic of AD, sequencing of the encoding GFAP gene revealed no mutation. We believe that this case report expands the so far known clinical spectrum and MRI dynamics of adult AD, and suggest that analysis of the coding part of GFAP may be inconclusive in rare cases. In such patients, only histology may lead to definitive diagnosis.


Asunto(s)
Enfermedad de Alexander/diagnóstico , Estado Vegetativo Persistente/diagnóstico , Enfermedad Aguda , Adulto , Enfermedad de Alexander/complicaciones , Enfermedad de Alexander/genética , Diagnóstico Diferencial , Progresión de la Enfermedad , Resultado Fatal , Humanos , Masculino , Estado Vegetativo Persistente/etiología , Estado Vegetativo Persistente/genética
15.
Neurology ; 60(12): 1976-8, 2003 Jun 24.
Artículo en Inglés | MEDLINE | ID: mdl-12821743

RESUMEN

Intrathecal baclofen (ITB) is used for unresponsiveness to other treatment for patients with stiff-person syndrome (SPS). The authors report a patient with SPS who developed acute and life-threatening baclofen withdrawal symptoms. Open surgery disclosed a small position-dependent leak in the catheter connector. This catheter failure was not detected by standard noninvasive checking methods.


Asunto(s)
Baclofeno/efectos adversos , Cateterismo/efectos adversos , Hipertensión/inducido químicamente , Bombas de Infusión Implantables/efectos adversos , Relajantes Musculares Centrales/efectos adversos , Espasmo/inducido químicamente , Síndrome de la Persona Rígida/tratamiento farmacológico , Síndrome de Abstinencia a Sustancias/etiología , Taquicardia/inducido químicamente , Enfermedad Aguda , Adulto , Baclofeno/administración & dosificación , Baclofeno/uso terapéutico , Falla de Equipo , Humanos , Inyecciones Espinales/instrumentación , Masculino , Insuficiencia Multiorgánica/inducido químicamente , Relajantes Musculares Centrales/administración & dosificación , Relajantes Musculares Centrales/uso terapéutico
16.
Stroke ; 34(3): 745-51, 2003 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-12624302

RESUMEN

BACKGROUND AND PURPOSE: The potential neuroprotective effect of the granulocyte colony-stimulating factor (G-CSF) after glutamate-induced excitotoxicity in cell culture and after focal cerebral ischemia in rats was studied. We hypothesized the existence of the G-CSF receptor (G-CSFR) as a main G-CSF effector on neurons, and immunohistochemistry, immunoblotting, and polymerase chain reaction were performed. The G-CSFR-mediated action was studied by activation of signal transducer(s) and activator(s) of transcription-3 (STAT3) in the periphery of the infarction. METHODS: Neuroprotection of various G-CSF concentrations on glutamate-induced excitotoxicity was studied in cell culture. In vivo, ischemia was induced by use of a suture occlusion model of the middle cerebral artery (90-minute occlusion) in the rat. Thirty minutes after the induction of ischemia, the animals (n=12 per group) received G-CSF at 60 microg/kg body wt IV for 90 minutes or vehicle (saline). Infarct volume was calculated on the basis of 2,3,5-triphenyltetrazolium chloride staining 24 hours after ischemia. Expression of the G-CSFR was studied by immunohistochemistry and verified by reverse transcription-polymerase chain reaction and immunoblotting. Expression of STAT3 was determined by immunohistochemistry. RESULTS: In cell culture, G-CSF exhibited a significant neuroprotective effect after glutamate-induced excitotoxicity (P<0.05). A G-CSF concentration of 10 ng/mL was maximally effective, resulting in a nearly complete protection. In vivo, G-CSF reduced infarct volume to 47% (132.0+/-112.7 mm3 versus 278.9+/-91.6 mm3 [P<0.05] in the control group). Immunohistochemistry, Western blotting, and reverse transcription-polymerase chain reaction revealed the existence of G-CSFRs in neurons and glial cells. Animals treated with G-CSF significantly upregulated STAT3 in the periphery of the infarction compared with control animals (P<0.05). CONCLUSIONS: G-CSF achieved a significant neuroprotective effect in cell culture and after intravenous administration after stroke. Increased STAT3 expression in the penumbra of G-CSF-treated rats suggests mediation by G-CSFR.


Asunto(s)
Infarto Cerebral/prevención & control , Factor Estimulante de Colonias de Granulocitos/farmacología , Ataque Isquémico Transitorio/tratamiento farmacológico , Fármacos Neuroprotectores/farmacología , Animales , Western Blotting , Supervivencia Celular/efectos de los fármacos , Células Cultivadas , Infarto Cerebral/patología , Circulación Cerebrovascular , Proteínas de Unión al ADN/biosíntesis , Modelos Animales de Enfermedad , Proteína Ácida Fibrilar de la Glía/biosíntesis , Inmunohistoquímica , Ataque Isquémico Transitorio/patología , Flujometría por Láser-Doppler , Masculino , Ratones , Neuroglía/metabolismo , Neuroglía/patología , Neuronas/efectos de los fármacos , Neuronas/metabolismo , Neuronas/patología , Ratas , Ratas Wistar , Receptores de Factor Estimulante de Colonias de Granulocito/biosíntesis , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factor de Transcripción STAT3 , Transactivadores/biosíntesis
17.
Nervenarzt ; 73(12): 1183-5, 2002 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-12486569

RESUMEN

Myxedema coma is a rare and life-threatening complication of untreated hypothyroidism. Therefore, it must be part of the differential diagnosis in comatose patients. We report one patient who presented with CO(2) narcosis,hypothermia, bradycardia,hyporeflexia, tetraparesis, ascitis, pleural effusions, and heart insufficiency. Examination of the CSF, cranial CT, MRI, and MR angiography were normal. In suspicion of myxedema coma,the patient was treated with high dose L-thyroxine and hydrocortisone for preventing secondary adrenal insufficiency. A fast clinical recovery, decreased T4 (7.2 ng/l) and T3 (0.93 ng/l), and increased TSH (20.19 mU/l) together with the following anamnesis of radio iodine therapy and insufficient thyroxine intake confirmed the diagnosis. In conclusion, treatment of the myxedema coma must be started as soon as the laboratory results are confirmatory, since its course depends on the time of initiation of treatment.


Asunto(s)
Coma/etiología , Mixedema/diagnóstico , Insuficiencia Suprarrenal/diagnóstico , Insuficiencia Suprarrenal/tratamiento farmacológico , Anciano , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Hidrocortisona/administración & dosificación , Masculino , Mixedema/tratamiento farmacológico , Examen Neurológico , Pruebas de Función de la Tiroides , Tiroxina/administración & dosificación
18.
Stroke ; 33(7): 1899-904, 2002 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-12105372

RESUMEN

BACKGROUND AND PURPOSE: In contrast to early hypothermia, the effects of delayed hypothermia in focal cerebral ischemia have not been widely addressed. We examined the influence of delayed hypothermia on secondary ischemic injury, MRI lesion size, and neurological outcome after transient focal cerebral ischemia in a rat model. METHODS: Rats (n=30) were subjected to transient middle cerebral artery occlusion (MCAO, 120 minutes) by use of the intraluminal filament model. Animals of the treatment group (n=12) were exposed to whole-body hypothermia of 33 degrees C for 5 hours starting 3 hours after MCAO, whereas the control group (n=18) was kept at 37 degrees C throughout the whole experiment. The normothermia- and hypothermia-treated animals were investigated daily by using the Menzies neurological score. Serial MRI was performed 1, 3, and 6 hours after MCAO and on days 1, 2, 3, and 5. After the final MRI scan, the rats were euthanized, and brain slices were stained by 2,3,5-triphenyltetrazolium chloride. RESULTS: Delayed hypothermia resulted in a significant increase of survival rate and a significant improvement of the Menzies score. Moreover, a significant decrease in the extent of hyperintense volumes in T2-weighted scans and a reduction of cerebral edema as calculated from T2-weighted scans throughout the examination period were obvious. The extent of cerebral infarct volume and cerebral brain edema examined by MRI was consistent with 2,3,5-triphenyltetrazolium chloride staining. CONCLUSIONS: Our results suggest that even delayed postischemic hypothermia can reduce the extent of infarct volume and brain edema after transient focal cerebral ischemia.


Asunto(s)
Edema Encefálico/prevención & control , Infarto Cerebral/prevención & control , Hipotermia Inducida/métodos , Infarto de la Arteria Cerebral Media/terapia , Ataque Isquémico Transitorio/terapia , Animales , Temperatura Corporal , Peso Corporal , Edema Encefálico/etiología , Edema Encefálico/patología , Infarto Cerebral/etiología , Infarto Cerebral/patología , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Infarto de la Arteria Cerebral Media/complicaciones , Infarto de la Arteria Cerebral Media/patología , Ataque Isquémico Transitorio/complicaciones , Ataque Isquémico Transitorio/patología , Imagen por Resonancia Magnética , Masculino , Ratas , Ratas Wistar , Recuperación de la Función , Reperfusión , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento
19.
Stroke ; 32(5): 1226-33, 2001 May.
Artículo en Inglés | MEDLINE | ID: mdl-11340238

RESUMEN

BACKGROUND AND PURPOSE: Insulin-like growth factor (IGF) treatment has been shown to have trophic and neuroprotective effects in vitro and in vivo in different lesion models. IGF-I has potent neuroprotective effects after hypoxic-ischemic injury and global ischemia. The role of IGF-I in focal cerebral ischemia is only partially understood. Therefore, in the present study, we evaluated, by applying MRI monitoring, whether a clinically relevant systemic administration of IGF-I can achieve a long-lasting neuroprotective effect. METHODS: Male Wistar rats underwent transient occlusion of the right middle cerebral artery for 1 hour by using the suture occlusion model. Animals then were intraventricularly treated with 33.33 microg IGF-I/d for 3 days (group A, the IGF-I group [n=13]; group B, the placebo group [n=14]) or subcutaneously treated with 200 microg IGF-I/d for 7 days (group D, the IGF-I group [n=10]; group E, the placebo group [n=10]). Groups C and F served as sham-operated controls (n=5 and n=3, respectively). Treatment was begun 30 minutes after occlusion of the middle cerebral artery. Subcutaneously treated animals underwent MRI studies (diffusion-weighted imaging, perfusion imaging, and T2-weighted imaging) beginning 60 minutes after vessel occlusion at 6 hours and at days 1, 2, 5, and 7 after ischemia. The animals were weighed and neurologically assessed daily (rating scale ranged from 0, indicating no deficit, to 5, indicating death). On the third day (intraventricular trial) and on the seventh day (subcutaneous trial), animals were euthanized, and brain sections were stained with triphenyltetrazolium chloride. RESULTS: The mean infarct volume was 52.9+/-25.2 mm(3) in intraventricularly treated animals versus 146.4+/-62.2 mm(3) in control animals (P<0.01) and 42.2+/-17.9 mm(3) in subcutaneously IGF-I-treated animals versus 73.1+/-38.1 mm(3) in control animals (P<0.05). Apparent diffusion coefficient-derived lesion volume at 60 minutes after occlusion was 40.4+/-23.7 mm(3) versus 38.3+/-19.3 mm(3) (P=NS), increased to 168.3+/-49.55 mm(3) versus 105.5+/-33.8 mm(3) (P<0.05) at 24 hours, and then decreased to 55.8+/-30.3 mm(3) versus 23.3+/-20.2 mm(3) (P<0.05) for control and IGF-I-treated animals, respectively. The T2-weighted-derived ischemic lesion volume at 24 hours after occlusion was 236+/-49.2 mm(3) versus 115.9+/-56.8 mm(3) (P<0.05) and decreased to 115.9+/-26.2 mm(3) versus 75.7+/-35.8 mm(3) (P<0.05) at day 7 for control and IGF-I-treated animals, respectively. The relative regional cerebral blood volume was reduced to 50% before reperfusion in all regions of interest except for region of interest 1 (vessel territory of anterior cerebral artery), recovered during reperfusion, but was not different between the control and the growth factor-treated group at any imaging time point. There was no significant difference in weight loss. There was less neurological deficit after ischemia in intraventricularly and subcutaneously IGF-I-treated animals compared with control animals (P<0.05). CONCLUSIONS: Continuous treatment with intraventricularly and subcutaneously administered IGF-I achieved a long-lasting neuroprotective effect as early as 24 hours after ischemia as measured by MRI. Therefore, IGF-I may represent a new approach to the treatment of focal cerebral ischemia.


Asunto(s)
Factor I del Crecimiento Similar a la Insulina/administración & dosificación , Ataque Isquémico Transitorio/tratamiento farmacológico , Fármacos Neuroprotectores/farmacología , Animales , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Peso Corporal/efectos de los fármacos , Circulación Cerebrovascular/efectos de los fármacos , Modelos Animales de Enfermedad , Esquema de Medicación , Infarto de la Arteria Cerebral Media/complicaciones , Bombas de Infusión Implantables , Inyecciones Intraventriculares , Inyecciones Subcutáneas , Ataque Isquémico Transitorio/etiología , Ataque Isquémico Transitorio/patología , Imagen por Resonancia Magnética , Masculino , Examen Neurológico/efectos de los fármacos , Ratas , Ratas Wistar , Factores de Tiempo , Resultado del Tratamiento
20.
Biochem Biophys Res Commun ; 231(3): 696-7, 1997 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-9070874

RESUMEN

We present 12 common polymorphisms in the coding part of the IL4 receptor gene, 5 of them leading to amino acid changes of the gene product. The IL4-receptor represents a membrane bound protein on T-cells binding the cytokine IL4 and mediating its effect. The polymorphisms and mutations described here might be useful to shed light on the structure and functioning of the IL4 receptor. Furthermore, the protein represents a candidate gene for several immunological disorders involving the IL4 pathway.


Asunto(s)
Antígenos CD/genética , Interleucina-4/genética , Receptores de Interleucina/genética , Humanos , Polimorfismo Genético , Receptores de Interleucina-4
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